Oxidative stress and inflammation parameters-novel biomarkers for idiopathic pulmonary fibrosis

OBJECTIVE

The pathophysiological mechanisms of idiopathic pulmonary fibrosis (IPF) are not well elucidated. It is assumed that oxidative stress and inflammation are the key underlying culprits for its onset and progression. To gain deeper insight into these processes, we have evaluated several oxidative stress parameters, inflammation markers [i.e., high sensitivity C-reactive protein (hsCRP), serum amyloid A1 (SAA1)], soluble programmed cell death-ligand 1 (sPD-L1), and 25-hydroxyvitamin D [25(OH)D] in IPF patients.

PATIENTS AND METHODS

Biochemistry analyses were done in 30 consecutive IPF patients and 30 age and gender-matched healthy control group (CG).

RESULTS

IPF patients had significantly higher advanced oxidation protein products (p<0.001), pro-oxidant-antioxidant balance (p=0.010), total oxidative status (p<0.001), and ischemia modified albumin (p<0.001) compared to CG. Lower total antioxidant status and total sulfhydryl groups (tSGH) and significantly higher sPD-L1, hsCRP (p<0.001 for all), SAA1 proteins (p=0.014) and [25(OH)D] severe deficiency [11.0 (9.6-15.1) nmol/L] in IPF patients compared to CG were observed. Paraoxonase 1 activity and hsCRP level were lower, while tSHG and sPD-L1 were higher in IPF patients with more severe disease (i.e., II+III stage compared to I stage, p<0.05 for all).

CONCLUSIONS

IPF patients are in a state of profound oxidative stress compared to healthy people. The inflammatory component of the disease was confirmed by higher hsCRP and SAA1, but lower [25(OH)D] in IPF than in healthy people. Also, higher levels of sPD-L1 in patients with IPF compared to healthy individuals suggest that sPD-L1 may have a significant role in immune response in IPF.

[The effects of cycloplegic eyedrops on corneal tomography]

PURPOSE

Whether cycloplegics affect standard keratorefractometric and tomographic measurements is unknown. The purpose of our study was to compare the effects of cycloplegics (cyclopentolate and atropine) on corneal shape and refractive power of the eye.

METHODS

This study was performed on 84 eyes of 49 study participants. Patients were randomized into two groups: atropine 1% (32 eyes) and cyclopentolate 1% (52 eyes). Corneal tomography was performed with the Orbscan IIz. To evaluate the corneal shape, simulated keratometry values, anterior and posterior best-fit sphere, white-to-white and tangential and axial corneal power were performed for the anterior and posterior corneal surfaces before and during cycloplegia. Pupil diameter, anterior chamber depth, corneal thickness at the 3, 5 and 7mm optical zones, thinnest area of the cornea and corneal thickness at the visual axis were examined. Data were analyzed using an SPSS statistical package.

RESULTS

The anterior and posterior BFS (in the atropine 1% group, anterior BFS was P=0.188; anterior BFS in the cyclopentolate group was P=0.227) and tangential and axial corneal power showed no change during cycloplegia in either group. SimK showed no statistical significance. The ACD was deeper when using atropine than cyclopentolate. Corneal thickness remained unchanged during cycloplegia in both groups. Pupil diameter was larger in light-colored irides in the cyclopentolate group than the atropine group. There was no change in W to W before (P=0.473) and during cycloplegia (P=0.287) in either group.

CONCLUSIONS

Our results suggest that usage of atropine or cyclopentolate does not alter corneal shape.

Modeling reflection loss from an evacuated tube inside a compound parabolic concentrator with a cylindrical receiver

Linear compound parabolic concentrators with cylindrical receivers are often combined with evacuated tubes along their focal length to suppress convective heat loss for use as thermal collectors. When investigating the optical efficiency of such collectors it is important to consider the reflection loss introduced by the evacuated tube particularly at large angles of incidence of light onto the CPC aperture. In this paper reflection losses are determined using ray-tracing as a function of the angle of incidence in both the longitudinal and transversal planes of a CPC. The reflection losses are found to be approximately constant except close to the maximum acceptance angle.

Contribution of immunohistochemistry in the differential diagnosis of non-small cell lung carcinomas on small biopsy samples

PURPOSE

Targeted therapy increases survival and the quality of life of non-small cell lung cancer (NSCLC) patients but it needs precise histological subtyping. The present study evaluated 6 monoclonal antibodies for the differential diagnosis of NSCLC on small-sized tissue samples.

METHODS

50 small-sized tissue samples were obtained by bronchoscopy or fine needle aspiration biopsy (FNAB). According to morphology before immunohistochemistry 2 squamous cell carcinomas (SCC), 6 adenocarcinomas (AC), 9 NSCLC-probably SCC, 11 NSCLC-probably AC and 22 unclassified NSCLCs were diagnosed. Thyroid transcription factor-1 (TTF-1), cytokeratin 5/6, cytokeratin 7, p63, and the neuroendocrine markers CD56 and synaptophysin were used in the differential diagnosis of NSCLC.

RESULTS

After immunohistochemistry 13 (26.0%) SCC, 27 (54.0%) AC, 3 (6.0%) NSCLC with neuroendocrine differentiation (NSCLC-NE) and 7 (14.0%) NSCLC- unclassified were diagnosed. Twenty-two NSCLC- unclassified were further diagnosed as SCC (n=7), AC (n=7) NSCLC-NE (n=2) and 6 remained NSCLC- unclassified. Significant difference was found between definitely diagnosed 8 NSCLCs and 15 ACs (20.5 vs. 38.57percnt;, p=0.008). TTF-1 and cytokeratin 7 were expressed in 85.2% (23/27) of AC, and cytokeratin 5/6 and p63 in 100% (13/13) of SCC. Positivity of CD56 and synaptophysin in 3 NSCLC determined NSCLC-NE.

