ISSN:0025-7931    

DOI:10.1159/000196370

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

In addition to their role in oxygen transport and ventilation, the lungs serve as an important defense function consisting of nonspecific and specific components. The nonspecific factors include aerodynamic filtration, mucociliary apparatus, bronchoalveolar fluid flow and lymphohematogenous drainage (anatomic systems) as well as phagocytosis and inflammation; the specific factors include B-cell immunity (IgG, A, M, D and E) and T-cell immunity (cell-mediated immunity). In the lungs, specialized lymphoid tissues in contact with epithelium (bronchus-associated lymphoid tissues; BALT) function in local antibody (secretory IgA) and cell-mediated immunity responses to foreign antigens. Based upon these considerations, a number of therapeutic interventions have been developed to enhance various components of lung defense. These include substances which enhance both nonspecific elements (leukocyte transfusion, plasma, nonspecific immunostimulants, e.g., immunoactive bacterial extracts) as well as specific elements (vaccines, intravenous gammaglo-bulin, plasma, interferons, cytokines). The need for further development and utilization of new immune interventions is underscored by the large number of infants and children who suffer from recurrent respiratory infections, who have either maturational immaturity (e.g. small for gestational age newborn), genetically determined (e.g. cystic fibrosis) or acquired defects (e.g. AIDS) of lung defense mechanisms. The emergence of antibiotic-resistant bacterial organisms, e.g. Streptococcus pneumoniae, poses an additional need for new immune interventions.

ISSN:0025-7931    

DOI:10.1159/000196371

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

OM-85 BV, an immunomodulating preparation containing extracts from eight commonly pathogenic bacterial species, has been used with success as an oral adjuvant in the prevention of respiratory tract infections. Results from in vitro and in vivo experiments suggest various mechanisms that can underlie this beneficial effect. Thus, exposure of murine macrophages in vitro to OM-85 BV led to stimulation of biochemical and functional parameters associated with the disposal of microorganisms and tumor cells. Similarly, blood-derived human phagocytes were stimulated to express adhesion molecules (LFA-1, MAC-1, pl50,95, ICAM-1), to synthesize TNF-α and IL-2, and to develop a natural killer activity. These in vitro functions are reflected in the activation of immunological processes in vivo following administration of OM-85 BV per os. Oral treatment of mice and rabbits increased the capacity of the animals to clear bacteria from the blood, an effect that could be ascribed to enhanced functional activity of polymorphonuclear leukocytes. Administration of OM-85 BV per os also led to enhanced salivary IgA levels in man, and in gut and lung secretions in animals. Stimulation of migration and the beneficial effects of OM-85 BV correlated with phagocytosis-induced superoxide production in human bronchoalveolar lavage cells from orally treated individuals. Finally, injection of OM-85 BV was shown to enhance recovery from irradiation in animals, presumably by improving hemopoietic recovery. These findings indicate that OM-85 BV is capable of stimulating both cellular and humoral components of the immune response. In particular, administration per os promotes immune protective mechanisms active at the level of mucosal surfaces, thus providing a rationale for the oral prevention of acute exacerbations of chronic and recurrent respiratory tract infections using bacteria-derived immunomodulating agents

ISSN:0025-7931    

DOI:10.1159/000196372

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We performed overnight polysomnography in 77 patients for diagnosis of sleep apnea syndrome (SAS) and assessment of severity. Patients were classified into 3 groups according to apnea index (AI): group 1 (G1; no SAS), AI < 10 (21 patients), group 2 (G2; moderate SAS), 10 < AI < 40 (34 patients), and group 3 (G3; severe SAS), AI ≧ 40 (22 patients). In all 3 groups, 60% of the apneas were obstructive, but the proportion of mixed apnea increased from G1 to G3 (6% in G1, 12% in G2, and 24% in G3). The duration of REM sleep was shorter in G2 and G3 than in G1 (G1 61 min, G2 44 min, G3 41 min; p < 0.03). In G3 a dramatic decrease in deep sleep was noted in comparison with G1 and G2 (G1 29 min, G2 31 min, G3 10 min). The distribution of the apnea in the different sleep stages was similar in G3; in G2, 16 patients had a REM apnea predominance, but in this subgroup duration of REM sleep was longer and AI was lower than in the other 18 G2 patients. So, absence of sleep stage apnea predominance and high proportion of mixed apnea were observed in the most severe SA

