Cellular Recycling Gone Wrong: The Role of Dysregulated Autophagy and Hyperactive mTORC1 in the Pathogenesis of Sarcoidosis

BACKGROUND AND AIMS

Autophagy is a highly regulated, complex intracellular recycling process that is vital to maintaining cellular homeostasis in response to diverse conditions and stressors. Despite the presence of robust regulatory pathways, the intricate and multi-step nature of autophagy creates opportunity for dysregulation. Errors in autophagy have been implicated in the development of a broad range of clinical pathologies including granulomatous disease. Specifically, activation of the mTORC1 pathway has been identified as a key negative regulator of autophagic flux, prompting the study of dysregulated mTORC1 signaling in the pathogenesis of sarcoidosis. Our review: We conducted a thorough search of the extant literature to identify the regulatory pathways of autophagy, and more specifically the implication of upregulated mTORC1 pathways in the pathogenesis of sarcoidosis. We review data showing spontaneous granuloma formation in animal models with upregulate mTORC1 signaling, human genetic studies showing mutation in autophagy genes in sarcoidosis patients, and clinical data showing that targeting autophagy regulatory molecules like mTORC1 may provide new therapeutic approaches for sarcoidosis.

CONCLUSIONS

Given the incomplete understanding of sarcoidosis pathogenesis and the toxicities of current treatments, a more complete understanding of sarcoidosis pathogenesis is crucial for the development of more effective and safer therapies. In this review, we propose a strong molecular pathway driving sarcoidosis pathogenesis at which autophagy is at the center. A more complete understanding of autophagy and its regulatory molecules, like mTORC1, may provide a window into new therapeutic approaches for sarcoidosis.

Normalizing salt content by mixing native human airway mucus samples normalizes sample rheology

Across the globe, millions of people are affected by muco-obstructive pulmonary diseases like cystic fibrosis, asthma, and chronic obstructive pulmonary disease. In MOPDs, the airway mucus becomes hyperconcentrated, increasing viscoelasticity and impairing mucus clearance. Research focused on treatment of MOPDs requires relevant sources of airway mucus both as a control sample type and as a basis for manipulation to study the effects of additional hyperconcentration, inflammatory milieu, and biofilm growth on the biochemical and biophysical properties of mucus. Endotracheal tube mucus has been identified as a prospective source of native airway mucus given its several advantages over sputum and airway cell culture mucus such as ease of access and in vivo production that includes surface airway and submucosal gland secretions. Still, many ETT samples suffer from altered tonicity and composition from either dehydration, salivary dilution, or other contamination. Herein, the biochemical compositions of ETT mucus from healthy human subjects were determined. Samples were characterized in terms of tonicity, pooled, and restored to normal tonicity. Salt-normalized ETT mucus exhibited similar concentration-dependent rheologic properties as originally isotonic mucus. This rheology agreed across spatial scales and with previous reports of the biophysics of ETT mucus. This work affirms previous reports of the importance of salt concentration on mucus rheology and presents methodology to increase yield native airway mucus samples for laboratory use and manipulation.

Secretory Cells Dominate Airway CFTR Expression and Function in Human Airway Superficial Epithelia

Rationale: Identification of the specific cell types expressing CFTR (cystic fibrosis [CF] transmembrane conductance regulator) is required for precision medicine therapies for CF. However, a full characterization of CFTR expression in normal human airway epithelia is missing. Objectives: To identify the cell types that contribute to CFTR expression and function within the proximal-distal axis of the normal human lung. Methods: Single-cell RNA (scRNA) sequencing (scRNA-seq) was performed on freshly isolated human large and small airway epithelial cells. scRNA in situ hybridization (ISH) and single-cell qRT-PCR were performed for validation. In vitro culture systems correlated CFTR function with cell types. Lentiviruses were used for cell type-specific transduction of wild-type CFTR in CF cells. Measurements and Main Results: scRNA-seq identified secretory cells as dominating CFTR expression in normal human large and, particularly, small airway superficial epithelia, followed by basal cells. Ionocytes expressed the highest CFTR levels but were rare, whereas the expression in ciliated cells was infrequent and low. scRNA ISH and single-cell qRT-PCR confirmed the scRNA-seq findings. CF lungs exhibited distributions of CFTR and ionocytes similar to those of normal control subjects. CFTR mediated Cl^- secretion in cultures tracked secretory cell, but not ionocyte, densities. Furthermore, the nucleotide-purinergic regulatory system that controls CFTR-mediated hydration was associated with secretory cells and not with ionocytes. Lentiviral transduction of wild-type CFTR produced CFTR-mediated Cl^- secretion in CF airway secretory cells but not in ciliated cells. Conclusions: Secretory cells dominate CFTR expression and function in human airway superficial epithelia. CFTR therapies may need to restore CFTR function to multiple cell types, with a focus on secretory cells.

Combined Pulmonary Fibrosis Emphysema: Role of Cigarette Smoking and Pulmonary Hypertension in a Rural Cohort

Background

Disease heterogeneity in idiopathic pulmonary fibrosis (IPF) often complicates the systematic study of disease, management of patients and clinical investigations.

Objective

To describe combined pulmonary fibrosis emphysema (CPFE) phenotype in a rural Appalachian IPF cohort with the highest smoking rates in the United States.

Methods

CPFE patients (n = 60) in a developed IPF cohort (n = 153) were characterized. Groups (CPFE vs IPF without emphysema) were categorized based on the predominant HRCT patterns of UIP (n = 109). Demographics, clinical variables, and treatment details were recorded. Kaplan–Meier survival and multivariate logistic regression analysis were performed.

Results

The prevalence of CPFE in our IPF cohort was 45% (n = 49). The CPFE group was younger (73.9 vs 78.2), had a more extensive smoking history (93.9% vs 53.3%) with greater mean smoking pack years (49.09 vs 15.39) and had lower percentage predicted DL_CO on presentation (38.35 vs 51.09) compared to IPF without emphysema group. Both groups shared equivalent higher burden of comorbidities, including pulmonary hypertension (PH) (46.9% vs 33.3%). One-fifth of patients were prescribed antifibrotics and only a subset (5%) of patients underwent lung transplantation. There was a non-significant trend towards reduced survival in CPFE (p = 0.076). Smoking status and DL_CO predicted CPFE in our cohort. Body mass index (BMI), PH, and pirfenidone use were significant predictors of mortality.

Conclusion

CPFE was highly prevalent in our rural IPF cohort. In contrast to previous studies, CPFE group was older and had higher female (approx. 30%) occurrence. A greater exposure to cigarette smoke and reduced DL_CO at diagnosis predicted CPFE. Lower BMI and PH predicted higher mortality whereas use of pirfenidone improved survival in our cohort. This study highlights a complex interaction of cigarette smoking, advanced fibrosis of UIP, PH and potential utility of antifibrotic agents in CPFE phenotype. Substantial burden of comorbidities, older age, and the limited utilization of advanced therapeutics in the cohort emphasize the challenges faced by rural Appalachian patients.

