The American review of respiratory disease (Am J Respir Crit Care Med )

Publisher: American Thoracic Society; American Lung Association


The AJRCCM focuses on human biology and disease, as well as animal and in vitro studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients.

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    American Journal of Respiratory and Critical Care Medicine website
  • Other titles
    American journal of respiratory and critical care medicine, AJRCCM
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    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publications in this journal

  • The American review of respiratory disease 05/2014;
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    ABSTRACT: Brain oxygen, CO2 pH and temperature in head injured patients
    The American review of respiratory disease 01/1997; 155:99.
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    ABSTRACT: To investigate the role of IL-5 in airway hyperreactivity and pulmonary eosinophilia, we used a model of allergic asthma in guinea pigs and a neutralizing monoclonal antibody (TRFK-5) directed against murine IL-5. Sensitized guinea pigs were challenged with 1% ovalbumin (OVA) aerosol and assessed for airway eosinophilia (by bronchoalveolar lavage [BAL] and histologic evaluation of airway tissue) and bronchoconstrictor responsiveness to substance P (SP) (as RL100 and Cdyn40) 24 h later. OVA challenge of sensitized animals caused a significant increase in airway responsiveness to SP, with a 4.9-fold decrease in RL100 and a 4.7-fold decrease in Cdyn40. Accompanying this increased sensitivity to SP was a 9-fold increase in eosinophils recovered in BAL and a 4- to 5-fold increase in eosinophils in intrapulmonary bronchial tissue. Intraperitoneal treatment with 10 mg/kg of the IL-5 antibody 2 h before OVA challenge blocked BAL and lung tissue increases in eosinophils but had no effect on the development of airway sensitivity to SP. In contrast, similar treatment with 30 mg/kg of this antibody blocked OVA-induced increased sensitivity to SP as well as BAL and lung tissue eosinophilia. These data suggest a critical and possibly independent role for IL-5 in allergic airway hyperresponsiveness and the accumulation of eosinophils within the lung of the guinea pig.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1623-7.
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    ABSTRACT: Endothelial damage is a hallmark of acute lung injury. Endothelial mediators may increase pulmonary vascular tone and induce pulmonary arterial muscularization, thereby contributing to the pulmonary hypertension seen with acute lung injury. We measured plasma levels and net pulmonary clearance of endothelin-1, a potent endothelium-derived vasoconstrictor peptide and smooth muscle mitogen, in 26 patients with early acute lung injury, the adult respiratory distress syndrome, and pulmonary hypertension. Nineteen had another data collection at clinical improvement or worsening. Control subjects (n = 25) had no pulmonary hypertension or lung injury. Initial mixed venous and systemic arterial plasma endothelin-1 levels were elevated (4.6 +/- 0.6 SEM and 4.9 +/- 0.6 pg/ml, respectively) as compared with control subjects (0.9 +/- 0.1 and 0.6 +/- 0.1 pg/ml). The systemic arterial/venous endothelin-1 ratio was 1.1 +/- 0.1 (0.7 +/- 0.1 in control subjects), indicating a reduction in normal net pulmonary endothelin-1 clearance. With clinical improvement, as compared with clinical worsening, mean plasma endothelin-1 levels, arterial/venous ratio, and pulmonary arterial pressure fell significantly towards normal. Thus, patients with acute lung injury have marked early increases in circulating plasma endothelin-1 levels, associated with abnormal pulmonary endothelin-1 metabolism. These abnormalities reverse in patients who recover. Through its actions, endothelin-1 could contribute to the pulmonary hypertension seen in acute lung injury.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1646-50.
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    ABSTRACT: The integrin alpha 4 beta 1 and its counter receptor vascular cell adhesion molecule-1 (VCAM-1) mediate well-described cell-cell interactions that are critical for immune function. However, these receptors also mediate cell-cell interactions that are important for skeletal muscle differentiation. We have found that contrasting transcriptional mechanisms control their patterns of expression in the immune system and in muscle. Recent studies indicate that alpha 4 beta 1 and VCAM-1 are also expressed in a number of developing tissues, implying that these receptors have a general role in facilitating cell-cell interactions during development.
