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Dosis - Wirkungs - Studie zum Einsatz von inhalativem Stickstoffmonoxid bei Patienten mit schwerem akutem LungenversagenBösel, Matthias 06 July 2004 (has links)
Studienziel: Untersuchung der Dosis-Wirkung von inhalativem Stickstoffmonoxid (NO) bei Patienten mit schwerem akuten Lungenversagen (ARDS) und der diese Wirkung beeinflussenden Faktoren. Design: Prospektive, offene Beobachtungsstudie. Setting: Universitäts-Klinikum. Intensivstation. Patienten: 26 Intensivpatienten mit hohem pulmonal-vaskulärem Druck (PAP) bei zugrunde liegendem ARDS. Behandlung: Patienten mit ARDS wurden einer Therapie mit konventioneller Beatmung und Beimischung von inhalativem NO zugeführt. Das Protokoll sah die Applikation von NO in steigender Dosierung von 0,01 parts per million (ppm), 0,01 ppm, 1, 10 und 100 ppm vor. Zischen den Messungen wurden für 15 bis 20 Minuten Nullmessungen durchgeführt. Ein Anstieg des pulmonal-areriellen Sauerstoffdrucks (Pao2) um 20% wurde als "Responding" definiert. Messungen: Es wurden die Parameter des pulmonalen Gasaustausches wie PaO2, PaCo2 und CaO2 gemessen. Des Weiteren wurden die Werte für den mittleren systemischen Blutdruck (AP), den mittleren pulmonal-arteriellen Druck (PAP), den systemischen Widerstand (SVR), den pulmonalvaskulären Widerstand (PVR), die Herzfrequenz (HR), den Herzindex (CI), das Herz-Zeit-Volumen (HZV), den Wedgedruck (PCWP) und die venöse Beimischung registriert. Ergebnisse: NO verursachte einen dosisabhängigen Anstieg des Pao2 von 0,01 bis 10 ppm (p / STUDY OBJECTIVE: To determine the dose responsiveness to nitric oxide in adult patients with acute respiratory distress syndrom (ARDS), especially in those patients with pulmonary hypertension. To find factors influencing the response to NO. DESIGN: Prospective, open, nonblinded observation study. SETTING: University teaching hospital. PATIENTS: 26 ICU patients suffering from ARDS demonstrating pulmonary hypertension. INTERVENTIONS: Patients with severe acute respiratory distress syndrome received inhalation therapy with NO. Inhaled NO was sequentially titrated from 0,01 parts per million to 0,1 ppm, 1, 10, and 100 ppm at 15-minute intervals followed by a 15 to 20 min OFF interval. Changes in hemodynamics and gas exchange were monitored. An increase of at least 20 % in the oxygenation index was considered as a therapeutic response. MEASUREMENTS: Heart rate, mean arterial pressure, mean pulmonary arterial pressure, pulmonary vascular resistance (PVR), peripheral vascular resistance, cardiac index,rigt to left shunting , venous admixture and right ventricular ejection fraction were monitored throughout the study, as well as the Pao2, Cao2 and PaCo2. RESULTS: 26 patients received inhaled NO. Nitric oxide induced a dose-dependent increase in Pao2 for inspiratory nitric oxide concentrations ranging between 0.01 and 10 ppm (p
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Molecular Regulation of Interleukin-13 and Monocyte Chemoattractant Protein-1 Expression in Human Mast Cells by Interleukin-1betaLee, Steven A., Fitzgerald, S M., Huang, Shau K., Li, Chuanfu, Chi, David S., Milhorn, Denise M., Krishnaswamy, Guha 01 September 2004 (has links)
Mast cells play pivotal roles in immunoglobulin (Ig) E-mediated airway inflammation, expressing interleukin (IL)-13 and monocyte chemoattractant protein-1 (MCP-1), which in turn regulate IgE synthesis and/or inflammatory cell recruitment. The molecular effects of IL-1beta on cytokine expression by human mast cells (HMC) have not been studied well. In this report, we provide evidence that human umbilical cord blood-derived mast cells (CBDMC) and HMC-1 cells express the type 1 receptor for IL-1. We also demonstrate that IL-1beta and tumor necrosis factor-alpha are able to induce, individually or additively, dose-dependent expression of IL-13 and MCP-1 in these cells. The induction of IL-13 and MCP-1 gene expression by IL-1beta was accompanied by the activation of IL-1 receptor-associated kinase and translocation of the transcription factor, nuclear factor (NF) kappaB into the nucleus. Accordingly, Bay-11 7082, an inhibitor of NF-kappaB activation, inhibited IL-1beta-induced IL-13 and MCP-1 expression. IL-1beta also induced IL-13 promoter activity while enhancing the stability of IL-13 messenger RNA transcripts. Dexamethasone, a glucocorticoid, inhibited IL-1beta-induced nuclear translocation of NF-kappaB and also the secretion of IL-13 from mast cells. Our data suggest that IL-1beta can serve as a pivotal costimulus of inflammatory cytokine synthesis in human mast cells, and this may be partly mediated by IL-1 receptor-binding and subsequent signaling via nuclear translocation of NF-kappaB. Because IL-1beta is a ubiquitously expressed cytokine, these findings have important implications for non-IgE-mediated signaling in airway mast cells as well as for innate immunity and airway inflammatory responses, such as observed in extrinsic and intrinsic asthma.
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