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Mold allergens in respiratory allergy: from structure to therapy.

Authors: Twaroch TE, Curin M, Valenta R, Swoboda I Abstract Allergic reactions to fungi were described 300 years ago, but the importance of allergy to fungi has been underestimated for a long time. Allergens from fungi mainly cause respiratory and skin symptoms in sensitized patients. In this review, we will focus on fungi and fungal allergens involved in respiratory forms of allergy, such as allergic rhinitis and asthma. Fungi can act as indoor and outdoor respiratory allergen sources, and depending on climate conditions, the rates of sensitization in individuals attending allergy clinics range from 5% to 20%. Due to the poor quality of natural fungal allergen extracts, diagnosis of fungal allergy is hampered, and allergen-specific immunotherapy is rarely given. Several factors ar...

Mitochondrial DNA alteration in obstructive sleep apnea

Background: Obstructive Sleep Apnea (OSAS) is a disease associated with the increase of cardiovascular risk and it is characterized by repeated episodes of Intermittent Hypoxia (IH) which inducing oxidative stress and systemic inflammation. Mitochondria are cell organelles involved in the respiratory that have their own DNA (MtDNA). The aim of this study was to investigate if the increase of oxidative stress in OSAS patients can induce also MtDNA alterations. Methods: 46 OSAS patients (age 59.27 ± 11.38; BMI 30.84 ± 3.64; AHI 36.63 ± 24.18) were compared with 36 control subjects (age 54.42 ± 6.63; BMI 29.06 ± 4.7; AHI 3.8 ± 1.10). In blood cells Content of MtDNA and nuclear DNA (nDNA) was measured in OSAS patients by Real Time PCR. The ratio between MtDNA/nDNA...

Expiratory positive airway pressure (EPAP) nasal device therapy: a welcome addition to obstructive sleep apnea syndrome therapy

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by intermittent partial or complete occlusion of the upper airway, affecting 5 to 10 % of middle-aged adults and up to 20 % of adults over 65 years of age [1]. Treatments for patients with OSAHS include positive airway pressure (PAP) therapy, oral appliances, various surgeries that modify the upper airway, and/or weight loss. However, it is well documented that there is lack of acceptance or suboptimal adherence to these available medical therapies [2, 3]. Therefore, given the high prevalence of OSAHS, new effective treatment options would be welcomed.

Alternative management approaches for OSAHS, less intrusive and simpler to use, have emerged. One of these alternatives is expiratory positive airway pressure (EPAP) nasal device, a small, lightweight, and quiet device that does not require an external power source. There are several mechanisms by which nasal EPAP devices positively impact OSAHS. These disposable adhesive ...

Hospital management of acute exacerbations of chronic obstructive pulmonary disease.

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The course of chronic obstructive pulmonary disease (COPD) is often complicated by episodes of acute worsening of respiratory symptoms, which may lead to escalation of therapy and occasionally emergency department visits and hospitalization.

Acute exacerbations of COPD (AECOPD) have a negative impact on quality of life and hasten the decline of lung function. They also significantly contribute to the direct and indirect healthcare costs of this disease. Severe exacerbations (those leading to hospital admission) have been associated with significant poor outcomes including an increased risk of readmissions and mortality.

COPD is currently the fourth leading cause of hospital readmission in the United States. In this review, we will provide a broad overview on the etiology, assessment, management, discharge planning, and follow-up care of patients hospitalized with AECOPD. Journal of Hospital Medicine 2015. © 2015 Society of Hospital Medicine.

Patient-Specific Airway Wall Remodeling in Chronic Lung Disease.

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Chronic lung disease affects more than a quarter of the adult population; yet, the mechanics of the airways are poorly understood. The pathophysiology of chronic lung disease is commonly characterized by mucosal growth and smooth muscle contraction of the airways, which initiate an inward folding of the mucosal layer and progressive airflow obstruction.

Since the degree of obstruction is closely correlated with the number of folds, mucosal folding has been extensively studied in idealized circular cross sections. However, airflow obstruction has never been studied in real airway geometries; the behavior of imperfect, non-cylindrical, continuously branching airways remains unknown. Here we model the effects of chronic lung disease using the nonlinear field theories of mechanics supplemented by the theory of finite growth. We perform finite element analysis of patient-specific Y-branch segments created from magnetic resonance images. We demonstrate that the mucosal folding pattern is insensitive to the specific airway geometry, but that it critically depends on the mucosal and submucosal stiffness, thickness, and loading mechanism. Our results suggests that patient-specific airway models with inherent geometric imperfections are more sensitive to obstruction than idealized circular models.

Our models help to explain the pathophysiology of airway obstruction in chronic lung disease and hold promise to improve the diagnostics and treatment of asthma, bronchitis, chronic obstructive pulmonary disease, and respiratory failure.

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