http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Sun, 12 May 2013 13:36:49 +0000 http://www.hindawi.com/journals/pm/2013/359021/ The advent of microprocessed “metabolic carts” and rapidly incremental protocols greatly expanded the clinical applications of cardiopulmonary exercise testing (CPET). The response normalcy to CPET is more commonly appreciated at discrete time points, for example, at the estimated lactate threshold and at peak exercise. Analysis of the response profiles of cardiopulmonary responses at submaximal exercise and recovery, however, might show abnormal physiologic functioning which would not be otherwise unraveled. Although this approach has long been advocated as a key element of the investigational strategy, it remains largely neglected in practice. The purpose of this paper, therefore, is to highlight the usefulness of selected submaximal metabolic, ventilatory, and cardiovascular variables in different clinical scenarios and patient populations. Special care is taken to physiologically justify their use to answer pertinent clinical questions and to the technical aspects that should be observed to improve responses’ reproducibility and reliability. The most recent evidence in favor of (and against) these variables for diagnosis, impairment evaluation, and prognosis in systemic diseases is also critically discussed. Roberta P. Ramos, Maria Clara N. Alencar, Erika Treptow, Flávio Arbex, Eloara M. V. Ferreira, and J. Alberto Neder Copyright © 2013 Roberta P. Ramos et al. All rights reserved. Mon, 15 Apr 2013 10:15:30 +0000 http://www.hindawi.com/journals/pm/2013/768064/ Coronary artery disease (CAD) and obstructive sleep apnea (OSA) are both complex and significant clinical problems. The pathophysiological mechanisms that link OSA with CAD are complex and can influence the broad spectrum of conditions caused by CAD, from subclinical atherosclerosis to myocardial infarction. OSA remains a significant clinical problem among patients with CAD, and evidence suggesting its role as a risk factor for CAD is growing. Furthermore, increasing data support that CAD prognosis may be influenced by OSA and its treatment by continuous positive airway pressure (CPAP) therapy. However, stronger evidence is needed to definitely answer these questions. This paper focuses on the relationship between OSA and CAD from the pathophysiological effects of OSA in CAD, to the clinical implications of OSA and its treatment in CAD patients. Fernando De Torres-Alba, Daniele Gemma, Eduardo Armada-Romero, Juan Ramón Rey-Blas, Esteban López-de-Sá, and José Luis López-Sendon Copyright © 2013 Fernando De Torres-Alba et al. All rights reserved. Sun, 14 Apr 2013 11:17:26 +0000 http://www.hindawi.com/journals/pm/2013/645747/ Anete Trajman, José R. Lapa e Silva, Margareth Dalcolmo, and Jonathan E. Golub Copyright © 2013 Anete Trajman et al. All rights reserved. Thu, 11 Apr 2013 18:29:25 +0000 http://www.hindawi.com/journals/pm/2013/618576/ The technique of measuring transpulmonary pressure and respiratory airflow with manometry and pneumotachography using the least mean squared analysis (LMS) has been used broadly in both preclinical and clinical settings for the evaluation of neonatal respiratory function during tidal volume breathing for lung tissue and airway frictional mechanical properties measurements. Whereas the technique of measuring respiratory function using the impulse oscillation technique (IOS) involves the assessment of the relationship between pressure and flow using an impulse signal with a range of frequencies, requires less cooperation and provides more information on total respiratory system resistance (chest wall, lung tissue, and airways). The present study represents a preclinical animal study to determine whether these respiratory function techniques (LMS and IOS) are comparable in detecting changes in respiratory resistance derived from a direct pharmacological challenge. Elena Rodriguez, Charrell M. Bullard, Milena H. Armani, Thomas L. Miller, and Thomas H. Shaffer Copyright © 2013 Elena Rodriguez et al. All rights reserved. Mon, 08 Apr 2013 10:05:24 +0000 http://www.hindawi.com/journals/pm/2013/535820/ Kostas Spiropoulos, Kiriakos Karkoulias, Nikolaos Koulouris, and Edgardo D'Angelo Copyright © 2013 Kostas Spiropoulos et al. All rights reserved. Wed, 03 Apr 2013 11:40:51 +0000 http://www.hindawi.com/journals/pm/2013/426758/ Obstructive sleep apnea (OSA) is a common disorder characterized by repetitive interruption of ventilation during sleep caused by recurrent upper airway collapse, which