SARS-CoV-2 Reverse Genetics Reveals a Variable Infection Gradient in the Respiratory Tract

The mode of acquisition and causes for the variable clinical spectrum of coronavirus disease 2019 (COVID-19) remain unknown. We utilized a reverse genetics system to generate a GFP reporter virus to explore severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis and a luciferase reporter virus to demonstrate sera collected from SARS and COVID-19 patients exhibited limited cross-CoV neutralization. High-sensitivity RNA in situ mapping revealed the highest angiotensin-converting enzyme 2 (ACE2) expression in the nose with decreasing expression throughout the lower respiratory tract, paralleled by a striking gradient of SARS-CoV-2 infection in proximal (high) versus distal (low) pulmonary epithelial cultures. COVID-19 autopsied lung studies identified focal disease and, congruent with culture data, SARS-CoV-2-infected ciliated and type 2 pneumocyte cells in airway and alveolar regions, respectively. These findings highlight the nasal susceptibility to SARS-CoV-2 with likely subsequent aspiration-mediated virus seeding to the lung in SARS-CoV-2 pathogenesis. These reagents provide a foundation for investigations into virus-host interactions in protective immunity, host susceptibility, and virus pathogenesis.

SARS-CoV-2 Reverse Genetics Reveals a Variable Infection Gradient in the Respiratory Tract

The mode of acquisition and causes for the variable clinical spectrum of coronavirus disease 2019 (COVID-19) remain unknown. We utilized a reverse genetics system to generate a GFP reporter virus to explore severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogenesis and a luciferase reporter virus to demonstrate sera collected from SARS and COVID-19 patients exhibited limited cross-CoV neutralization. High-sensitivity RNA in situ mapping revealed the highest angiotensin-converting enzyme 2 (ACE2) expression in the nose with decreasing expression throughout the lower respiratory tract, paralleled by a striking gradient of SARS-CoV-2 infection in proximal (high) versus distal (low) pulmonary epithelial cultures. COVID-19 autopsied lung studies identified focal disease and, congruent with culture data, SARS-CoV-2-infected ciliated and type 2 pneumocyte cells in airway and alveolar regions, respectively. These findings highlight the nasal susceptibility to SARS-CoV-2 with likely subsequent aspiration-mediated virus seeding to the lung in SARS-CoV-2 pathogenesis. These reagents provide a foundation for investigations into virus-host interactions in protective immunity, host susceptibility, and virus pathogenesis.

French adaptation of the "Frenchay Dysarthria Assessment 2" speech intelligibility test

OBJECTIVES

Speech intelligibility can be defined as "the degree to which a speaker's intended message is recovered by a listener". Loss of intelligibility is one of the most frequent complaints in patients suffering from speech disorder, impairing communication. Measurement of intelligibility is therefore an important parameter in follow-up. We developed a French version of the "Frenchay Dysarthria Assessment, 2nd edition" (FDA-2), an intelligibility test recognized internationally in its English version. The present study details the construction of the test and its preliminary validation.

MATERIALS AND METHODS

We first compiled a set of words and phrases in French, based on the criteria defined in FDA-2. In a second step, we validated the test in healthy subjects in normal and noisy conditions, to check sensitivity to speech signal degradation.

RESULTS

The test proved valid and sensitive, as scores were significantly lower for noise-degraded stimuli.

CONCLUSION

This French-language intelligibility test can be used to evaluate speech disorder: for example, in dysarthria, head and neck cancer or after cochlear implantation.

Endotracheal tube mucus as a source of airway mucus for rheological study

Muco-obstructive lung diseases (MOLDs), like cystic fibrosis and chronic obstructive pulmonary disease, affect a spectrum of subjects globally. In MOLDs, the airway mucus becomes hyperconcentrated, increasing osmotic and viscoelastic moduli and impairing mucus clearance. MOLD research requires relevant sources of healthy airway mucus for experimental manipulation and analysis. Mucus collected from endotracheal tubes (ETT) may represent such a source with benefits, e.g., in vivo production, over canonical sample types such as sputum or human bronchial epithelial (HBE) mucus. Ionic and biochemical compositions of ETT mucus from healthy human subjects were characterized and a stock of pooled ETT samples generated. Pooled ETT mucus exhibited concentration-dependent rheologic properties that agreed across spatial scales with reported individual ETT samples and HBE mucus. We suggest that the practical benefits compared with other sample types make ETT mucus potentially useful for MOLD research.

Endotracheal tube mucus as a source of airway mucus for rheological study

Muco-obstructive lung diseases (MOLDs), like cystic fibrosis and chronic obstructive pulmonary disease, affect a spectrum of subjects globally. In MOLDs, the airway mucus becomes hyperconcentrated, increasing osmotic and viscoelastic moduli and impairing mucus clearance. MOLD research requires relevant sources of healthy airway mucus for experimental manipulation and analysis. Mucus collected from endotracheal tubes (ETT) may represent such a source with benefits, e.g., in vivo production, over canonical sample types such as sputum or human bronchial epithelial (HBE) mucus. Ionic and biochemical compositions of ETT mucus from healthy human subjects were characterized and a stock of pooled ETT samples generated. Pooled ETT mucus exhibited concentration-dependent rheologic properties that agreed across spatial scales with reported individual ETT samples and HBE mucus. We suggest that the practical benefits compared with other sample types make ETT mucus potentially useful for MOLD research.

Impact of acute exposure to WTC dust on ciliated and goblet cells in lungs of rats

Clinical studies and the World Trade Center (WTC) Health Registry have revealed increases in the incidence of chronic (non-cancer) lung disorders among first responders (FR) who were at Ground Zero during the initial 72 h after the collapse. Our previous analyses of rats exposed to building-derived WTC dusts using exposure scenarios/levels that mimicked FR mouth-breathing showed that a single WTC dust exposure led to changes in expression of genes whose products could be involved in the lung ailments, but few other significant pathologies. We concluded that rather than acting as direct inducers of many of the FR health effects, it was more likely inhaled WTC dusts instead may have impacted on toxicities induced by other rescue-related co-pollutants present in Ground Zero air. To allow for such effects to occur, we hypothesized that the alkaline WTC dusts induced damage to the normal ability of the lungs to clear inhaled particles. To validate this, rats were exposed on two consecutive days (2 h/d, by intratracheal inhalation) to WTC dust (collected 12-13 September 2001) and examined over a 1-yr period thereafter for changes in the presence of ciliated cells in the airways and hyperplastic goblet cells in the lungs. WTC dust levels in the lungs were assessed in parallel to verify that any changes in levels of these cells corresponded with decreases in host ability to clear the particles themselves. Image analyses of the rat lungs revealed a significant decrease in ciliated cells and increase in hyperplastic goblet cells due to the single series of WTC dust exposures. The study also showed there was only a nominal non-significant decrease (6-11%) in WTC dust burden over a 1-yr period after the final exposure. These results provide support for our current hypothesis that exposure to WTC dusts caused changes in airway morphology/cell composition; such changes could, in turn, have led to potential alterations in the clearance/toxicities of other pollutants inhaled at Ground Zero in the critical initial 72-h period.