    The American review of respiratory disease 01/1994; 148(6 Pt 2):S43-6.
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    ABSTRACT: The accumulation of leukocytes into tissues is a characteristic feature of inflammatory reactions. This process is triggered by chemical signals generated in a tissue in response to an inflammatory stimulus e.g., invading microbes, other foreign organisms, allergens, or damaged tissue cells. The mechanisms involved in neutrophil and eosinophil accumulation in vivo are complex and dependent on an initial interaction between the leukocytes and the microvascular endothelial cells. This response is regulated by the coordinated expression and/or activation of leukocyte and endothelial cell adhesion molecules. The precise mechanisms that control the selective accumulation of eosinophils, as opposed to neutrophils, in certain inflammatory reactions (e.g., in IgE-mediated allergic reactions) remain unclear. This may be explained partly by the generation of eosinophil-specific inflammatory mediators and activation of selective adhesion pathways such as the VLA-4/VCAM-1 interaction. Although the neutrophil and eosinophil have distinct roles in host defense, they have been implicated in the pathogenesis of a number of inflammatory disorders. Thus, a better understanding of the events mediating and regulating neutrophil and eosinophil accumulation in vivo will be of considerable value in the development of therapeutic strategies for inflammatory disease states.
    The American review of respiratory disease 01/1994; 148(6 Pt 2):S60-4.
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    ABSTRACT: Several studies have suggested that the TLC after childhood asthma is increased compared wtih that in healthy subjects. The aim of this study was to assess whether TLC is increased after childhood asthma and whether this is associated with an increased growth of the lung during adolescence. During a mean period of 29 months we studied 53 patients and 106 healthy control subjects who were matched for sex, age, and standing height. The patients had had asthma for a mean period of 10 yr. We found that in asthmatics TLC was increased in both sexes by about 7% predicted compared with that in the matched control subjects. The growth of TLC in ml/yr during adolescence was less in patients; this can be accounted for by a delay in pubertal development. When corrected for the delay in growth of stature, growth of TLC in ml/cm in asthmatics was similar to that found in control subjects. These findings support the hypothesis of a developmental change of enhanced lung growth during childhood asthma; they do not support a mechanism with progressive loss of elastic recoil of the lung.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1484-9.
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    ABSTRACT: Conventional virgin T cells efficiently and homogeneously recirculate through all secondary lymphoid tissues, but not "extralymphoid" effector sites. In contrast, memory/effector populations are composed of distinct subsets with differential, often tissue-selective, migratory capability to both secondary lymphoid tissues and effector sites. In keeping with these observations, CD45RA(high)/RO(low) virgin T cells in human peripheral blood uniformly express the peripheral lymph node (PLN) homing receptor (HR) L-selectin, and lack the skin-selective HR CLA, whereas among the CD45RA(low)/RO(high) "memory/effector" population, differential expression of these HR yields three predominant subsets: L-selectin+/CLA+, L-selectin+/CLA-, L-selectin-/CLA-. Although these subsets are of approximately equal size in the peripheral blood, the vast majority of T cells obtained from cutaneous chronic inflammatory sites display the L-selectin+/CLA+ phenotype. To investigate the mechanisms responsible for the generation of these memory/effector T-cell subsets, we developed a multiparameter flow cytometric technique that defines a common pathway of postthymic T-cell differentiation in secondary lymphoid tissues: the virgin to memory/effector transition. Our analyses indicate that these HR are differentially regulated during the virgin to memory/effector transition in a tissue-specific fashion. The great majority of memory/effector T cells produced in PLN retain high levels of L-selectin expression, and 50 to 60% upregulate CLA. In contrast, memory/effector T cells produced in appendix and tonsil are generally L-selectin(low), and CLA is upregulated on less than 10% of newly formed memory/effector T cells in appendix and on about 30 to 35% of such cells in tonsil.(ABSTRACT TRUNCATED AT 250 WORDS)
    The American review of respiratory disease 01/1994; 148(6 Pt 2):S47-54.