leads to intermittent hypoxia. The disorder is commonly undiagnosed despite its relationship with substantial cardiovascular morbidity and mortality. Moreover, the effects of the disorder appear to be particularly dangerous in young subjects. In the last decade, substantial clinical evidence has identified OSA as independent risk factor for both bradyarrhythmias and tachyarrhythmias. To date the mechanisms leading to such arrhythmias have not been completely understood. However, recent data from animal models and new molecular analyses have increased our knowledge of the field, which might lead to future improvement in current therapeutic strategies mainly based on continuous positive airway pressure. This paper aims at providing readers a brief and specific revision of current knowledge about the mechanisms underlying atrial arrhythmias in OSA and their clinical and therapeutic implications. David Filgueiras-Rama, Miguel A. Arias, Ángel Iniesta, Eduardo Armada, José L. Merino, Rafael Peinado, and J. L. López-Sendón Copyright © 2013 David Filgueiras-Rama et al. All rights reserved. Thu, 28 Mar 2013 16:55:01 +0000 http://www.hindawi.com/journals/pm/2013/749860/ When expiratory flow is maximal during tidal breathing and cannot be increased unless operative lung volumes move towards total lung capacity, tidal expiratory flow limitation (EFL) is said to occur. EFL represents a severe mechanical constraint caused by different mechanisms and observed in different conditions, but it is more relevant in terms of prevalence and negative consequences in obstructive lung diseases and particularly in chronic obstructive pulmonary disease (COPD). Although in COPD patients EFL more commonly develops during exercise, in more advanced disorder it can be present at rest, before in supine position, and then in seated-sitting position. In any circumstances EFL predisposes to pulmonary dynamic hyperinflation and its unfavorable effects such as increased elastic work of breathing, inspiratory muscles dysfunction, and progressive neuroventilatory dissociation, leading to reduced exercise tolerance, marked breathlessness during effort, and severe chronic dyspnea. Claudio Tantucci Copyright © 2013 Claudio Tantucci. All rights reserved. Sun, 17 Mar 2013 08:34:31 +0000 http://www.hindawi.com/journals/pm/2013/929028/ Background. Asthma and depression are important public-health concerns worldwide. While some epidemiologic studies have shown asthma and wheezing to be associated with depression and anxiety, the patterns are unclear at the multinational level due to the lack of cross-study comparability. Our study examined the associations of self-reported asthma diagnosis and current wheezing with self-reported depression diagnosis and 30-day anxiety using an international survey. Methods. Using the 2002 World Health Survey, a standardized international survey conducted by the WHO, we estimated the associations between diagnosed asthma and current wheezing with diagnosed depression and 30-day anxiety via multiple logistic regressions for 54 countries worldwide. Results. Diagnosed depression and 30-day anxiety were associated with diagnosed asthma in 65% and 40% of the countries, respectively. Diagnosed depression and 30-day anxiety were associated with current wheezing in 83% and 82% of the countries, respectively. Conclusions. The association between asthma and depression was generally seen at the global level. These results indicated the importance of addressing the asthma-depression comorbidity as public-health and clinical management priorities, in order to improve the overall health of the countries. Kai On Wong, Brian Hunter Rowe, Jeroen Douwes, and Ambikaipakan Senthilselvan Copyright © 2013 Kai On Wong et al. All rights reserved. Tue, 26 Feb 2013 09:26:41 +0000 http://www.hindawi.com/journals/pm/2013/621736/ In recent years, growing evidence suggests an association between obstructive sleep apnea (OSA), a common sleep breathing disorder which is increasing in prevalence as the obesity epidemic surges, and atrial fibrillation (AF), the most common cardiac arrhythmia. AF is a costly public health problem increasing a patient’s risk of stroke, heart failure, and all-cause mortality. It remains unclear whether the association is based on mutual risk factors, such as obesity and hypertension, or whether OSA is an independent risk factor and causative in nature. This paper explores the pathophysiology of OSA which may predispose to AF, clinical implications of stroke risk in this cohort who display overlapping disease processes, and