6267711
Allergic bronchopulmonary aspergillosis in asthma: epidemiological, clinical and therapeutic issues.
Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder caused by immunologic reactions to antigens released by Aspergillus fumigatus, a ubiquitous fungi colonizing the tracheobronchial tree of asthmatic patients. The clinical presentation is usually poorly controlled asthma, recurrent pulmonary opacities and bronchiectasis. The prevalence of ABPA in asthma clinics may be as high as 13% with a global burden of almost 5 million patients. A. fumigatus-specific IgE level is the most sensitive test in diagnosis of ABPA, and all asthmatic patients should be routinely screened with A. fumigatus-specific IgE levels for early diagnosis. The goals of managing ABPA include control of asthma, prevention and treatment of acute exacerbations, and preventing the development or progression of bronchiectasis. Glucocorticoids are the treatment of choice with itraconazole reserved for those with recurrent exacerbations and glucocorticoid-dependent disease. There is a dire need for newer treatment approaches including oral antifungal agents and immunomodulatory therapy.
26068481
Efficacy and safety of iodopovidone pleurodesis through tube thoracostomy.
OBJECTIVE
To evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis through tube thoracostomy in patients with recurrent pleural effusions and pneumothorax.


METHODS
This was a prospective study in which pleurodesis was performed with a solution of 20 mL 10% iodopovidone and 80 mL normal saline solution infused through a tube thoracostomy and left in the pleural cavity for 4 h.


RESULTS
A total of 64 patients (34 men) with a mean (+/-SD) age of 47.1 +/- 15.4 years were included. There were 37 cases of pleural effusion and 27 of pneumothorax. A complete response (neither reaccumulation of fluid nor recurrence of pneumothorax) was obtained in 32 (86.5%) patients with pleural effusion and 25 (92.6%) patients with pneumothorax. A second procedure (i.e. repeated pleurodesis) was attempted successfully in four patients in the pleural effusion group. All patients experienced chest pain to a varying degree as recorded on a Visual Analogue Scale (median 50.5, range 10-95). Seven patients developed fever and one immunocompromised patient developed empyema following the procedure. There were no recurrences at a median follow up of 5 months (range 3-15 months) in the pleural effusion group, and 13 months (range 6-24 months) in the pneumothorax group.


CONCLUSIONS
Iodopovidone can be used as an effective and safe agent for (chemical) pleurodesis (through tube thoracostomy), which is inexpensive and readily available.
45999589
Noninvasive ventilation in acute heart failure.
33491888
Noninvasive ventilation in ARDS caused by Mycobacterium tuberculosis: report of three cases and review of literature
22528299
Pulmonary hypertension as a presenting manifestation of allergic bronchopulmonary aspergillosis.
The case of a 46-year-old lady who presented with respiratory failure and pulmonary hypertension in the absence of clinical signs of asthma or bronchiectasis, and in whom a diagnosis of allergic bronchopulmonary aspergilloma [ABPA] was made subsequently on the basis of radiological and laboratory investigations is reported. Symptomatic and objective improvement was seen with corticosteroid therapy. To the best of the authors' knowledge, such an occurrence has not been reported previously. This case highlights the importance of keeping a high index of suspicion while investigating a patient with pulmonary hypertension in whom the aetiology is not apparent on initial evaluation. Identification of the disease, in its early-stage, can prevent progression to bronchiectasis and fibrotic lung disease, and thus, patients can be saved from the morbidity related to end-stage disease.
3038618
Is the mortality higher in the pulmonary vs the extrapulmonary ARDS? A meta analysis.
BACKGROUND AND AIM
ARDS can occur from the following two pathogenetic pathways: a direct pulmonary injury (ARDSp); and an indirect injury (ARDSexp). The predisposing clinical factor can influence the pathogenesis and clinical outcome of ARDS. This metaanalysis was aimed at evaluating whether there is any difference in mortality between the two groups.