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    ABSTRACT: Pulmonary function growth rate varies with a child's stage of growth. Since attained pulmonary function reflects the cumulative effects of growth, insults, and repair, rate of growth may be a more sensitive indicator of a child's current pulmonary health status. The sample for analyses included 2,478 white boys and 2,785 white girls followed annually by questionnaire and spirometry. Empirically derived annual growth velocities, peak velocity (Vpk), and age at which peak velocity occurred (Agepk) were determined for height, FVC, FEV1, and FEF25-75 for each child. Mean velocity curves for height, FVC, FEV1, and FEF25-75, stratified by sex and Agepk of height (an indicator for early, middle, or late maturity) were produced as a function of age. The differences between Agepk of FVC, FEV1, and FEF25-75 and Agepk of height (i.e., the lag period) were compared by sex and by the indicator of maturity. Linear regression analyses were performed to investigate associations between Vpk and Agepk of height, as well as between the lag period and Agepk of height. As is generally observed in height growth, there were considerable variations in the age of onset and magnitudes of the adolescent growth spurts of the pulmonary function parameters both between sexes and among children of the same sex. The duration of adolescent growth spurt appeared to be similar for all children, regardless of early, middle, or late maturity. Thus, those who matured earlier had shorter total growth periods than those who matured later. On the other hand, early maturers had greater growth velocities during preadolescence and greater adolescent Vpk than later maturers.(ABSTRACT TRUNCATED AT 250 WORDS)
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1502-8.
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    ABSTRACT: Functional residual capacity (FRC), the only lung volume to be assessed routinely in infants, can be measured using plethysmography or gas dilution. Although it is well recognized that both methods yield similar FRC values in healthy adults, gas dilution techniques have consistently produced lower values in healthy infants when compared with plethysmography. However, interpretation of this difference is difficult since data comparing the different techniques within the same infants have rarely been reported. We performed paired measurements of FRC using an automated open-circuit nitrogen washout technique (FRCN2) and whole-body plethysmography (FRCpleth) in 11 healthy infants with a median age of 12 months (range, 2 to 18 months). The mean (SD) FRC was 21.7 (4.0) ml/kg for the N2 washout and 25.6 (4.9) ml/kg for plethysmography. The mean within-subject difference between FRCN2 and FRCpleth was 3.9 (range, -0.3 to 7.2) ml/kg (p = 0.001). Both N2 washout and plethysmography yielded reproducible results, with the mean of the coefficients of variation (CV) being 3.6 and 3.9%, respectively. The results from these paired measurements support previously reported data from separate populations of infants which suggest that gas dilution techniques consistently yield smaller values for FRC than do those measured by plethysmography.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1496-501.
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    ABSTRACT: A possible role for hepatitis C virus (HCV) infection in the pathogenesis of idiopathic pulmonary fibrosis (IPF) has recently been suggested on the basis of an unusually high seroprevalence rate of anti-HCV in such patients from Japan. In an attempt to confirm these findings, we tested sera from 62 patients with IPF by two second-generation anti-HCV ELISAs. Only one serum was reactive. Serum from this patient gave an indeterminate result when tested by four-antigen RIBA (c22 band only), and it was negative for the presence of HCV RNA when tested by the reverse transcriptase polymerase chain reaction assay. HCV infection is thus no more prevalent in patients with IPF from the UK than in the general population.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1683-4.
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    ABSTRACT: In order to determine whether endotoxemia induced generalized defects in vascular contraction and endothelium-dependent relaxation, we studied the effect of in vivo endotoxin administration in Sprague-Dawley rats and New Zealand White rabbits on endothelial and arterial smooth-muscle responses of isolated thoracic aorta in vitro. Endotoxin treatment significantly decreased contractile responses to phenylephrine (PE), angiotensin II (AII), serotonin (5-HT), and potassium chloride. This effect was not altered by indomethacin or endothelial denudation. Treatment of vessels with NG-nitro-L-arginine (NNLA), an inhibitor of arginine-dependent nitric oxide biosynthesis, or with methylene blue, an inhibitor of soluble guanylate cyclase, resulted in significant improvement of the contractile defect in endotoxin-treated vessels. The restorative effect of NNLA on contractile responses in endotoxin-treated aortic rings was similar in the presence or absence of an intact endothelium. Endothelium-dependent relaxation in response to acetylcholine, substance P, or the calcium ionophore A23187 was markedly impaired in vessels from endotoxin-treated rabbits, while endothelium-independent relaxation in response to nitroprusside was similar in both groups. These results suggest that endotoxemia both induces basal, nonendothelial nitric oxide synthesis and impairs the agonist-stimulated release of endothelium-derived relaxing factor (EDRF). These findings may have mechanistic importance in the hemodynamic derangements of endotoxemia.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1638-45.