targeted treatment strategies such as continuous positive airway pressure and AF ablation. Jacqueline M. Latina, N. A. Mark Estes III, and Ann C. Garlitski Copyright © 2013 Jacqueline M. Latina et al. All rights reserved. Tue, 19 Feb 2013 15:18:28 +0000 http://www.hindawi.com/journals/pm/2013/814169/ Sleep-disordered breathing (SDB) causes hypoxemia, negative intrathoracic pressure, and frequent arousal, contributing to increased cardiovascular disease mortality and morbidity. Obstructive sleep apnea syndrome (OSAS) is linked to hypertension, ischemic heart disease, and cardiac arrhythmias. Successful continuous positive airway pressure (CPAP) treatment has a beneficial effect on hypertension and improves the survival rate of patients with cardiovascular disease. Thus, long-term compliance with CPAP treatment may result in substantial blood pressure reduction in patients with resistant hypertension suffering from OSAS. Central sleep apnea and Cheyne-Stokes respiration occur in 30–50% of patients with heart failure (HF). Intermittent hypoxemia, nocturnal surges in sympathetic activity, and increased left ventricular preload and afterload due to negative intrathoracic pressure all lead to impaired cardiac function and poor life prognosis. SDB-related HF has been considered the potential therapeutic target. CPAP, nocturnal O2 therapy, and adaptive servoventilation minimize the effects of sleep apnea, thereby improving cardiac function, prognosis, and quality of life. Early diagnosis and treatment of SDB will yield better therapeutic outcomes for hypertension and HF. Akiko Noda, Seiko Miyata, and Yoshinari Yasuda Copyright © 2013 Akiko Noda et al. All rights reserved. Thu, 14 Feb 2013 10:08:57 +0000 http://www.hindawi.com/journals/pm/2013/438236/ Yuzuru Niibe, Joe Y. Chang, Hiroshi Onishi, Joseph Salama, Takao Hiraki, and Hideomi Yamashita Copyright © 2013 Yuzuru Niibe et al. All rights reserved. Tue, 12 Feb 2013 08:49:43 +0000 http://www.hindawi.com/journals/pm/2013/828939/ The risk of progression from exposure to the tuberculosis bacilli to the development of active disease is a two-stage process governed by both exogenous and endogenous risk factors. Exogenous factors play a key role in accentuating the progression from exposure to infection among which the bacillary load in the sputum and the proximity of an individual to an infectious TB case are key factors. Similarly endogenous factors lead in progression from infection to active TB disease. Along with well-established risk factors (such as human immunodeficiency virus (HIV), malnutrition, and young age), emerging variables such as diabetes, indoor air pollution, alcohol, use of immunosuppressive drugs, and tobacco smoke play a significant role at both the individual and population level. Socioeconomic and behavioral factors are also shown to increase the susceptibility to infection. Specific groups such as health care workers and indigenous population are also at an increased risk of TB infection and disease. This paper summarizes these factors along with health system issues such as the effects of delay in diagnosis of TB in the transmission of the bacilli. Padmanesan Narasimhan, James Wood, Chandini Raina MacIntyre, and Dilip Mathai Copyright © 2013 Padmanesan Narasimhan et al. All rights reserved. Thu, 07 Feb 2013 16:11:06 +0000 http://www.hindawi.com/journals/pm/2013/601737/ A profusion of articles have been published on the accuracy and uses of interferon-gamma releasing assays. Here we review the clinical applications, advantages, and limitations of the tuberculin skin test and interferon-gamma release assays and provide an overview of the most recent systematic reviews conducted for different indications for the use of these tests. We conclude that both tests are accurate to detect latent tuberculosis, although interferon-gamma release assays have higher specificity than tuberculin skin testing in BCG-vaccinated populations, particularly if BCG is received after infancy. However, both tests perform poorly to predict risk for progression to active tuberculosis. Interferon-gamma release assays have significant limitations in serial testing because of spontaneous variability and lack of a validated definition of conversion and reversion, making it difficult for clinicians to interpret changes in category (conversions and reversions). So far, the most important clinical evidence, that is, that isoniazid preventive therapy reduces the risk for progression to disease, has been produced only in tuberculin skin test-positive individuals. A. Trajman, R. E. Steffen, and