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Barisione G.,Fisiopatologia Respiratoria | Bacigalupo A.,Ematologia 2 | Brusasco C.,University of Genoa | Scanarotti C.,University of Genoa | And 6 more authors.
Respiratory Physiology and Neurobiology | Year: 2014

Lung diffusing capacity for CO (DLCO) is compromised in haematopoietic stem-cell transplantation (HSCT) recipients. We derived alveolar-capillary membrane conductance (DM,CO) and pulmonary capillary volume (VC) from DLCO and diffusing capacity for NO (DLNO). Forty patients were studied before and 6 weeks after HSCT. Before HSCT, DLNO and DLCO were significantly lower than in 30 healthy controls. DM,CO was ~40% lower in patients than in controls (p<0.001), whereas VC did not differ significantly. After HSCT, DLNO and DM,CO further decreased, the latter by ~22% from before HSCT (p<0.01) while VC did not change significantly. Lung density, serum CRP and reactive oxygen metabolites were significantly increased, with the latter being correlated (R2=0.71, p<0.001) with the decrement in DLNO. We conclude that DLNO and, to a lesser extent, DLCO are compromised before HSCT mainly due to a DM,CO reduction. A further reduction of DM,CO without VC loss occurs after HSCT, possibly related to development of oedema, or interstitial fibrosis, or both. © 2014 Elsevier B.V. Source


The sleep correlated respiratory disturbances are an emergent sanitary problem and the obesity is also an increasing disease in west-countries. Because of the majority of patients with OSAS are obese and OSAS is the prevalent respiratory disturbance in the dedicated surgery, in the last years there is an increasing request of diagnosis and therapy of this disease. Epidemiologic data, different therapies indications, therapeutic ventilatory approach, more frequent therapy of severe OSAS, and its effects are described. Finally, is reported the economic aspect involving by the ventilatory therapy causing a great cost requiring a correct follow-up. Source


De Martino M.,University of Naples Federico II | Trotta A.,UOSC Immunologia Oncologica | Bruzzese D.,University of Naples Federico II | Cicchitto G.,Fisiopatologia Respiratoria | And 4 more authors.
Cytokine | Year: 2014

The immune response plays an unsettled role in the pathogenesis of idiopathic pulmonary fibrosis (IPF), the contribution of inflammation being controversial as well. Emerging novel T cell sub-populations including regulatory T lymphocytes (Treg) and interleukin (IL)-17 secreting T helper cells (Th17) may exert antithetical actions in this scenario. Phenotype and frequency of circulating immune cell subsets were assessed by multi-parametric flow cytometry in 29 clinically stable IPF patients and 17 healthy controls. The interplay between Treg lymphocytes expressing transforming growth factor (TGF)-β and Th17 cells was also investigated. Proportion and absolute number of natural killer (NK) cells were significantly reduced in IPF patients in comparison with controls (p<0.001). Conversely, the proportion and absolute number of CD3+CD4+CD25highFoxp-3+ cells were significantly increased in IPF patients (p=0.000). As in controls, almost the totality of cells (>90%) expressed TGF-β upon stimulation. Interestingly, the frequency of Th17 cells was significantly compromised in IPF patients (p=0.000) leading to an increased TGF-β/IL-17 ratio (4.2±2.3 vs 0.5±0.3 in controls, p=0.000). Depletion of NK and Th17 cells along with a not compromised Treg compartment delineate the existence of an "immune profile" that argue against the recent hypothesis of IPF as an autoimmune disease. Our findings along with the imbalance of the Treg/Th17 axis more closely suggest these immune perturbations to be similar to those observed in cancer. Clinical relevance, limitations and perspectives for future research are discussed. © 2014 Elsevier Ltd. Source


Ambrosino N.,U.O. Pneumologia e Terapia | Ambrosino N.,Volterra | Confalonieri M.,Science Pneumologia | Crescimanno G.,Cervello | And 2 more authors.
Rassegna di Patologia dell'Apparato Respiratorio | Year: 2012

Respiratory failure is an unavoidable or very frequent event in the natural history of some neuromuscular diseases, whereas it appears very unfrequently in others. In some cases, like Pompe disease, respiratory failure shows a more rapid worsening compared to motor impairment, sometimes being the onset event. The most frequent respiratory onset manifestation is exercise breathlessness, frequently associated to a history of lung infections. Nevertheless these patients may show a physiological picture of chronic respiratory insufficiency. Home mechanical ventilation improves survival and quality of life of these patients, with a reduction in health care costs. As a consequence pulmonologists must perform a more relevant role in the care of these patients and they must increase their skills for such a task. In Pompe disease mechanical ventilation is started during an episode of Acute Respiratory Failure (ARF) without any previous lung function tests: as a consequence these patients require more frequent physiological evaluations to avoid potentially fatal exacerbations. Therefore a collaboration between pulmonologist and neurologist is mandatory. Respiratory follow-up is aimed to early diagnosis and treatment of respiratory complications. It may differ according to different diagnosis and disease stage. The specific interest for adult onset Pompe disease relies on the aivailability of enzimatic therapy which has been shown to be effective in slowing disease progression. The aim of this statement is to give pulmonologists some simple information in order they can fulfil their role of "main caregiver" with appropriate and quick diagnosis and treatment. Source


Ambrosino N.,U.O. Pneumologia e Terapia Intensiva Respiratoria | Ambrosino N.,Volterra | Confalonieri M.,Science Pneumologia | Crescimanno G.,Cervello | And 2 more authors.
Respiratory Medicine | Year: 2013

Respiratory failure is an unavoidable event in the natural history of some neuromuscular diseases, while appearing very infrequently in others. In some cases, such as Pompe disease, respiratory failure progresses more rapidly than motor impairment, sometimes being the onset event. Home mechanical ventilation improves survival and quality of life of these patients, with a reduction in healthcare costs. Therefore, pulmonologists must improve their skills in order to play a more relevant role in the care of these patients. The aim of this statement is to provide pulmonologists with some simple information in order for them to fulfil their role of primary caregiver, enabling appropriate and rapid diagnosis and treatment. © 2013. Source

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