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    ABSTRACT: Using various animal models of toxic or antigenic-induced airway inflammation, we have demonstrated that adhesion molecules play an important role in the recruitment, retention, and site-specific activation of inflammatory cells within the airways. Furthermore, we have shown that cytokines may contribute to inflammatory responses in the airways by enhancing the expression of adhesion molecules on respiratory epithelial cells.
    The American review of respiratory disease 01/1994; 148(6 Pt 2):S83-7.
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    ABSTRACT: Integrins are heterodimeric glycoproteins that mediate cell-to-matrix and some cell-to-cell interactions. Recent evidence underscores the important roles of these receptors in signaling machines that transduce positional information into complex changes in cell behavior. As such, integrins have been shown to play critical roles in cell growth, differentiation, and migration. Most cells express multiple members of this family, but the integrin repertoire of any given cell appears to be highly tissue- and cell-type-specific. We have used the homology-based polymerase chain reaction to identify known and novel integrin subunits in airway epithelial cells. With this technique we have identified three novel integrin subunits that participate in the formation of at least four novel integrin heterodimers. The best characterized of these, alpha v beta 6, is a receptor for the extracellular matrix protein fibronectin, and appears to be expressed only in terminally differentiated mucosal epithelial cells. The novel alpha subunit, alpha 9, forms a heterodimer with the known beta subunit, beta 1, in some epithelial cell lines. Elucidatation of the specific roles these receptors play in airway health and disease will likely provide unique insights into both the biology of integrins and the biology of the airway epithelium.
    The American review of respiratory disease 01/1994; 148(6 Pt 2):S38-42.
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    ABSTRACT: Epidemiologic studies of irritants are difficult to perform using standard epidemiologic methods for several reasons, including the reversible nature of the health outcomes, the selection of sensitive individuals from the study population, and the wide heterogeneity in normal responses to irritants. This study examined the feasibility of using repeated measurements of peak expiratory flow (PEF) and reported symptoms to study respiratory irritants and their effects in students exposed to formaldehyde during a clinical anatomy laboratory course. We studied 24 physical therapy students dissecting cadavers for 3 h per week over a 10-wk period. Formaldehyde exposures in the breathing zone ranged from 0.49 to 0.93 ppm (geometric mean +/- geometric SD, 0.73 +/- 1.22). Irritant symptoms increased strongly over the course of the average laboratory period, but this effect was stronger at the beginning than at the end of the semester. PEF measured before each laboratory session declined over the semester by an average of about 10 L/min (2% of baseline), a trend that was statistically significant in random-effects regression models. After 14 wk away from the laboratory, the group's mean baseline PEF had returned to its preexposure level. Mean PEF also declined over each laboratory period, although this effect was attenuated over the course of the semester. Other important predictors of cross-laboratory PEF decrements were asthma and reporting throat irritation during the laboratory. It appears that mild irritant effects can be detected in naive subjects using a repeated monitoring design and relatively simple instrumentation.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1509-15.
  • The American review of respiratory disease 01/1994; 148(6 Pt 1):1697.