Metal rich particulate matter impairs acetylcholine-mediated vasorelaxation of microvessels in mice

Background

Exposure to PM_2.5 (particulate matter <2.5 μm) has been associated with changes in endothelial function. PM_2.5 was collected from two Chinese cities, Jinchang (JC) and Zhangye (ZH), both with similar PM_2.5 concentrations. However, JC had levels of nickel (Ni), selenium (Se), copper (Cu), and arsenic (As) that were 76, 25, 17, and 7 fold higher than that measured in ZH, respectively. We used this unique PM sample to delineate the chemical components that drive pulmonary and systemic effects and explore the mechanism(s) by which vascular dysfunction is caused.

Methods

Male FVB/N mice received oropharyngeal aspiration of water or PM_2.5 from JC, ZH or ZH spiked with one of the following elements at the same concentrations found in the JC PM (Ni = 4.76; As = 2.36; Se = 0.24; Cu = 2.43 μg/mg) followed by evaluation of markers of pulmonary and systemic inflammation. Mesenteric arteries were isolated for gene expression or functional response to various agonists (Phenylephrine, Acetylcholine, and Sodium Nitroprusside) and inhibitors (L-NAME, Apocynin, and VAS2870) ex vivo.

Results

Protein and total cell counts from lung lavage revealed significant pulmonary inflammation from ZH (p < 0.01) and JC and ZH + NiSO₄ (p < 0.001) as compared to control and a significant decrease in mesenteric artery relaxation (p < 0.001) and this decrease is blunted in the presence of NADPH oxidase inhibitors. Significant increases in gene expression (TNF-α, IL-6, Nos3; p < 0.01; NOX4; p < 0.05) were observed in JC and ZH + NiSO₄, as well as significantly higher concentrations of VEGF and IL-10 (p < 0.01, p < 0.001; respectively).

Conclusions

Our results indicate that the specific toxicity observed in PM from JC is likely due to the nickel component in the PM. Further, since VAS2870 was the most successful inhibitor to return vessels to baseline relaxation values, NADPH Oxidase is implicated as the primary source of PM-induced O₂^•-.

[Prosody and reading: Temporal and melodic characteristics in the dyslexic child in reading and narration]

Dyslexia is widely associated to a massive phonological awareness deficit. This deficit leads to difficulties in grapheme to phoneme conversions in reading and difficulties in words and sentences productions. The origin of the phonological deficit is partially explained by the magnocellular, cerebellar and articulatory theories. Recently, an increasing number of studies demonstrated the relationship between prosody and reading and, more specifically, the potential key role of suprasegmental phonology in the healthy development of phonological representations. The aim of this study is to explore part of prosodic features in dyslexics and normal developing children in reading and narration tasks, in French. We examined reading accuracy, reading rate, pauses frequency and duration, inter-pausal units (IPUs) duration and instantaneous variations of F0. Results show correct decoding skills for all subjects but a lack of automation of this procedure for dyslexics. Differences in pauses frequency and duration, IPUS duration and F0 variations observed between dyslexics and controls confirm the link between prosodic reading and automaticity. The longer pause duration in narrative form a temporal feature of dyslexic's production. This temporal characteristic reflects the cognitive cost done by a speech generation task involving lexical selection, syntactic planning and articulatory programming processes. This result is a first step towards evidence of a suprasegmental phonological deficit in spoken language that could be an early marker of later reading difficulties.

A novel system to generate WTC dust particles for inhalation exposures

First responders (FRs) present at Ground Zero within the critical first 72 h after the World Trade Center (WTC) collapse have progressively exhibited significant respiratory injury. The majority (>96%) of WTC dusts were >10 μm and no studies have examined potential health effects of this size fraction. This study sought to develop a system to generate and deliver supercoarse (10-53 μm) WTC particles to a rat model in a manner that mimicked FR exposure scenarios. A modified Fishing Line generator was integrated onto an intratracheal inhalation (ITIH) system that allowed for a bypassing of the nasal passages so as to mimic FR exposures. Dust concentrations were measured gravimetrically; particle size distribution was measured via elutriation. Results indicate that the system could produce dusts with 23 μm mass median aerodynamic diameter (MMAD) at levels up to ≥1200 mg/m(3). To validate system utility, F344 rats were exposed for 2 h to ≈100 mg WTC dust/m(3). Exposed rats had significantly increased lung weight and levels of select tracer metals 1 h after exposure. Using this system, it is now possible to conduct relevant inhalation exposures to determine adverse WTC dusts impacts on the respiratory system. Furthermore, this novel integrated Fishing Line-ITIH system could potentially be used in the analyses of a wide spectrum of other dusts/pollutants of sizes previously untested or delivered to the lungs in ways that did not reflect realistic exposure scenarios.

[F0 characteristics in Parkinsonian speech: Contrast between the effect of hypodopaminergy due to Parkinson's disease and that of the therapeutic delivery of L-Dopa]

Voice and speech impairments are frequent in Parkinson's disease, particularly when the disease is at an advanced stage. These impairments affect spoken communication and may become a serious disability for someone with Parkinson's disease. Many studies based on auditory-perceptual or acoustic methods have been carried out to characterize dysarthria. The heterogeneity of evaluation methods and experimental bias however make results difficult to understand. For instance, in terms of phonatory impairments and with regard to F0, results are contradictory: PD speech may be characterized by either higher F0 or lower F0 compared to control subjects, or there may be no difference at all between the two population. In this study, we aim to provide a conceptual and methodological framework which allows for interpreting the results obtained from 44 speakers (29 PD and 15 control subjects) in relation to physiological (gender, age, PD subjects' pharmacologic state) and linguistic (speech production tasks) constraints. For the present corpus, we did not observe any F0 mean difference between the two groups. Our results however reveal a significant increase in F0 mean in PD subjects under L-dopa. We assume a double and opposite effect on F0 mean during drug withdrawal: low sub-glottal pressure, due to PD, results in a decrease in F0, while laryngeal rigidity leads to an increase in F0. These two effects thus mutually annihilate. Under L-Dopa, however, the drug effect increases sub-glottal pressure, which combined with an increase in F0 due to rigidity, leads to a global increase in F0.

[Social consequence of a dysphonic voice, design and validation of a questionnaire and first results]

In our society, based on communication, dysphonia becomes a handicap that could be responsible of work discrimination. Actually, several commercial services are provided by phone only, and voice quality is mandatory for the employees. This work aim was to determine the social picture relayed by dysphonia. Our hypothesis was that dysphonia sounds pejorative compared to normal voice. 40 voice samples (30 dysphonic and 10 normal) were presented randomly to a perceptual jury of 20 naïve listener. The task was for each of them to fill a questionnaire, designed specifically to describe the speaker's look and personality. 20 items were evaluated, divided into 4 categories: health, temperament, appearance, and way of life. The results showed significant differences between normal subjects and dysphonic patients. For instance, the pathological voices were depicted as more tired, introverted, sloppy than normal voices, and less trustable. No significant differences were found according to the severity of voice disorders. This work is presently continued. It allowed to validate our questionnaire and has offers great perspectives on patient's management and voice therapy.

[From intelligibility to comprehension, which measurement in practice?]

The modelling of the tests assessing speech disorders in touch with the international classification of the functioning implies a reflection on measurement tools. The access to the sense of the message from decoding of the signal to the action infers at the interlocutor's justifies various methods. The objective of this work is to demonstrate the limit of the usual tests of intelligibility.