D. Menzies Copyright © 2013 A. Trajman et al. All rights reserved. Thu, 07 Feb 2013 14:20:36 +0000 http://www.hindawi.com/journals/pm/2013/956081/ Cardiopulmonary exercise testing (CPET) is an established method for evaluating dyspnea and ventilatory abnormalities. Ventilatory reserve is typically assessed as the ratio of peak exercise ventilation to maximal voluntary ventilation. Unfortunately, this crude assessment provides limited data on the factors that limit the normal ventilatory response to exercise. Additional measurements can provide a more comprehensive evaluation of respiratory mechanical constraints during CPET (e.g., expiratory flow limitation and operating lung volumes). These measurements are directly dependent on an accurate assessment of inspiratory capacity (IC) throughout rest and exercise. Despite the valuable insight that the IC provides, there are no established recommendations on how to perform the maneuver during exercise and how to analyze and interpret the data. Accordingly, the purpose of this manuscript is to comprehensively examine a number of methodological issues related to the measurement, analysis, and interpretation of the IC. We will also briefly discuss IC responses to exercise in health and disease and will consider how various therapeutic interventions influence the IC, particularly in patients with chronic obstructive pulmonary disease. Our main conclusion is that IC measurements are both reproducible and responsive to therapy and provide important information on the mechanisms of dyspnea and exercise limitation during CPET. Jordan A. Guenette, Roberto C. Chin, Julia M. Cory, Katherine A. Webb, and Denis E. O'Donnell Copyright © 2013 Jordan A. Guenette et al. All rights reserved. Mon, 04 Feb 2013 08:51:10 +0000 http://www.hindawi.com/journals/pm/2013/297371/ Background. Cognitive deterioration may impair COPD patient’s ability to perform tasks like driving vehicles. We investigated: (a) whether subclinical neuropsychological deficits occur in stable COPD patients with mild hypoxemia (PaO2 > 55 mmHg), and (b) whether these deficits affect their driving performance. Methods. We recruited 35 stable COPD patients and 10 normal subjects matched for age, IQ, and level of education. All subjects underwent an attention/alertness battery of tests for assessing driving performance based on the Vienna Test System. Pulmonary function tests, arterial blood gases, and dyspnea severity were also recorded. Results. COPD patients performed significantly worse than normal subjects on tests suitable for evaluating driving ability. Therefore, many (22/35) COPD patients were classified as having inadequate driving ability (failure at least in one of the tests), whereas most (8/10) healthy individuals were classified as safe drivers (). PaO2 and FEV1 were correlated with almost all neuropsychological tests. Conclusions. COPD patients should be warned of the potential danger and risk they face when they drive any kind of vehicle, even when they do not exhibit overt symptoms related to driving inability. This is due to the fact that stable COPD patients may manifest impaired information processing operations. Foteini Karakontaki, Sofia-Antiopi Gennimata, Anastasios F. Palamidas, Theocharis Anagnostakos, Epaminondas N. Kosmas, Anastasios Stalikas, Charalambos Papageorgiou, and Nikolaos G. Koulouris Copyright © 2013 Foteini Karakontaki et al. All rights reserved. Mon, 28 Jan 2013 15:45:03 +0000 http://www.hindawi.com/journals/pm/2013/410748/ Exercise intolerance is a key element in the pathophysiology and course of Chronic Obstructive Pulmonary Disease (COPD). As such, evaluating exercise tolerance has become an important part of the management of COPD. A wide variety of exercise-testing protocols is currently available, each protocol having its own strengths and weaknesses relative to their discriminative, methodological, and evaluative characteristics. This paper aims to review the responsiveness of several exercise-testing protocols used to evaluate the efficacy of pharmacological and nonpharmacological interventions to improve exercise tolerance in COPD. This will be done taking into account the minimally important difference, an important concept in the interpretation of the findings about responsiveness of exercise testing protocols. Among the currently available exercise-testing protocols (incremental, constant work rate, or self-paced), constant work rate exercise tests (cycle endurance test and endurance shuttle walking test) emerge as the most responsive ones for detecting