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    ABSTRACT: Pediatric obstructive sleep apnea (OSAS) is characterized by partial airway obstruction, alveolar hypoventilation, and elevated arterial CO2 (PaCO2). Thus, a reliable, practical method of estimating CO2 is needed for pediatric polysomnography. Therefore, we measured both transcutaneous CO2 (PtcCO2) and end-tidal CO2 (PETCO2) in 15 pediatric polysomnographic evaluations. Sleep state, the highest PtcCO2, and the highest PETCO2 were recorded for 5,159 thirty-second epochs. Although PtcCO2 and PETCO2 were available for 78.5 and 73.0% of epochs, respectively, at least one estimator was available for 92% of the epochs. One infant who would not tolerate a nasal sampling catheter had no PETCO2 data. For 13 of 14 studies there was a relatively constant difference between PtcCO2 and PETCO2. The difference between PtcCO2 and PETCO2 was within 4 mm Hg in 63.9% of 3,072 epochs. Across 14 studies, mean PtcCO2 exceeded mean PETCO2 by 2.8 +/- 3.0 mm Hg, and it was within 4 mm Hg in 10 studies. In three subjects, PETCO2 was intermittently or consistently less than PtcCO2 because of tachypnea, increased physiologic dead space, or severe partial airway obstruction; in one subject PtcCO2 exceeded PETCO2 for undetermined reasons during one electrode application. The results of this study indicate that PtcCO2, as well as PETCO2, should be measured during pediatric polysomnography. By utilizing both PtcCO2 and PETCO2 there was a 70% reduction in the number of epochs that could not be assessed for hypoventilation. For an individual subject or electrode application there was a constant, and usually close, relationship, between PtcCO2 and PETCO2.(ABSTRACT TRUNCATED AT 250 WORDS)
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1599-604.
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    ABSTRACT: Inflammation may play a central role in the pathogenesis of HIV-related Pneumocystis carinii pneumonia (PCP). Serum levels of the amino-terminal propeptide of Type III procollagen (PIIINP) reflect inflammatory activity in granulation tissue and in chronic rheumatic and liver disorders. To investigate changes in PIIINP serum levels during an episode of HIV-related PCP, consecutive serum samples were taken from 48 HIV-infected patients with PCP in a randomized, placebo-controlled study of the effect of adjunctive methylprednisolone therapy (26 in corticosteroid [CS] group and 22 in control group). All patients were treated with co-trimoxazole. In the control group, PIIINP serum levels at day of initiation of therapy (Day 0) were significantly higher in patients requiring mechanical ventilation and/or dying during the course of the pneumonia, and serum levels of PIIINP higher than 5 ng/ml were associated with a higher mortality than levels below 5 ng/ml. The level of PIIINP increased from Day 0 to Day 5. There was a significant correlation between changes in PIIINP levels and changes in the alveolar-arterial oxygen gradient from Day 0 to Day 5. In the CS group, the PIIINP levels decreased while steroid was administered. At Days 21 to 28 there were no difference in the levels of PIIINP between the two groups. PIIINP serum levels may predict the clinical outcome of PCP. The antimicrobial therapy may exacerbate the inflammatory reaction in HIV-related PCP, leading to respiratory failure. CS prevents this increased inflammatory activity.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1558-62.
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    ABSTRACT: The early bactericidal and sterilizing activities of ciprofloxacin were evaluated in the treatment of adult patients with smear positive pulmonary tuberculosis. Two randomized prospective studies were performed in Northern Tanzania. In study 1, ten patients received either 750 mg ciprofloxacin or 300 ng isoniazid daily for 7 days. Counts of colony-forming units (cfu) of Mycobacterium tuberculosis in early morning sputum were performed. In study 2, twenty patients received either a standard regimen of rifampin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E) (regimen HRZE) or a trial regimen of ciprofloxacin (C), isoniazid (H), and rifampin (R) (regimen HRC). Sputum colony counts were performed for 8 wk. Patients were tested for antibodies to human immunodeficiency virus (HIV)-1. The results demonstrate that ciprofloxacin alone has useful early bactericidal activity, resulting in a mean daily fall of 0.20 log10cfu/ml/day during 7 days compared with 0.25 log10cfu/ml/day for isoniazid. When HRZE and HRC regimens were compared, the HRC regimen appeared to be inferior in its sterilizing ability, with a culture conversion rate of 67% at 2 months compared with 100% for HRZE. The difference in outcome was most marked in HIV-1 positive patients. The role of ciprofloxacin in combination regimens may be as a bactericidal rather than a sterilizing agent.
    The American review of respiratory disease 01/1994; 148(6 Pt 1):1547-51.

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