MATERIAL AND METHOD

A population of 10 subjects presenting a speech disorder secondary to a Head and Neck cancer and 2 subjects controls recorded a corpus of 80 syllables developed with the most frequent 16 French consonants and 5 vowels. The test of intelligibility consisted of a task of identification of consonants by a jury of 11 listeners.

RESULTS

About is the method used to estimate the informative value of the consonants tested, the uvular consonant /r/ and the nasal In/, /m/ are very well perceived. The weighting by the rate of confusion makes tipped over the position of labiodentales If/, /v/ and that of / p/. The just perception of the sound/p/ would be underestimated while sounds /v/ and /f/ would be overestimated. Sounds /g/, /k/, /j/ remain the least well received. This observation results probably from the profile of distortions produced by the selection of the population and probably from the frequency of the syllables containing these consonants in the french language for the sample of the corpus.

CONCLUSION

The rate of confusion appears as a fundamental element, inciting to look for more relevant methods of analysis of the results of the tests of intelligibility.

Influence of phonetic context on the dysphonic event: contribution of new methodologies for the analysis of pathological voice

Widely studied in terms of perception, acoustics or aerodynamics, dysphonia stays nevertheless a speech phenomenon, closely related to the phonetic composition of the message conveyed by the voice. In this paper, we present a series of three works with the aim to understand the implications of the phonetic manifestation of dysphonia. Our first study proposes a new approach to the perceptual analysis of dysphonia (the phonetic labeling), which principle is to listen and evaluate each phoneme in a sentence separately. This study confirms the hypothesis of Laver that the dysphonia is not a constant noise added to the speech signal, but a discontinuous phenomenon, occurring on certain phonemes, based on the phonetic context. However, the burden of executing the task has led us to look to the techniques of automatic speaker recognition (ASR) to automate the procedure. With the collaboration of the LIA, we have developed a system for automatic classification of dysphonia from the techniques of ASR. This is the subject of our second study. The first results obtained with this system suggest that the unvoiced consonants show predominant performance in the task of automatic classification of dysphonia. This result is surprising since it is often assumed that dysphonia occurs only on laryngeal vibration. We started looking for explanations of this phenomenon and we present our assumptions and experiences in the third work we present.

[Prosodic features of computer-assisted presentations: a preliminary study]

INTRODUCTION

Computer-assisted presentations (CAP) seem to be characterized by changes of rhythm and melody of speech, compared to spontaneous speech, in many cases with periods with rapid and excessively regular breaks interspersed with long pauses.

METHODS

We analyzed the prosody and especially the pace in the temporal organization of prominences (distribution of stress, articulatory speed, pause duration) in 37 inexperienced subjects in a CAP corresponding to an actual review of graduation. The results were compared with a presentation without support (PWS) conducted immediately after the first. A jury had to propose a gradation of prosody (typical CAP, intermediate, non-typical). Accentual distribution was analyzed from a perceptual experiment. The articulatory speed and length of breaks were analyzed from the speech signal.

RESULTS

We found the main elements of prosodic style assumed in three-quarters of subjects. This style was characterized by a faster articulatory rate and a more regular and rhythmic breaks due to excessive elongation of silent pauses when changing view of the slide.

DISCUSSION

The assumption seems validated because the majority of subjects in our study are of particular prosodic rhythm (faster and more regular). Subjects with archetypal prosody of CAP appear to be those whose speech followed closely their slide presentation, which disrupted their communication.

Glucagon-like peptide-1 secretion in women with gestational diabetes mellitus during and after pregnancy

Gestational diabetes mellitus (GDM) predisposes women to future development of Type 2 diabetes mellitus (DM2) and the two conditions share similar metabolic alterations. Recent observations suggest that a defective glucose stimulated insulin secretion by glucagon-like peptide-1 (GLP- 1) plays a role in the pathogenesis of DM2. Whether such a defect is impaired in GDM remains to be ascertained.

AIM

We have determined GLP-1 secretion in response to oral glucose tolerance test (OGTT) in GDM and normal glucose tolerance (NGT) during and after pregnancy.

MATERIALS AND METHODS

100-g-3h OGTT was performed in 12 GDM and 16 NGT women at 27.3 ± 4.1 weeks of gestation, for determination of plasma GLP-1, glucose, insulin, and C-peptide. Insulin sensitivity (ISI) and insulin secretion (first and second phase); as well as ISI-secretion index (ISSI) were also derived.

RESULTS

NGT and GDM women were comparable for age pre-pregnancy body mass index (BMI) and weight gain. GDM had higher glucose area under the curve (AUC): 27,575.5 ± 3448 vs 20,685.88 ± 2715 mg/dl min (p<0.01), but lower first-phase insulin secretion (993.12±367 vs 1376.61 ± 423, p<0.05) and ISSI compared to controls (3873.23 ± 1185 vs 6232.13 ± 1734, p<0.001). When we examined GLP-1 mean levels in relation to mean glycemic values, GLP-1 secretion was inappropriately low with respect to mean glycemic values in GDM compared to NGT. At follow-up, AUCGLP-1 was significantly lower in post-partum GDM compared to post-partum NGT women (2542 ± 273 vs 10,092 ± 7367 pmol·l-1·min-1, p<0.05, respectively).

CONCLUSIONS

Our study suggests that GLP-1 secretion in GDM women is inadequate for the prevailing glycemic levels both in pregnancy and post partum. Moreover, we cannot exclude that other important aspects of the incretin effect may be involved in GDM development.

TRPV4-mediated calcium influx into human bronchial epithelia upon exposure to diesel exhaust particles

BACKGROUND

Human respiratory epithelia function in airway mucociliary clearance and barrier function and have recently been implicated in sensory functions.

OBJECTIVE

We investigated a link between chronic obstructive pulmonary disease (COPD) pathogenesis and molecular mechanisms underlying Ca2+ influx into human airway epithelia elicited by diesel exhaust particles (DEP).

METHODS AND RESULTS

Using primary cultures of human respiratory epithelial (HRE) cells, we determined that these cells possess proteolytic signaling machinery, whereby proteinase-activated receptor-2 (PAR-2) activates Ca2+-permeable TRPV4, which leads to activation of human respiratory disease-enhancing matrix metalloproteinase-1 (MMP-1), a signaling cascade initiated by diesel exhaust particles (DEP), a globally relevant air pollutant. Moreover, we observed ciliary expression of PAR-2, TRPV4, and phospholipase-Cβ3 in human airway epithelia and their DEP-enhanced protein-protein complex formation. We also found that the chronic obstructive pulmonary disease (COPD)-predisposing TRPV4P19S variant enhances Ca2+ influx and MMP 1 activation, providing mechanistic linkage between man-made air pollution and human airway disease.

CONCLUSION

DEP evoked protracted Ca2+ influx via TRPV4, enhanced by the COPD-predisposing human genetic polymorphism TRPV4P19S. This mechanism reprograms maladaptive inflammatory and extracellular-matrix-remodeling responses in human airways. The novel concept of air pollution-responsive ciliary signal transduction from PAR-2 to TRPV4 in human respiratory epithelia will accelerate rationally targeted therapies, possibly via the inhalatory route.

