American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Mar 1997
Phenotypic analysis of alveolar macrophages and monocytes in allergic airway inflammation. I. Evidence for activation of alveolar macrophages, but not peripheral blood monocytes, in subjects with allergic rhinitis and asthma.
Macrophages and monocytes play important proinflammatory roles in allergic inflammation. We hypothesized that these cells would express an activated phenotype in allergic disease of the airways. We therefore compared the expression of 17 activation markers on the surface of alveolar macrophages (AM) and peripheral blood monocytes (PBM) in 13 subjects with asymptomatic allergic asthma (AA), nine subjects with asymptomatic allergic rhinitis (AR), and 11 nonallergic (N). ⋯ In contrast, no significant differences were found among the three groups in the expression in eight other markers (CD11b, CD14, CD23, CD29, CD33, CD35, CD63, and CD64). Finally, similar analysis of PBM from these same subjects failed to find any difference between the three groups in any of the 17 activation markers studied. These data suggest that AM are activated in allergic respiratory diseases, and that levels of HLA Class I and CD44 on AM are altered during allergic inflammation in the upper and lower airways.
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Am. J. Respir. Crit. Care Med. · Mar 1997
The effects of post-treatment with lisofylline, a phosphatidic acid generation inhibitor, on sepsis-induced acute lung injury in pigs.
The effects of lisofylline [(R)-1-(5-hydroxyhexyl)-3,7-dimethylxanthine] (LSF), an inhibitor of de novo phosphatidic acid (PA) generation, on sepsis-induced acute lung injury was studied using Hanford minipigs weighing 18 to 25 kg. Sepsis was induced by an intravenous infusion of Pseudomonas aeruginosa (1 x 10(6)/colony-forming units/kg/min over 2 h). Saline was used as the control vehicle. ⋯ LSF treatment attenuated sepsis-induced pulmonary hypertension, neutropenia, and hypoxemia, and increased MPO activity and lung injury measurements in the Pre and Post-1 h groups, but its efficacy was blunted in the Post-2 h group. Plasma TNF-alpha was decreased only in the Pre group. Thus, inhibition of intracellular PA generation through de novo pathways attenuates sepsis-induced acute lung injury.
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Am. J. Respir. Crit. Care Med. · Mar 1997
PEEP and low tidal volume ventilation reduce lung water in porcine pulmonary edema.
This study analyzed the effect of both positive end-expiratory pressure (PEEP) and reduction in tidal volume (VT) on extravascular lung water (EVLW) in a permeability model of pulmonary edema. Immediately after producing a pulmonary edema with oleic acid, 21 pigs were randomized into three groups. Group I (n = 8): PEEP of 0 cm H2O (ZEEP), VT of 12 ml/kg; Group II (n = 6): PEEP of 10 cm H2O, VT of 12 ml/kg; Group III (n = 7): PEEP of 10 cm H2O, VT of 6 ml/kg. ⋯ EVLW-G was less in Group II than in Group I at 16.3 +/- 2.7 and 23.2 +/- 4.2 ml/kg, respectively (p < 0.0001), and less in Group III than in Group II at 10.7 +/- 0.9 and 16.3 +/- 2.7 ml/kg (p < 0.0001). We conclude that early application of 10 cm H2O of PEEP reduces EVLW in permeability pulmonary edema. The lowering of VT reduced EVLW even further.
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Am. J. Respir. Crit. Care Med. · Mar 1997
Proteins and phospholipids in BAL from patients with hydrostatic pulmonary edema.
The purpose of the present study is twofold: to evaluate alterations in total phospholipid content and individual phospholipid classes of the surfactant, and to detect markers of inflammatory reaction in bronchoalveolar lavage (BAL) from patients with hydrostatic pulmonary edema (HPE). Mechanically ventilated patients with HPE (Group 1) were compared with mechanically ventilated patients without cardiopulmonary disease (Group 2), considered as the control group. Group 3, including patients with high-permeability pulmonary edema, was used for further comparison. ⋯ There was an inverse correlation between PAF-AcH and PAF. Quantitative reduction of total BAL phospholipids (PL) and qualititative deficiency was observed in both patients with HPE and ARDS. The findings of this study suggest that there is evidence of inflammation in the airspaces of patients with HPE.
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Am. J. Respir. Crit. Care Med. · Mar 1997
Multicenter Study Clinical Trial Controlled Clinical TrialOutcomes of advance directive education of pulmonary rehabilitation patients.
We performed a two-site prospective, controlled interventional study of patients enrolled in pulmonary rehabilitation to assess effects of advance directive education on completion of (1) living wills, (2) durable powers of attorney for health care (DPAHC), (3) patient-physician discussions about advance directives, and (4) discussions about life support, in addition to (5) patient impressions that their physicians understood their end-of-life preferences. The educational group had an increase (p < 0.05) in all five study outcomes compared with baseline values; the control group had an increase in three of five outcomes. ⋯ The educational intervention was an independent explanatory factor by multivariate analysis. We conclude that patients enrolled in pulmonary rehabilitation are receptive to advance care planning, which is promoted by education on end-of-life issues.