METHODS
We searched the MEDLINE, EMBASE, and CINAHL databases for relevant studies published from 1987 to 2007, and included studies that have reported mortality in the two groups of ARDS. We calculated the odds ratio (OR) and 95% confidence interval (CI) to assess mortality in patients with ARDSp vs patients with ARDSexp and pooled the results using three different statistical models.


RESULTS
Our search yielded 34 studies. In all, the studies involved 4,311 patients with 2,330 patients in the ARDSp group and 1,981 patients in the ARDSexp group. The OR of mortality in ARDSp group compared to the ARDSexp group was 1.11 (95% CI, 0.88 to 1.39), as determined by the random-effects model; 1.04 (95% CI, 0.92 to 1.18), as determined by the fixed-effects model; and 1.04 (95% CI, 0.92 to 1.18), as determined by the exact method, indicating that mortality is similar in the two groups. The mortality was no different whether the studies were classified as prospective (OR, 1.15; 95% CI, 0.87 to 1.51) or retrospective (OR, 1.01; 95% CI, 0.61 to 1.69); small (OR, 1.11; 95% CI, 0.77 to 1.60) or large (OR, 1.1; 95% CI, 0.82 to 1.49); or observational (OR, 1.10; 95% CI, 0.82 to 1.49) or interventional (OR, 0.97; 95% CI, 0.79 to 1.19). There was methodological and statistical heterogeneity (I(2), 50.9%; 95% CI, 21.3 to 66.2%; chi(2) statistic, 67.22; p = 0.0004).


CONCLUSIONS
The results of this study suggest that there is no difference in mortality between these two groups. Further studies should focus on specific etiologies within the subgroups rather than focusing on the broader division of ARDSp and ARDSexp.
5649152
Differential distribution of pigment-protein complexes in the Thylakoid membranes of Synechocystis 6803
AbstractThylakoids in Synechocystis 6803, though apparently uniform in appearance in ultrastructure, were found to consist of segments which were functionally dissimilar and had distinct proteomes. These thylakoid segments can be isolated from Synechocystis 6803 by successive ultracentrifugation of cell free extracts at 40,000×g (40 k segments), 90,000×g (90 k segments) and 150,000×g (150 k segments). Electron microscopy showed differences in their appearance. 40 k segments looked feathery and fluffy, whereas the 90 k and 150 k thylakoid membrane segments appeared tiny and less fluffy. The absorption spectra showed heterogeneous distribution of pigment-protein complexes in the three types of segments. The photochemical activities of Photosystem I (PSI) and Photosystem II (PSII) showed unequal distributions in 40 k, 90 k and 150 k segments which were substantiated with low temperature fluorescence measurements. The ratio of PSII/PSI fluorescence emission at 77 K (λex = 435 nm) was highest in 150 k segments indicating higher PSII per unit PSI in these segments. The chlorophyll fluorescence lifetimes in the membranes, determined with a time-correlated single-photon counting technique, could be resolved in three components: τ1 
 = <40 ps, τ2 
 = 425–900 ps and τ3 
 = 2.4–3.2 ns. The percentage contribution of the fastest component (τ1) decreased in the order 40 k > 90 k > 150 k segments whereas that of the other two components showed a reversed trend. These studies indicated differential distribution of pigment-protein complexes in the three membrane segments suggesting heterogeneity in the thylakoids of Synechocystis 6803.
206196304
Interdialytic hypertension-an update.
The reference standard for diagnosing hypertension among hemodialysis patients is 44-hour interdialytic ambulatory blood pressure (BP) recording. However, a more practical way to diagnose and manage hypertension is to measure home BP over the interdialytic interval. In contrast to pre- and postdialysis BP recordings, measurements of BP performed outside the dialysis unit correlate with the presence of left ventricular hypertrophy and directly and strongly with all-cause mortality. Hypervolemia that is not clinically obvious is the most common treatable cause of hypertension among patients with end-stage renal disease; thus, volume control should be the initial therapy to treat hypertension in most hemodialysis patients. To diagnose hypervolemia, continuous blood volume monitoring is emerging as an effective and simple technique. Reducing dietary and dialysate sodium is an often overlooked strategy to improve BP control. Although definitive randomized trials that show cardiovascular benefits of BP lowering among hypertensive hemodialysis have not been performed, emerging evidence suggests that lowering BP might reduce cardiovascular events. The treatment should be guided by BP obtained outside the dialysis unit because predialysis and postdialysis BP are quite variable and agree poorly with measurements obtained outside the dialysis unit. Although the appropriate level to which BP should be lowered remains elusive, current data suggest that interdialytic ambulatory systolic BP should be lowered to <130 mm Hg and averaged home systolic BP to <140 mm Hg. Antihypertensive drugs will be required by most patients receiving thrice weekly dialysis for 4 hours. Beta blockers, dihydropyridine calcium blockers, and agents that block the renin-angiotensin system appear to be effective in lowering BP in these patients.
38466120
Novel therapeutic agents in ovarian cancer.
AIMS
Epithelial ovarian cancer is responsible for 4% of all cancer deaths in women, and the five-year overall survival of patients with advanced disease is 30-40%. Treatment currently comprises a combination of surgery and chemotherapy with carboplatin and paclitaxel. The main reason for treatment failure is that the majority of patients present with advanced disease, and current drugs are unable to effect a cure even in chemosensitive patients. This article systematically reviews novel therapeutic strategies that have been evaluated in patients with ovarian cancer in the last 5 years.