and quantifying changes in exercise capacity after an intervention in COPD. Benoit Borel, Steeve Provencher, Didier Saey, and François Maltais Copyright © 2013 Benoit Borel et al. All rights reserved. Sun, 27 Jan 2013 15:41:36 +0000 http://www.hindawi.com/journals/pm/2013/219746/ The clinical results after carbon ion radiotherapy for the metastatic lung tumors believed to be in the state of oligo-recurrence were evaluated. One hundred and sixteen lesions in 91 patients with lung cancer metastasis were treated with carbon ion radiotherapy at our institute from April 1997 to February 2011. Regarding the prescribed dose, total dose ranged between 40 gray equivalents (GyE) and 80 GyE, and fraction size ranged from 1 to 16 fractions. After a median followup period of 2.3 years (range, 0.3–13.1 years), the statistical overall survival rate and local control rate were 71.2% and 91.9% at 2 years after treatment, respectively. Treatment-related side effects were not a clinical problem. When classified by the primary organ, there were 49 cases of lung cancer, 20 cases of colorectal cancer, and 22 cases of others. The overall survival rate and local control rate for lung metastasis cases from lung cancer at 2 years after treatment were 81.5% and 92.4%, respectively, and 65.0% and 92.0% regarding lung metastasis from colorectal cancer. Carbon ion beam therapy for the metastatic lung tumors is a safe therapy, and the therapeutic effect is comparable to the outcome obtained from reported surgical resections. Naoyoshi Yamamoto, Mio Nakajima, Hirohiko Tsujii, and Tadashi Kamada Copyright © 2013 Naoyoshi Yamamoto et al. All rights reserved. Mon, 14 Jan 2013 18:32:12 +0000 http://www.hindawi.com/journals/pm/2013/874161/ Bronchopulmonary dysplasia (BPD) is the chronic lung disease of prematurity that affects very preterm infants. Although advances in perinatal care have changed the course of lung injury and enabled the survival of infants born as early as 23-24 weeks of gestation, BPD still remains a common complication of extreme prematurity, and there is no specific treatment for it. Furthermore, children, adolescents, and adults who were born very preterm and developed BPD have an increased risk of persistent lung dysfunction, including early-onset emphysema. Therefore, it is possible that early-life pulmonary insults, such as extreme prematurity and BPD, may increase the risk of COPD later in life, especially if exposed to secondary challenges such as respiratory infections and/or smoking. Recent advances in our understanding of stem/progenitor cells and their potential to repair damaged organs offer the possibility of cell-based treatments for neonatal and adult lung injuries. This paper summarizes the long-term pulmonary outcomes of preterm birth and BPD and discusses the recent advances of cell-based therapies for lung diseases, with a particular focus on BPD and COPD. Megan O'Reilly and Bernard Thébaud Copyright © 2013 Megan O'Reilly and Bernard Thébaud. All rights reserved. Thu, 10 Jan 2013 11:57:23 +0000 http://www.hindawi.com/journals/pm/2013/658638/ Young people with cystic fibrosis (CF) are asked to avoid a number of environments associated with increased infection risk, but in practice they need to balance this with competing priorities such as building and sustaining relationships with friends and family. This study explored the process by which young people make these decisions. Mixed methods were used: a vignette study presenting choices around engaging in activities involving a degree of infection risk and a thematic analysis of participant's accounts of their decision making. The eight participants chose to engage in high risk behaviours in 59% of the choices. All participants chose to engage in at least one risky behavior, though this was less likely when the risk was significant. Thematic analysis revealed large areas of misunderstanding and lack of knowledge, leading to some potentially worrying misconceptions about the nature of infections and risk. Young people with CF are not currently making informed decisions around activities that involve increased risk of infection, and there is an urgent need for CF teams to address this in information provision. Lisa Reynolds, Gary Latchford, Alistair J. A. Duff, Miles Denton, Tim Lee, and Daniel Peckham Copyright © 2013 Lisa Reynolds et al. All rights reserved. Thu, 10 Jan 2013 09:30:33 +0000 http://www.hindawi.com/journals/pm/2013/135036/ Objectives. To study the diagnostic value of pleural fluid cholesterol in differentiating transudative and exudative pleural