[Context influence on the perception of dysphonia: when the knowledge of the patient's clinical state can modify the results of perceptual voice quality assessment]

Two experiments were conducted to examine how knowledge of the patient's clinical state affects the results of perceptual voice quality assessment performed by specialists in voice therapy. This study involved 53 patients with a dysphonia. For each speaker, we selected a pair of recordings made in different circumstances. These pairs of voices were presented to seven listeners (ENT surgeons or speech therapists). The task was to perceptually compare the severity of the dysphonia between the 2 recordings of the pair. Stimuli were presented first in a blind test, then several weeks later with accompanying information about the patient; in particular, whether the voice was pre- or post- treatment was explicitly specified. We balanced this artificial contextual information in order to (alpha) reinforce the blind judgment (for example, voices perceived as better in the blind test were indicated as post treatment); (beta) be inconsistent (in a clinical point of view) compared to the blind test (for example, voices perceived as more disordered during the blind test were indicated as post treatment). Results revealed that in the clinical-consistent context alpha, the preference was amplified in a significant way. In clinical-inconsistent condition beta, we observed an inhibition effect or a change of decision. In this condition, the judgment was more dependant on the contextual information (pre/post treatment) than on the auditory sensation obtained in blind condition. These findings are discussed with reference to results in the literature on visual, olfactory or auditory perception in context. In the frame of perceptual voice assessment, results revealed that only blind tests can provide reliable results.

[Perceptual assessment of dysphonia: a training protocol with natural speech]

INTRODUCTION

In this study, we proposed and tested the effectiveness of a training procedure on perceptual evaluation of dysphonia. Participants were naive listeners who learned to judge the severity of vocal disorders.

MATERIALS AND METHODS

The corpus consisted of 142 female voices ranging from normal to severely dysphonic voices. A total of 38 naive listeners were tested, and the experiment was divided in 3 phases: (1) A pretest to assess the level of our listeners in the categorization of dysphonia, (2) the training phase and (3) a post-test to assess the improvement associated with the training. To examine the persistence of the training, the post-test was administrated twice: Immediately after the training session and one week later.

RESULTS

Improvement in the performance between the pretest and the post-test was found for moderate and severe dysphonia. No improvement was observed in the categorization of slightly dysphonic voices, which seem the more resistant to learning. Normal voices also showed no improvement, which is likely due to the high performance on these voices during the pre-test. The improvement observed in the categorization of moderate and severe dysphonia was still present even one week after the training.

DISCUSSION

The protocol tested in this study appears to be effective and could constitute an element of training courses for speech and voice therapists. The perception of the intermediate levels of dysphonia, however, remains difficult to quantify and needs to be improved.

[Dysarthria across Parkinson's disease progression. Natural history of its components: dysphonia, dysprosody and dysarthria]

Dysarthria refers to a collective name for a group of neurologic motor speech disorders, resulting from central and/or peripheral nervous system abnormalities. Speech alteration in Parkinson's disease, so-called hypokinetic dysarthria, presents with prosodic insufficiency, related to a monotony of pitch and intensity, a reduction of accentuation, variable speech rate and possible phoneme imprecision. In most cases, voice is harsh and breathy. This symptom can affect both voice and speech quality, as well as prosody and intelligibility. As a consequence, many patients complain about speech impairments, which affect their communication in daily living activities. Perceptual and instrumental assessments require different and numerous investigation methods, which use may help to further understand the specific dysarthria pathophysiology. This is of importance in order to adjust treatments for dysarthria; as a matter of fact, dopa-therapy, functional neurosurgery or even behavioural speech therapy have variable effects on voice and speech quality in Parkinson's disease.

Roles of MAPK pathway activation during cytokine induction in BEAS-2B cells exposed to fine World Trade Center (WTC) dust

The World Trade Center (WTC) collapse on September 11, 2001 released copious amounts of particulate matter (PM) into the atmosphere of New York City. Follow-up studies on persons exposed to the dusts have revealed a severely increased rate for asthma and other respiratory illnesses. There have only been a few studies that have sought to discern the possible mechanisms underlying these untoward pathologies. In one study, an increased cytokine release was detected in cells exposed to WTC fine dusts (PM₂.₅ fraction or WTC₂.₅). However, the mechanism(s) for these increases has yet to be fully defined. Because activation of the mitogen-activated protein kinase (MAPK) signaling pathways is known to cause cytokine induction, the current study was undertaken to analyze the possible involvement of these pathways in any increased cytokine formation by lung epithelial cells (as BEAS-2B cells) exposed to WTC₂.₅. Our results showed that exposure to WTC₂.₅ for 5 hr increased interleukin-6 (IL-6) mRNA expression in BEAS-2B cells, as well as its protein levels in the culture media, in a dose-dependent manner. Besides IL-6, cytokine multiplex analyses revealed that formation of IL-8 and -10 was also elevated by the exposure. Both extracellular signal-regulated kinase (ERK) and p38, but not c-Jun N-terminal protein kinase, signaling pathways were found to be activated in cells exposed to WTC₂.₅. Inactivation of ERK signaling pathways by PD98059 effectively blocked IL-6, -8, and -10 induction by WTC₂.₅; the p38 kinase inhibitor SB203580 significantly decreased induction of IL-8 and -10. Together, our data demonstrated activation of MAPK signaling pathway(s) likely played an important role in the WTC₂.₅-induced formation of several inflammatory (and, subsequently, anti-inflammatory) cytokines. The results are important in that they help to define one mechanism via which the WTC dusts may have acted to cause the documented increases in asthma and other inflammation-associated respiratory dysfunctions in the individuals exposed to the dusts released from the WTC collapse.

[Preliminary experimental studies of whispered voice: subglottal pressure and postural aspects]

OBJECTIVES

Whispered voice is investigated from the energetic point of view. Our hypothese is that whispered voice, and mainly the forced whispers are very similar to vocal effort, for non acoustic vocal parameters, and body movements.

DESIGN

Two experiments are combined. The first experiment focused on the laryngeal aspects, mainly the subglottal pressure, and also the electroglottography. The second experiment analyzed the body movements associated with loud whispered voice.

RESULTS

No electroglottograhic wave was observed during the two experiments. The vocal intensity was always lower during whispered voice than during comfortable voice (p < 0.001). In experiment 1, subglottal pressure was significantly higher during forced whisper than during the other conditions (p < 0.001). In experiment 2, the amplitude of the trunk movements in the sagittal plane were greater during loud whisper than during comfortable voice (p < 0.001).

CONCLUSION

Whispered voice can be close to vocal loading, especially the loud whispered voice.

Eosinophil and T cell markers predict functional decline in COPD patients

Background

The major marker utilized to monitor COPD patients is forced expiratory volume in one second (FEV1). However, asingle measurement of FEV1 cannot reliably predict subsequent decline. Recent studies indicate that T lymphocytes and eosinophils are important determinants of disease stability in COPD. We therefore measured cytokine levels in the lung lavage fluid and plasma of COPD patients in order to determine if the levels of T cell or eosinophil related cytokines were predictive of the future course of the disease.