ISSN:0025-7931    

DOI:10.1159/000196297

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

This population-based prospective cohort study compared the risk of recurrent infections in children attending family day care ( 2 episodes of croup (OR = 4.1; 95% CI = 1.6-10.9). The risk for children attending large DCCs was intermediate between those in family day care and those in small DCCs. Apart from sampling variation, one explanation for this result could be that children in large DCCs are divided into groups according to their age (i.e. 24 months). It is possible that the homogeneity of age within each group and the absence of direct contact between groups confers some protection against the spread of infections. Children who had been in day care for at least 6 months at the beginning of the study were at a lower risk for recurrent infections than those who had entered day care earlier. This result might be explained by the acquisition of specific immunity as well as by nonspecific immunity that protects against microorganisms not previously encountered by the body. These results suggest that, for children with repeated infections in DCCs, a move to the family day-care setting, when feasible, should be contemplated. It also suggests that the development of family day-care settings should be encouraged. However, the decision of promoting one type of day-care setting rather than another requires further studies focusing on different outcomes such as the long-term health consequences, the psychological development, and also the total economic consequences related to attendance of each type of structure.

ISSN:0025-7931    

DOI:10.1159/000196375

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Rabbit IgG antibodies against ovalbumin (OA) was injected intravenously into Wistar rats. When the animals were challenged with OA aerosolized by ultrasonic nebulization, acute lung injury occurred as reflected by increased recovery of bronchoalveolar cells, especially polymorphonuclear leukocytes (PMN) in bronchoalveolar lavage fluid (BALF). Lung morphology demonstrated cellular infiltration in the alveolar septa and intra-alveolar hemorrhage. When the rats were administered ST-638, a novel tyrosine kinase inhibitor, intraperitoneally prior to nebulization, the number of PMN in BALF decreased in a dose-dependent manner and superoxide anion (O2-)producing activity in peripheral leukocytes was significantly suppressed. Furthermore, the reagent inhibited migration of human peripheral blood neutrophils induced by the chemotactic peptide f-met-leu-phe in vitro. These studies strongly indicate that tyrosine kinase plays an important role in immune complex-triggered neutrophil-related lung disorders, and the novel tyrosine kinase inhibitor ST-638 attenuates lung injury by preventing superoxide production and neutrophil migration.

ISSN:0025-7931    

DOI:10.1159/000196307

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Recurrent upper respiratory tract infections in children have an important socioeconomic impact, with consequences on both the quality of life of the children, the possible medical sequelae and the inherent direct and indirect costs. The possibility to prevent these infections is limited in the absence of specific vaccines against microorganisms responsible for most of the respiratory tract infections (i.e. respiratory syncitial virus, adenovirus, rhinovirus). Immunoactive bacterial extracts that stimulate the nonspecific component of the immune system may protect against a large variety of microorganisms that enter the body by the oral and respiratory pathway; they may, therefore, play an important role with regard to this preventive action. OM-85 BV is an IBE that has been used in children who suffer from repeated infections to prevent the occurrence of new episodes (secondary prevention). In this condition, the drug has been shown to be effective in protecting children against recurrent airway infections. Its use as a primary preventive agent to prevent the development of repeated infections in children attending day-care centers (a very high-risk environment for repeated infections), however, did not show a similar efficacy. The risk of having > 4 episodes of upper respiratory tract infections over a period of 7.5 months was 26.7% in the verum group and 33.8% in the placebo group (relative risk 0.79, confidence interval 0.59-1.06]. In an exploratory analysis concentrating on the 3-month treatment period, however, a 48% reduction of the risk of presenting > 3 episodes was observed. Furthermore, this exploratory analysis showed a strong correlation between drug efficacy and age of the children. Three reasons could possibly explain the discrepancy between primary and secondary prevention: first, the environment is very different in day-care and at home. Second, evaluating the efficacy in primary prevention inevitably includes a number of children that are not prone to repeated infections, thus influencing the overall figures by diluting the effect. And third, the efficacy of OM-85 BV in children younger than 1 year could be limited, probably due to the immaturity of their immune system. These questions will have to be further investigated.