effusion. To compare pleural fluid cholesterol level for exudates with Light’s criteria. Design. Cross sectional descriptive study. Settings. Medical wards of Tribhuvan University Teaching Hospital. Methods. Sixty two cases of pleural effusion with definite clinical diagnosis admitted in TUTH were taken and classified as transudates (19) and exudates (43). The parameters pleural fluid protein/serum protein ratio (pfP/sP), pleural fluid LDH/ serum LDH ratio, pleural fluid LDH (pfLDH) and pleural fluid cholesterol (pCHOL) were compared with clinical diagnosis with regard to their usefulness for distinguishing between pleural exudates and transudates. Results. The pCHOL values determined were for exudates, for transudates, the differences between the transudates and others are statistically significant (). It is seen that pfP/sP ratio has a sensitivity of 81.4% and specificity of 82.6%; pfLDH/sLDH ratio has a sensitivity of 86% and specificity of 94.7% and pCHOL with sensitivity of 97.7% and specificity of 100% for differentiating exudative and transudative PE. Conclusion. The determination of pCHOL is of great value for distinguishing between pleural exudates and transudates and should be included in routine laboratory analysis of pleural effusion. A. B. Hamal, K. N. Yogi, N. Bam, S. K. Das, and R. Karn Copyright © 2013 A. B. Hamal et al. All rights reserved. Wed, 09 Jan 2013 11:48:36 +0000 http://www.hindawi.com/journals/pm/2013/374283/ Chronic Obstructive Pulmonary Disease (COPD) is a complex pathological condition associated with an important reduction in physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life. Pulmonary rehabilitation is aimed to eliminate or at least attenuate these difficulties, mainly by promoting muscular reconditioning. The scope of this paper has been the analysis of the literature on pulmonary rehabilitation in COPD patients has appeared in the last five years, focusing on the principal outcomes obtained. The results demonstrate that pulmonary rehabilitation has a beneficial effect on dyspnoea relief, improving muscle strength and endurance. Moreover, pulmonary rehabilitation appears to be a highly effective and safe treatment for reducing hospital admissions mortality and improving health-related quality of life in COPD patients. It represents, therefore, a very important therapeutic option that, along with standard pharmachological therapy, can be used to obtain the best patient management. The favourable results obtained with pulmonary rehabilitation programs should stimulate researchers to improve our understanding of the mechanisms that form the basis of the beneficial effects of this therapeutic intervention. This would in turn increase the effectiveness of pulmonary rehabilitation in COPD patients. Pierachille Santus, Linda Bassi, Dejan Radovanovic, Andrea Airoldi, Rita Raccanelli, Francesco Triscari, Francesca Giovannelli, and Antonio Spanevello Copyright © 2013 Pierachille Santus et al. All rights reserved. Mon, 31 Dec 2012 18:27:15 +0000 http://www.hindawi.com/journals/pm/2012/962598/ Patients with pulmonary arterial hypertension (PAH) and heart failure (HF) display many abnormalities in respiratory gas exchange. These abnormalities are accentuated with exercise and track with disease severity. However, use of gas exchange measures in day-to-day clinical practice is limited by several issues, including the large number of variables available and difficulty in data interpretation. Moreover, maximal exercise testing has limitations in clinical populations due to their complexity, patient anxiety and variability in protocols and cost. Therefore, a multivariable gas exchange index (MVI) that integrates key gas exchange variables obtained during submaximal exercise into a severity score that ranges from normal to severe-very-severe is proposed. To demonstrate the usefulness of this index, we applied this to 2 groups (PAH, and HF, ) as well as to age matched healthy controls (). We demonstrate that this score tracks WHO classification and right ventricular systolic pressure in PAH ( and 0.73, ) and NYHA and cardiac index in HF ( and 0.74, ). This index demonstrates a stronger relationship than any single gas exchange variable alone. In conclusion, MVI obtained from light, submaximal exercise gas exchange is a useful approach to simplify data interpretation in PAH and HF populations. Chul-Ho Kim, Steve Anderson, Dean MacCarter, and Bruce Johnson Copyright © 2012 Chul-Ho Kim et al. All rights reserved. Mon, 31 Dec 2012 15:43:24 +0000 http://www.hindawi.com/journals/pm/2012/352850/ Tuberculosis is a public health problem in Bangladesh. This cross-sectional study was conducted to assess knowledge of TB patients about symptoms, ways of transmission and treatment of tuberculosis, and their perception of the illness. Between March and August 2008, 762 adult TB patients were interviewed at selected DOTS centre of Dhaka city. Male and female distribution was 55.6% and 44.4%, respectively. One quarter of them were illiterate, and more than half had extended family and live in a congested situation. Night fever was the most common symptom known (89.9%), and 56% were aware that it could spread through sneezing/coughing. Television was mentioned as a source of information about TB. The majority expressed a helping attitude towards other TB patients. Although most of them were positive about getting family support, 46.6% mentioned discrimination of separate utensils for food or drink. About 50.5% expressed increased sadness, 39.8% had fear of loss of job/wedges, and 21.4% felt socially neglected. Along with drug treatment the psychosocial reactions of TB patients should be addressed at DOTS centers for better control of the disease. Saria Tasnim, Aminur Rahman, and F. M. Anamul Hoque Copyright © 2012 Saria Tasnim et al. All rights reserved. Sun, 30 Dec 2012 16:14:40 +0000 http://www.hindawi.com/journals/pm/2012/291294/ Objective. To find a statistically significant separation point for the QuantiFERON Gold In-Tube (QFT) interferon gamma release assay that could define an optimal “retesting zone” for use in serially tested low-risk populations who have test “reversions” from initially positive to subsequently negative results. Method. Using receiver operating characteristic analysis (ROC) to analyze retrospective data collected from 3 major hospitals, we searched for predictors of reversion until statistically significant separation points were revealed. A confirmatory regression analysis was performed on an additional sample. Results. In 575 initially positive US healthcare workers (HCWs), 300 (52.2%) had reversions, while 275 (47.8%) had two sequential positive tests. The most statistically significant (Kappa = 0.48, chi-square = 131.0, ) separation point identified by the ROC for predicting reversion was the tuberculosis antigen minus-nil (TBag-nil) value at 1.11 International Units per milliliter (IU/mL). The second separation point was found at TBag-nil at 0.72 IU/mL (Kappa = 0.16, chi-square = 8.2, ). The model was validated by the regression analysis of 287 HCWs. Conclusion. Reversion likelihood increases as the TBag-nil approaches the manufacturer's cut-point of 0.35 IU/mL. The most statistically significant separation point between those who test repeatedly positive and those who revert is 1.11 IU/mL. Clinicians should retest low-risk individuals with initial QFT results < 1.11 IU/mL. Wendy Thanassi, Art Noda, Beatriz Hernandez, Jeffery Newell, Paul Terpeluk, David Marder, and Jerome A. Yesavage Copyright © 2012 Wendy Thanassi et al. All rights reserved. Sun, 30 Dec 2012 12:08:20 +0000 http://www.hindawi.com/journals/pm/2012/352719/ Respiratory amyloidosis is a rare disease which refers to localized aberrant extracellular protein deposits within the airways. Tracheobronchial amyloidosis (TBA) refers to the deposition of localized amyloid deposits within the upper airways. Treatments have historically focused on bronchoscopic techniques including debridement, laser ablation, balloon dilation, and stent placement. We present the outcomes after rigid bronchoscopy to remove the amyloid protein causing the airway obstruction in 6 cases of tracheobronchial amyloidosis. This is the first report of primary diffuse tracheobronchial amyloidosis in our department; clinical features, in addition to therapy in the treatment of TBA, are reviewed. This paper shows that, in patients with TBA causing airway obstruction, excellent results can be obtained with rigid bronchoscopy and stenting of the obstructing lesion. Ihsan Alloubi, Matthieu Thumerel, Hugues Bégueret, Jean-Marc Baste, Jean-François Velly, and Jacques Jougon Copyright © 2012 Ihsan Alloubi et al. All rights reserved. Wed, 26 Dec 2012 10:09:45 +0000 http://www.hindawi.com/journals/pm/2012/564134/ Luke Howard, Michael P. W. Grocott, Robert Naeije, Ron Oudiz, and Roland Wensel Copyright © 2012 Luke Howard et al. All rights reserved. Mon, 24 Dec 2012 14:38:25 +0000 http://www.hindawi.com/journals/pm/2012/952741/ Lung function abnormalities both at rest and during exercise are frequently observed in patients with chronic heart failure, also