Methods

Baseline lung lavage and plasma samples were collected from COPD subjects with moderately severe airway obstruction and emphysematous changes on chest CT. The study participants were former smokers who had not had a disease exacerbation within the past six months or used steroids within the past two months. Those subjects who demonstrated stable disease over the following six months (ΔFEV1 % predicted = 4.7 ± 7.2; N = 34) were retrospectively compared with study participants who experienced a rapid decline in lung function (ΔFEV1 % predicted = -16.0 ± 6.0; N = 16) during the same time period and with normal controls (N = 11). Plasma and lung lavage cytokines were measured from clinical samples using the Luminex multiplex kit which enabled the simultaneous measurement of several T cell and eosinophil related cytokines.

Results and Discussion

Stable COPD participants had significantly higher plasma IL-2 levels compared to participants with rapidly progressive COPD (p = 0.04). In contrast, plasma eotaxin-1 levels were significantly lower in stable COPD subjects compared to normal controls (p < 0.03). In addition, lung lavage eotaxin-1 levels were significantly higher in rapidly progressive COPD participants compared to both normal controls (p < 0.02) and stable COPD participants (p < 0.05).

Conclusion

These findings indicate that IL-2 and eotaxin-1 levels may be important markers of disease stability in advanced emphysema patients. Prospective studies will need to confirm whether measuring IL-2 or eotaxin-1 can identify patients at risk for rapid disease progression.

Questionnaire assessment of airway disease symptoms in equine barn personnel

BACKGROUND

People working in cattle, swine and poultry barns have a higher prevalence of respiratory symptoms and decreased lung function. There is scant evidence regarding the respiratory health of humans working in horse barns, although it is well documented that stabled horses have a high prevalence of airway disease.

AIMS

To determine whether people spending time in horse barns have a higher prevalence of self-reported respiratory symptoms than non-exposed controls.

METHODS

A cross-sectional questionnaire study was conducted from May 2005 to January 2006 to investigate the prevalence of self-reported respiratory symptoms in 82 barn-exposed subjects and 74 control subjects. Logistic regression and the chi-square test were used to analyse the data.

RESULTS

There was a significantly higher prevalence of self-reported respiratory symptoms in the barn-exposed group (50%) versus the control group (15%). Exposure to horse barns, smoking and family history of asthma or allergies was independent risk factors for respiratory symptoms. High exposure to the horse barn yielded a higher odds ratio for self-reported respiratory symptoms (8.9).

CONCLUSIONS

Exposure to the equine barn is a risk factor for respiratory symptoms. Investigation of organic dust exposures, lung function and horse dander allergies in the barn-exposed group will be necessary to determine how best to protect the health of this group.

[Postural study on healthy subjects during experimental vocal effort]

INTRODUCTION

The objective of the study was to assess how posture and vocal acoustics are modified when one needs to communicate despite environmental obstacles (i.e. vocal effort performance).

METHOD

20 healthy young women participated to this study. They had to communicate numbers to a listener. Environmental obstacles were the distance between the subject and the auditor, and the noise. Segmental posture modifications were recorded and analyzed using the numerical infra-red system for movement analysis SMART. Vocal acoustics and electroglottography were also recorded and analyzed using the EVA system.

RESULTS

The study showed the presence of objective postural modifications during vocal effort. Their amplitude increased when the environmental obstacles to communications increased, and they anticipated the vocal production.

DISCUSSION

The vocal effort concept and its relation with the posture, the voice and the subject's feeling are reviewed on the basis of these results. Laryngeal effort is not isolated, but belongs to a global behavioral strategy which aims to improving the efficiency of the communication.

[Use of instrumental vocal analysis in phoniatrics]

The growing need for quantitative evaluation of health care intervention along with the pitfalls of perceptual analysis is leading clinicans to utilise different instrumental vocal analysis methods including acoustic and aerodynamic methods. The fact that perceptual analysis is most often presented as the gold standard for vocal evaluation remains paradoxical. The authors present the use of aerodynamic measurements in particular oral airflow and subglottic pressure.

Colchicine Decreases Airway Hyperreactivity Afrer Phosgene Exposure

Phosgene (COCl(2)) exposure affects an influx of inflammatory cells into the lung, which can be reduced in an animal model by pretreatment with colchicine. Inflammation in the respiratory tract can be associated with an increase in airway hyperreactivity. We tested the hypotheses that (1) phosgene exposure increases airway reactivity and (2) colchicine can decrease this elevation. Sprague Dawley rats (70 d old; male) were exposed to 1 ppm COCl(2) for 1 h. Airway reactivity was tested at 0, 4, and 24 h postexposure by infusing anesthetized animals intravenously with acetylcholine and assessing expiratory resistance and dynamic compliance. Immediately and 4 h postexposure, a significant change in expiratory resistance and dynamic compliance was observed in those animals exposed to COCl(2), while at 24 h this response was greater. A second experiment was performed in rats pretreated with colchicine (1 mg/kg) or saline given intraperitoneally, exposed to 1 ppm COCl(2) for 1 h, with both expiratory resistance and dynamic compliance assessed at 24 h. After exposure, cell differentials and protein in lavage were also quantitated. The results indicate that colchicine decreased neutrophil influx, protein accumulation, and changes in both expiratory resistance and dynamic compliance after COCl(2) exposure. Colchicine may affect injury and changes in expiratory resistance and dynamic compliance by diminishing the incursion of inflammatory cells, but other properties of this medication may also be responsible for the observed results.

C-reactive protein and metabolic syndrome in women with previous gestational diabetes

BACKGROUND

This study evaluates the presence of metabolic syndrome (MS) and its association with C-reactive protein (CRP) and other cardiovascular (CV) risk factors, in a sample of women with and without previous Gestational Diabetes (pGDM).

METHODS

One hundred and sixty-six women with pGDM and 98 women (controls) with uncomplicated pregnancy were studied 16 months after delivery. In all women, plasma glucose, insulin, lipid profile, serum uric acid, C-reactive protein, fibrinogen and homocysteine were measured. MS was defined according to NCEP ATPIII criteria.

RESULTS

MS was identified in 15 pGDM women (9%) versus 1 control (1%) (p < 0.001). The more frequent metabolic traits were abdominal obesity (36% vs 17%) and low HDL-cholesterol (34% vs 17% in pGDM women and controls, respectively; all p < 0.01). HOMA-R, LDL-cholesterol, fibrinogen, serum uric acid and CRP resulted significantly higher in pGDM women with MS as compared to those without MS after adjustment for BMI. In women with no criteria for MS, only CRP levels were found to be higher in pGDM women compared to controls (p < 0.05). Seventeen percent of pGDM women with no criteria for MS had CRP levels >or=1 mg/L (all controls showed CRP levels <1 mg/L). After a stepwise regression analysis, CRP levels were independently correlated to HOMA-R (r2 = 0.27, p < 0.001) and fibrinogen (r2 = 0.30, p < 0.001).

CONCLUSIONS

In our population, MS occurs in a sizable proportion of pGDM women and is associated with increased levels of CRP, fibrinogen, uric acid and LDL-cholesterol. Moreover, higher levels of CRP, a marker of chronic low-grade inflammation, are present in a subset of women with pGDM, independently of MS.

[The role of laryngeal kinesthetic feedback in the control of pitch in speech production]

OBJECTIVES

Pitch change during voice production is under the control of auditive and kinesthetic feedback phenomenona. The aim of the study was to determine the role of larynx kinesthetic feedback in speech production control.