CONCLUSION

No one monoclonal antibody is totally specified for one histological type of tumor and its origin. Combination of TTF-1, cytokeratin 7, p63, cytokeratin 5/6, CD56 and synaptophysin allows for differentiation of NSCLC but Napsin-A for AC differentiation and chromogranin A for NSCLC-NE differentiation should be added in an optimal panel.

Does oral health counseling effectively improve oral hygiene of orthodontic patients?

AIM

The aim of this study was to compare the effectiveness of oral health counseling sessions with traditional oral hygiene education in orthodontic patients with fixed appliances.

STUDY DESIGN

randomised control trial with experimental and control group. A group of 99 adolescents with fixed orthodontic appliances were randomly assigned to oral health counseling (experimental) or traditional health education (control) group. Subjects in the control group received verbal instructions and a demonstration of the modified Bass brushing technique on a model. The experimental group also received the verbal information with demonstration on the model and in addition a personalised 40-minutes counseling session on oral hygiene. Plaque Index (PI) and gingivitis (G) were recorded before, 1 and 6 months after the counseling session/traditional education.

RESULTS

Oral health counseling and traditional education improved the oral hygiene of orthodontic patients. PI values were significantly lower after 6 months compared to the baseline in both groups, but the prevalence of gingival inflammation remained significantly lower only in the experimental group.

CONCLUSION

Oral health counseling increased plaque removal efficacy and control of gingival inflammation. The efficiency of counseling and traditional education was similar. Counseling is a promising approach that warrants further attention in a variety of dental contexts.

Does preoperatively created right to left shunt adequately reflect hypoxemia during pneumonectomy for lung cancer?

BACKGROUND

No method is currently available for preoperative approximation of the patient's situation to the one existing during pneumonectomy in general anesthesia with alternations of single and double-lung ventilation in the lateral position. We hypothesized that a patient breathing the room air in the sitting position, with the main bronchus occluded by the inflatable catheter (aimed to predict a postpneumonectomy ventilatory function), could, at least in some aspects, simulate the intraoperative situation in certain clinical conditions discussed in the text. To evaluate the hypothesis, we used data of 15 candidates for pneumonectomy at increased risk, who underwent a spirometry with the left man bronchus occluded, as a part of the postoperative lung function prediction. Arterial blood samples (pO2, pCO2, saturation, and pH) were obtained before placement of the Fogarty catheter, than after at least 60s of normal breathing with the main bronchus occluded. Significant drop in pO2 (10.35±1.65 vs. 7.79±1.40 kPa) ensued within 1 min after occlusion of the main bronchus. All patients were able to perform spirometry in presence of induced hypoxemia without dyspnea that would require cessation of the procedure. These results, together with the absence of cardiac rhythm disorders, lead us to believe that they would behave in the same way during a pneumonectomy with alternations of single and double-lung ventilation. Such an assumption is based on the fact that breathing the room air is less favorable from the standpoint of oxygen delivery--the content of oxygen in the room air is smaller in the room air compared to that delivered through endotracheal tube. The practical implication of this hypothesis is that assessment of oxygenation during this procedure, additionally facilitates the preoperative risk assessment in patients undergoing pneumonectomy for lung cancer. Moreover, a slight postoperative oxygenation improvement and smaller loss in FEV1 in patients with moderate COPD, mean that COPD patients are likely to do a little bit better postoperatively than predicted.

Uncertainties in the current understanding of gas exchange in spontaneous pneumothorax: effective lung ventilation may persist in a smaller-sized pneumothorax

Clinical aspects of spontaneous pneumothorax (SP) are far more clear than some patophysiological issues. The exact mechanism that maintains adequate oxygenation in spontaneous pneumothorax of lesser size is still unclear. Experimental and rare studies in humans could not explicitely confirm whether it is hyperventilation of the nonaffected lung, still effective gas exchange within the affected lung, or hypoxic vasoconstriction. Similarly, it is unclear why the severity of dyspnoea sometimes differs between patients with the same size of SP. The idea that a certain degree of effective lung ventilation might exist in SP of lesser size was based on clinical observation of these patients on admission, on our measurements of pleural pressures and oxygenation in a group of patients with SP of different size and on rare experimental studies. Clinical observation that oxygenation was not significantly impaired in patients with SP of lesser size, without documented hyperventilation, served as a base for critical analysis of possible factors influencing oxygenation in SP of lesser size. Our hypothesis that pleural pressure swings in a partially collapsed lung, but still slightly expanding in inspiration, enable a certain degree of gas exchange, was confirmed both by several experimental studies and by our measurements. On the other hand, our clinical observation that patients with SP of greater size frequently differ in the severity of dyspnoea suggested the need of a more detailed analysis of the causes of hypoxaemia in these patients. The fact that hypoxaemia in these patients usually cannot be abolished by the existing hyperventilation, means that in SP of greater size, despite minimal lung volume, circulation in the pulmonary artery system still exists, causing right to left blood shunting. The fact that the severity of dyspnoea is not equal in all patients with complete SP means that hypoxic vasoconstriction exists only in some of them, following a still unknown pattern. Literature data and our measurements suggest that without further studies of hypoxic vasoconstriction in the acute phase of SP, the exact answer is not possible.