in the absence of respiratory disease. Alterations of respiratory mechanics and of gas exchange capacity are strictly related to heart failure. Severe heart failure patients often show a restrictive respiratory pattern, secondary to heart enlargement and increased lung fluids, and impairment of alveolar-capillary gas diffusion, mainly due to an increased resistance to molecular diffusion across the alveolar capillary membrane. Reduced gas diffusion contributes to exercise intolerance and to a worse prognosis. Cardiopulmonary exercise test is considered the “gold standard” when studying the cardiovascular, pulmonary, and metabolic adaptations to exercise in cardiac patients. During exercise, hyperventilation and consequent reduction of ventilation efficiency are often observed in heart failure patients, resulting in an increased slope of ventilation/carbon dioxide (VE/VCO2) relationship. Ventilatory efficiency is as strong prognostic and an important stratification marker. This paper describes the pulmonary abnormalities at rest and during exercise in the patients with heart failure, highlighting the principal diagnostic tools for evaluation of lungs function, the possible pharmacological interventions, and the parameters that could be useful in prognostic assessment of heart failure patients. Anna Apostolo, Giuliano Giusti, Paola Gargiulo, Maurizio Bussotti, and Piergiuseppe Agostoni Copyright © 2012 Anna Apostolo et al. All rights reserved. Mon, 24 Dec 2012 14:18:28 +0000 http://www.hindawi.com/journals/pm/2012/368713/ Antonio M. Esquinas, Naomi Kondo Nakagawa, and Luiz Fernando Ferraz Da Silva Copyright © 2012 Antonio M. Esquinas et al. All rights reserved. Mon, 24 Dec 2012 13:30:32 +0000 http://www.hindawi.com/journals/pm/2012/196194/ Premature infants frequently develop bronchopulmonary dysplasia (BPD). Lung immaturity and impaired epithelial differentiation contribute together with invasive oxygen treatment to BPD onset and disease progression. Substantial evidence suggests that prematurity is associated with long term pulmonary consequences. Moreover, there is increasing concern that lung immaturity at birth may increase the risk of developing chronic obstructive pulmonary disease (COPD). The mechanisms contributing to this phenomenon remains unknown, largely as a consequence of inadequate experimental models and clinical follow-up studies. Recent evidence suggests that defective transcriptional regulation of epithelial differentiation and maturation may contribute to BPD pathogenesis as well as early onset of COPD. The transcriptional regulators CCAAT/enhancer-binding protein (C/EBP)α and C/EBPβ, SMAD family member (Smad)3, GATA binding protein (GATA)6, and NK2 homeobox (NKX)2-1 are reported to be involved in processes contributing to pathogenesis of both BPD and COPD. Increased knowledge of the mechanisms contributing to early onset COPD among BPD survivors could translate into improved treatment strategies and reduced frequency of respiratory disorders among adult survivors of BPD. In this paper, we introduce critical transcriptional regulators in epithelial differentiation and summarize the current knowledge on the contribution of impaired epithelial maturation to the pathogenesis of inflammatory lung disorders. Abraham B. Roos, Tove Berg, and Magnus Nord Copyright © 2012 Abraham B. Roos et al. All rights reserved. Mon, 17 Dec 2012 13:32:06 +0000 http://www.hindawi.com/journals/pm/2012/757152/ Objectives. We investigated IFN-γ levels before and after a six month course of isoniazid among individuals with latent tuberculosis infection (LTBI) in a high-transmission setting. Design. A total of 26 household contacts of pulmonary tuberculosis patients who were positive for LTBI by tuberculin skin test completed six months of treatment and submitted a blood sample for a follow-up examination. The IFN-γ response to Mycobacterium tuberculosis-specific antigens was measured, and the results before and after the completion of LTBI treatment were compared. Results. Of the 26 study participants, 25 (96%) showed an IFN-γ level higher than their baseline level before treatment (). Only one individual had a decreased IFN-γ level after treatment but remained positive for LTBI. Conclusion. In a high-transmission setting, the IFN-γ level has increased after LTBI treatment. Further studies must be undertaken to understand if this elevation is transient. Iukary Takenami, Brook Finkmoore, Almério Machado Jr., Krisztina Emodi, Lee W. Riley, and Sérgio Arruda Copyright © 2012 Iukary Takenami et al. All rights reserved.