MATERIALS AND METHODS

To validate our laryngeal model, five porcine larynges were excised and placed on a test bench consisting of a blower and a laser photoglottometer for measurement of vocal cord vibration. We applied vibratory stimuli to the cricothyroid muscles to determine whether vibrators supplied by a generator alter the biomechanics of the larynx. Fundamental frequency (F0) was recorded under three conditions--larynx on vibration--larynx on vibration with vibrators activation--larynx on rest and vibrators activation. Once validated, 7 male and 7 female, mean age 29 years, were enrolled. Vibrators were positioned on cricothyroid muscles, cricoid and thyroid cartilages. Masking noise was used. Fundamental frequency, intensity and speech time production was measured during speech production under three conditions--normal speech, vibrators activation, and masking activation.

RESULTS

The preliminary study demonstrated that larynx on vibration with vibrators activation doesn't alter the vocal fold F0. For the human trial, between normal speech and vibrators activation conditions, we found a significant difference (p= 0.045 for male, p= 0.010 for female) in intonation, and no significant difference for intensity and speech time. Between normal speech and masking activation conditions, no significant differences were measured for any condition.

CONCLUSION

Use of the vibrators is a reliable method to allow the evaluation of larynx kinesthetic feedback in speech production control.

p53 mediates particulate matter-induced alveolar epithelial cell mitochondria-regulated apoptosis

RATIONALE

Exposure to particulate matter (PM) causes lung cancer by mechanisms that are unknown, but p53 dysfunction is implicated.

OBJECTIVE

We determined whether p53 is required for PM-induced apoptosis in both human and rodent alveolar type (AT) 2 cells.

METHODS

A well-characterized form of urban PM was used to determine whether it induces mitochondrial dysfunction (mitochondrial membrane potential change [DeltaPsi m] and caspase-9 activation), p53 protein and mRNA expression, and apoptosis (DNA fragmentation and annexin V staining) in vitro using A549 cells and primary isolated human and rat AT2 cells. The role of p53 was assessed using inhibitors of p53-dependent transcription, pifithrin-alpha, and a genetic approach (overexpressing E6 or dominant negative p53). In mice, the in vivo effects of PM causing p53 expression and apoptosis were assessed 72 h after a single PM intratracheal instillation.

MEASUREMENTS AND MAIN RESULTS

PM-induced apoptosis in A549 cells was characterized by increased p53 mRNA and protein expression, mitochondrial translocation of Bax and p53, a reduction in DeltaPsi m, and caspase-9 activation, and these effects were blocked by inhibiting p53-dependent transcription. Similar findings were noted in primary isolated human and rat AT2 cells. A549-rho degrees cells that are incapable of mitochondrial reactive oxygen species production were protected against PM-induced DeltaPsi m, p53 expression, and apoptosis. In mice, PM induced p53 expression and apoptosis at the bronchoalveolar duct junctions.

CONCLUSIONS

These data suggest a novel interaction between p53 and the mitochondria in mediating PM-induced apoptosis that is relevant to the pathogenesis of lung cancer from air pollution.

Strategies for dissecting genetic-environmental interactions in neurodegenerative disorders

Complex genetic and environmental interactions contribute to abnormal aging and neurodegenerative disorders. We present information from a series of 1136 consecutive patients presenting with cognitive disorders and show possible significant contribution of toxic environmental and occupational exposures to pathological aging (21% of patients) and interactions of these exposures with common polymorphisms that affect cell injury and inflammation. Such exposures may lower age of onset to same degree as APOE4/4. Common polymorphisms in apolipoprotein E (APOE), hemochromatosis gene (Hfe) and alpha-1-antitrypsin (AAT) are present in up to 40+% of patients and may partially account for differences in clinical syndrome, age of onset and rate of progression. Strategies for the study of these disorders must also consider the role and treatment of common co-morbid illnesses such as alcohol use, nutritional deficiencies, sleep disorders, and pre-existing affective disorder. APOE, Hfe, and AAT genes are expressed in liver tissue and in macrophages and are involved in the host innate immune response to stress, inflammation and infections. Hfe and AAT are involved in iron metabolism and their polymorphisms may contribute to hepatosteatosis and altered homeostasis of lipids (role of APOE), iron, and trace minerals. Some of these responses may be adaptive. Hfe and AAT modulate the apparent effects of toxic exposures on age of onset and progression rate. C282Y polymorphism paradoxically reverses APOE4/4 effect on age of onset. S and Z AAT polymorphisms may attenuate earlier age of onset in persons with toxic or environmental exposure. AAT S or Z polymorphisms are present in 25% of persons with anxiety disorder and 42% of persons with bipolar disorder compared to 10% of control group without pre-existing affective disorder. Common genetic polymorphisms that affect the response to inflammation and cell injury provide a beginning strategy for dissecting neurodegenerative disorders. The effects of APOE, Hfe, and AAT on glucose, lipid, iron and trace mineral homeostasis may affect normal development and aging of the nervous system in addition to their effects on outcome of toxic environmental and occupational exposures and susceptibility and outcome of neurodegenerative illnesses.

Calcium stone lithoptysis in primary ciliary dyskinesia

BACKGROUND

An association between lithoptysis and primary ciliary dyskinesia (PCD) has not been previously reported. However, reports of lithoptysis from 2 older patients (>60 yr) prompted a study of this association.

METHODS

We performed a prospective study of all PCD patients presenting to our institution between August 2003 and March 2006, seeking the symptom of lithoptysis or calcium deposition on radiology. A retrospective analysis of all PCD patients presenting prior to August 2003 was also performed. Patients age > or = 40 previously reviewed were recontacted. If a history of lithoptysis or calcium deposition was present, we further reviewed radiographic, microbiologic, and biochemical data, including serum calcium and phosphate. Broncholiths were analyzed by light and electron microscopy- and electron-dispersive X-ray analysis.

RESULTS

In total, 142 patients (n=28 age > or = 40) were included, 41 in the prospective and 91 in the retrospective study. Lithoptysis was reported in 5 patients (all age > or = 40). Chest CT scans identified calcification (4/5), involving bronchiectatic airways in 3 patients and focal nodular calcification in 1 patient. Two other patients (age 46, 59) were identified with airway calcification without lithoptysis. Available broncholiths from 2 of these patients were composed of calcite, whereas a broncholith from 1 patient with focal nodular calcification contained calcium phosphate. Sputum was positive for Pseudomonas aeruginosa in all 7 patients, but negative for mycobacterial and fungal cultures.

CONCLUSION

There is an association between lithoptysis and PCD in patients age > or = 40. We hypothesize that calcite stone formation is a biomineralization response to chronic airway inflammation and retention of infected airway secretions in PCD in a subset of PCD patients.

Maternal triglyceride levels and newborn weight in pregnant women with normal glucose tolerance

OBJECTIVE

To determine the predictive value of serum triglyceride levels (TG) for neonatal weight in pregnant women with positive diabetic screening but normal glucose tolerance.

RESEARCH DESIGN AND METHODS

We enrolled 180 pregnant Caucasian women with positive diabetic screening. All women underwent a 3-h 100-g oral glucose tolerance test (OGTT) at 27th +/- 4 week of gestation. At the time of OGTT, we measured: fasting plasma glucose, fasting lipids profile and determined ApoE polymorphisms to evaluate the effects on lipid levels. In 83 women with normal glucose tolerance and at term delivery we evaluated the association between maternal serum TG, specific maternal parameters known to affect fetal growth and newborn weight.