ISSN:0025-7931    

DOI:10.1159/000196376

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We evaluated the effect of chronic tobacco smoke exposure on the function of the alveolar macrophage (AM) in mice. Tumor necrosis factor-α production of the AM triggered by lipopolysaccharides was smaller in smoke-exposed mice as compared to control mice but did not reach statistical significance (27.3 ± 4.0 vs. 34.8 ± 4.9 U/ml). The percentage of AM which did not phago-cytize latex particles in the smoke-exposed mice was significantly larger than that in control mice (33.9 ± 2.3 vs. 20.8 ± 2.1%; p < 0.05). la antigen expression of the AM was significantly larger in smoke-exposed mice (cytotoxicity index: 0.180 ± 0.033 vs. 0.038 ± 0.0118; p < O.Ol). The asialo-GMl antigen expression was similar in both groups (0.949 ± 0.007 vs. 0.961 ± 0.011). Although the precise mechanisms of these functional changes of the AM by tobacco smoke exposure are not clear, they may have some immunological effects on the alveol

ISSN:0025-7931    

DOI:10.1159/000196298

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Viral investigations were performed during 4 winter seasons (88/89, 89/90, 92/93, 93/94) in children attending day-care centers (DCCs) in the Rhone Département in eastern France. Over the total observation period of 4 winter seasons, 780 children were screened with a nasal swab for the presence of viruses. Of those, 230 (29.5%) had a positive viral culture. The viruses identified were respiratory syncytial virus (RSV), influenza A and B virus, parain-fluenza virus, coronavirus, rhinovirus, adenovirus and enterovirus. During that time, 83 epidemic events in 47 DCC were recorded. A particular virus was judged to be causally related to an epidemic if the identical virus was isolated in ≥ 3 children during the same outbreak of respiratory diseases. Thus, in 51 cases (61.4%) of all epidemics, the following viruses were responsible for an epidemic: RSV (n = 23), coronavirus (n = 10) (only during the season of 1993-1994), influenza A virus (n = 6), rhinovirus (n = 4), enterovirus (n = 4), adenovirus (n = 3) and parainfluenza virus (n = 1). Except for the somewhat surprising accumulation of coronavirus epidemics during the winter of 1993-1994, there were only minor seasonal variations from one year to another. As expected, RSV accounted for about one third of all respiratory tract infections in children attending DCCs and was therefore the most important single causative agent. These results are compared with data from children who did not attend a DCC and were cared for in a private practice. During the winter of 1989-1990, the viral epidemiological survey was performed at the same time and in parallel to a double-blind, placebo-controlled clinical study investigating the efficacy of OM-85 BV, an immunoactive bacterial extract. This study, enrolling 423 children attending DCCs demonstrated a protective effect of OM-85 BV in significantly reducing the risk of recurrent infections of the upper respiratory tract during the treatment period with the compound. 34% of all participating children (75 in the verum group, 70 in the placebo group) were enrolled in an additional virological study. In these patients, RSV was isolated 10 times in the placebo group, but only 5 times in the treated group (p < 0.05) and influenza A virus was present in 4 children in the placebo group, but only in 1 infant in the verum group giving a total of 14 positive virologie results in the placebo group versus 6 in the verum group (p < 0.05). Despite the small numbers of children investigated for their virologie status during respiratory infectious outbreaks, there was a statistically significant difference in the prevalence of virus carriers in favor of the children treated with OM-85 BV. These results corroborate the clinical findin

ISSN:0025-7931    

DOI:10.1159/000196377

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

We measured the maximal inspiratory and expiratory pressures of 200 healthy subjects (94 men and 106 women) using a membrane manometer designed by the authors. The reference intervals for maximal inspiratory pressure in men were -5 to -15 kPa, and for maximal expiratory pressure 9–21 kPa. For women the reference intervals for maximal inspiratory pressure were -3 to -14 kPa and for maximal expiratory pressure 5–15 kPa. In clinical practice only the lower limits are significant. The differences between subjects of different ages were small, thus age has little bearing on the strength of respiratory muscles in healthy men and wo

ISSN:0025-7931    

DOI:10.1159/000196299

出版商:S. Karger AG    

年代:1994

数据来源: Karger