Articles: disease.
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Curr Opin Anaesthesiol · Feb 2014
ReviewBronchoscopic treatment of end-stage chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating disease that in its final stages cripples the patient. The disappointing results of the National Emphysema Treatment Trial study led to a decrease in the acceptance of lung volume reduction surgery as a therapy. Thus, it became clear that debilitated COPD patients would need innovative alternative nonsurgical procedures to potentially alleviate their symptoms. This review will address the various techniques of bronchoscopic lung volume reduction (BLVR). ⋯ BLVR appears to be safer than surgery and presents an attractive alternative for the treatment of COPD patients. Unfortunately, the outcome data to date are inconclusive; the procedures remain experimental and any benefits unproven. However, the data that are emerging continue to appear promising.
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Meanwhile mitral valve insufficiency is probably the second most common heart valve disease represented in cardiac surgery. Due to low perioperative morbidity and mortality, nowadays mitral valve repair can even be considered in asymptomatic patients. The enhancements of minimally invasive surgical techniques led to a decrease in surgical trauma and accelerated postoperative recovery, resulting in increased acceptance of these operating techniques. Therefore, the present review focuses on the different surgical access ways to the mitral valve and their significance for mitral valve repair. ⋯ Today mitral valve repair is the gold standard for treatment of significant mitral valve regurgitation with low perioperative morbidity and mortality and excellent long-term results. It can be performed through minimally invasive surgical techniques without compromising long-term durability of repair results, but with a decrease in surgical trauma and accelerated postoperative recovery. Currently, endovascular therapy for mitral regurgitation (e.g., the MitraClip procedure) should be limited to patients who otherwise would not be eligible for surgery.
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Curr Opin Anaesthesiol · Feb 2014
ReviewSurgical and anesthetic considerations for the endovascular treatment of ruptured descending thoracic aortic aneurysms.
Ruptured descending thoracic aortic aneurysm (rDTAA) is a life-threatening disease. In the last decade, thoracic endovascular aortic repair (TEVAR) has evolved as a viable option and is now considered the preferred treatment for rDTAAs. New opportunities as well as new challenges are faced by both the surgeon and the anesthesiologist. This review describes the impact of current developments and new modalities for the surgical and anesthetic management of rDTAAs. ⋯ In order to improve outcomes of TEVAR for rDTAA, a close communication between the anesthesiologist and the surgeon and a thorough understanding of the events during the procedure is mandatory. The use of a proactive spinal cord protection protocol may decrease the rates of devastating spinal cord ischemia.
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Important protective roles of intestinal alkaline phosphatase (IAP)--including regulation of intestinal surface pH, absorption of lipids, detoxification of free nucleotides and bacterial lipopolysaccharide, attenuation of intestinal inflammation, and possible modulation of the gut microbiota--have been reviewed recently. IAP is modulated by numerous nutritional factors. The present review highlights new findings on the properties of IAP and extends the list of its protective functions. ⋯ Gastrointestinal administration of exogenous IAP ameliorates gut inflammation and favors gut tissue regeneration, whereas enteral and systemic IAP administration attenuates systemic inflammation only. Finally, the IAP gene family has a strong evolutionary link to food-driven changes in gastrointestinal tract anatomy and microbiota composition. Therefore, stimulation of IAP activity by dietary intervention is a goal for preserving gut homeostasis and health by minimizing low-grade inflammation.
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Frontiers in immunology · Jan 2014
ReviewFunctional Signatures of Human CD4 and CD8 T Cell Responses to Mycobacterium tuberculosis.
With 1.4 million deaths and 8.7 million new cases in 2011, tuberculosis (TB) remains a global health care problem and together with HIV and Malaria represents one of the three infectious diseases world-wide. Control of the global TB epidemic has been impaired by the lack of an effective vaccine, by the emergence of drug-resistant forms of Mycobacterium tuberculosis (Mtb) and by the lack of sensitive and rapid diagnostics. It is estimated, by epidemiological reports, that one third of the world's population is latently infected with Mtb, but the majority of infected individuals develop long-lived protective immunity, which controls and contains Mtb in a T cell-dependent manner. ⋯ In conclusion, the recent highlights on the role of different functional signatures of T cell subsets in the immune response toward Mtb infection will be discerned in this review, in order to summarize what is known about the immune response in human TB. In particular, we will discuss the role of CD4 and CD8 T cells in contrasting the advance of the intracellular pathogen in already infected people or the progression to active disease in subjects with latent infection. All the information will be aimed at increasing the knowledge of this complex disease in order to improve diagnosis, prognosis, drug treatment, and vaccination.