RESULTS

Based on OGTT, gestational diabetes mellitus (GDM) was diagnosed in 36 women (20%), impaired glucose tolerance (IGT) in 23 (13%), and normal glucose tolerance (NGT) in 121 (67%). Serum TG concentration was significantly higher in women with GDM (2.47 +/- 0.77 mmol/l) as compared with NGT (1.99 +/- 0.64 mmol/l) or IGT (1.98 +/- 0.81 mmol/l) (P < 0.01). ApoE3 allelic frequency was 86%, ApoE2 and ApoE4 were 5 and 9%, respectively. We found no clear-cut association between apoE genotype and serum TG concentration. Macrosomia and LGA newborns were more frequent in IGT than in GDM or NGT (P < 0.01). In the 83 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of LGA infants was significantly higher in those with TG levels higher than the 75th percentile (> 2.30 mmol/l) (21%) than in mothers who had normal TG levels (4.5%) (P < 0.05). Pre-pregnancy BMI (r(2) = 0.067), weight gain during pregnancy (r(2) = 0.062), fasting serum TG (r(2) = 0.09), and 2-h post-OGTT glucose levels (r(2) = 0.044) were all associated with neonatal body weight (all P < 0.05 or less). However, on a multiple regression analysis, only pre-pregnancy BMI (F-test = 7.26, P < 0.01), and fasting serum TG (F-test = 4.07, P < 0.01) were independently associated with birth weight.

CONCLUSIONS

Pre-pregnancy BMI and fasting maternal serum TG determined in the last trimester of gestation were independently associated with neonatal birth weight in women with normal glucose tolerance, but positive screening test. TG levels measured in the third trimester of pregnancy are independent of the genetic polymorphism of ApoE.

Prevalence and risk factors for gestational diabetes assessed by universal screening

In order to evaluate the prevalence of gestational diabetes mellitus (GDM) and the presence of risk factors for GDM, we conducted a retrospective study of a cohort of Italian women. In addition, we compared universal versus selective screening to validate the ADA's recommendations in our population. From June 1st, 1995 to December 31st, 2001, universal screening for GDM was performed in 3950 women. The glucose challenge test (GCT) was positive (GCT+) in 1389 cases (35.2%). The 1-h glucose level after GCT enabled us to diagnose GDM directly in 24 pregnant women. Oral glucose tolerance test (OGTT) was performed in 1221 GCT+ women (144 cases with GCT+ dropped out) and GDM was diagnosed in 284 (23.2%) of them. OGTT was also performed in 391 randomly chosen, women from the GCT negative (GCT-) group. In this last group 25 (6.3%) women had GDM. Thus, the total number of subjects with GDM was 333 out of 3806 with a prevalence of 8.74% in the entire cohort. Assuming that the rate of GDM observed in the random sample of GCT- women is applicable to the whole group of 2561 GCT- women, then 161 GCT- patients could also have GDM. This will further increase the estimated prevalence for the whole cohort up to 12.3% (i.e. 469 out of 3806 pregnant women). There were 236 (5.6%) women with a low risk for GDM (normal weight, age less than 25 years and without a family history of diabetes). In this group we found 34 cases and five cases with positive screening test and GDM, respectively. Thus, if we excluded low risk women from the screening test, as suggested by ADA recommendations, only five women with GDM would have been missed. However, about 95% of our population were at medium or high risk for GDM and, therefore, would have been screened. The rate of GDM was significantly higher in women with a positive history of diabetes, increasing age, previous pregnancies, pre-pregnancy overweight and short stature. After logistic regression analysis, GDM diagnosis was significantly correlated with age (P<0.0001), pre-pregnancy BMI (P<0.0001), weight gain (P<0.0001) and family history of diabetes (P<0.01).

[Importance of tussometry in unilateral laryngeal paralysis]

Cough is a physiological gesture witch requires a perfect laryngeal competence. Tussometry was described as a reliable and reproducible method of analysis based on the measure of oral air flow rate during cough. This test allows to quantify the efficiency of laryngeal occlusion in normal situation and in case of unilateral laryngeal paralysis. The measure of the time lag between the beginning of the cough and the maximal air flow rate (peak value time) is the most reliable parameter (8). Present study is designed to asses the reproducibility of tussometry realized on a vocal analysis workstation EVA II and to test the efficiency of intracordal injection of autologus fat in case of unilateral laryngeal paralysis following thoracotomy. 10 control subjects were recorded at two moments. 6 patients presenting unilateral laryngeal paralysis following thoracic surgery were recorded before and after injection of autologus fat in the paralysed vocal cord. Reproducibility of tussometry is good (r = 0.96). The mean peak value time is significantly improved (p = 0.048). In conclusion, tussometry is a reliable routine test on EVA III workstation. Intracordal autologus fat injection improves occlusive function of larynx during cough in case of unilateral paralysis.

Particulate matter induces alveolar epithelial cell DNA damage and apoptosis: role of free radicals and the mitochondria

Airborne particulate matter (PM) increases morbidity and mortality resulting from cardiopulmonary diseases including cancer. We hypothesized that PM is genotoxic to alveolar epithelial cells (AEC) by causing DNA damage and apoptosis. PM caused dose-dependent AEC DNA strand break formation, reductions in mitochondrial membrane potential (Delta psi m), caspase 9 activation, and apoptosis. An iron chelator and a free radical scavenger prevented these effects. Finally, overexpression of Bcl-xl, a mitochondrial anti-apoptotic protein, blocked PM-induced Delta psi m and DNA fragmentation. We conclude that PM causes AEC DNA damage and apoptosis by mechanisms that involve the mitochondria-regulated death pathway and the generation of iron-derived free radicals.

Regulation of reticuloendothelial iron transporter MTP1 (Slc11a3) by inflammation

Acute and chronic inflammation cause many changes in total body iron metabolism including the sequestration of iron in phagocytic cells of the reticuloendothelial system. This change in iron metabolism contributes to the development of the anemia of inflammation. MTP1, the duodenal enterocyte basolateral iron exporter, is also expressed in the cells of the reticuloendothelial system (RES) and is likely to be involved in iron recycling of these cells. In this study, we use a lipopolysaccharide model of the acute inflammation in the mouse and demonstrate that MTP1 expression in RES cells of the spleen, liver, and bone marrow is down-regulated by inflammation. The down-regulation of splenic expression of MTP1 by inflammation was also observed in a Leishmania donovani model of chronic infection. The response of MTP1 to lipopolysaccharide (LPS) requires signaling through the LPS receptor, Toll-like receptor 4 (TLR4). In mice lacking TLR4, MTP1 expression is not altered in response to LPS. In addition, mice lacking tumor necrosis factor-receptor 1a respond appropriately to LPS with down-regulation of MTP1, despite hyporesponsiveness to tumor necrosis factor-alpha signaling, suggesting that this cytokine may not be required for the LPS effect. We hypothesize that the iron sequestration in the RES system that accompanies inflammation is because of down-regulation of MTP1.