METHODS
Pubmed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed) and American Society of Clinical Oncology Annual conference abstracts were searched using the terms "(phase I OR phase II OR phase III OR phase 1 OR phase 2 OR phase 3) AND (ovary OR ovarian) AND (cancer OR carcinoma)" from January 2000 to May 2005 to identify studies for potential inclusion in this review. Reviews of novel therapies in ovarian cancer were also used to identify additional clinical trials.


FINDINGS
A wide range of therapeutic strategies are currently being evaluated in ovarian cancer. These include novel cytotoxics, small molecule inhibitors, monoclonal antibodies, gene therapy and immuno-therapy strategies. The rationale for the development of these agents includes enhancement of efficacy by targeting novel biological pathways, re-sensitisation to existing drugs, simplification of drug administration and/or reduction of drug-toxicity.


CONCLUSIONS
Current developments have the potential to result in substantial improvements in the outlook for women with ovarian cancer.
9771743
Home and ambulatory blood pressure monitoring in chronic kidney disease.
PURPOSE OF REVIEW
Whereas blood pressures (BPs) obtained in the clinic have formed the basis of diagnosis and treatment of hypertension among patients with chronic kidney disease (CKD), home and ambulatory BP monitoring obtained outside the physician's office have emerged as viable alternatives for the surveillance of hypertension. The purpose of this review is to discuss the recent advances in out-of-office BP recordings in the management of patients with CKD including those on hemodialysis.


RECENT FINDINGS
In patients with CKD not yet on dialysis, hypertension is often seemingly difficult to control in part because of 'white-coat hypertension'. Masked hypertension is seen in about 8% of patients. Nondipping ambulatory BP manifests early in the course of CKD but may not be independently associated with end-stage renal disease. Out-of-office measured BPs better predict end-organ damage and mortality outcomes in CKD and hemodialysis patients. The analysis of patterns of ambulatory BP monitoring has revealed that elevated BP in these patients is associated with increased arterial stiffness and a blunted rate of rise in BP between dialysis with volume overload.


SUMMARY
It is recommended that the diagnosis and treatment of hypertension among patients with CKD is best done with home (or ambulatory) BP monitoring.
556786
A novel mode of dimerization via formation of a glutamate anhydride crosslink in a protein crystal structure.
Acid anhydrides are formed by removal of water, are very active, and can react with water to form the original binary components.