Objetivou-se caracterizar clinicamente a Doença Inflamatória de Vias Aéreas (DIVA) assim como verificar o comportamento da atividade dos macrófagos alveolares destes animais. Utilizaram-se 17 eqüinos adultos machos e fêmeas, com idade variando entre 11 e 24 anos, sendo oito do Regimento Escola de Cavalaria Andrade Neves (grupo Controle) e nove da Polícia Militar do Rio de Janeiro (grupo Doente, com DIVA). Estes animais não apresentavam história pregressa recente (dois meses) compatível com doença respiratória, nesse período não foram submetidos a nenhum tipo de tratamento e apresentavam resultados de leucogramas e determinações de fibrinogênio plasmático dentro da normalidade. Realizaram-se exames físicos, endoscópicos, mensurações da diferença de pressão intrapleural máxima (Ventigrafia), e citologia broncoalveolar. Para o grupo Controle os animais foram selecionados levando-se em conta os resultados de normalidade nos exames executados. O grupo Doente foi selecionado considerando-se achados de anormalidade compatíveis com alterações inflamatórias pulmonares no mínimo em dois exames, sendo obrigatórios os exames endoscópicos e de citologia broncoalveolar. Para a avaliação da atividade macrofágica, macrófagos alveolares obtidos através de lavagem broncoalveolar foram cultivados a 37ºC em atmosfera de 7% CO2, aderidos em lamínulas de vidro estéril, de 13 mm de diâmetro em placas de 24 poços contendo 300 µL de RPMI 1640 enriquecido com 10% de Soro Fetal Bovino inativado pelo calor. Realizaram-se testes de fagocitose de Zymosan (por uma hora) e de interação com Promastigotas de Leishmania braziliensis cepa 3456 (por uma até 48 horas pós infecção). A análise das funções vitais e das mensurações da diferença de pressão intrapleural máxima revelou, ainda que dentro de valores fisiológicos, diferenças significativas apenas para a temperatura corpórea e freqüência cardíaca. Para os achados do exame do exame físico, não foi detectada diferença estatística entre os grupos. Com relação ao lavado broncoalveolar, o grupo Doente apresentou aumento na contagem celular total, moderado aumento na porcentagem de neutrófilos, discreta redução na porcentagem de macrófagos, porém com aumento no número de macrófagos espumosos e de células epiteliais além de discreto aumento na porcentagem de eosinófilos. Não observou-se diferença, entre os grupos, na capacidade fagocítica com relação ao Zymosan. Porém, uma diferença significativa na capacidade fagocítica após uma hora de interação e redução do índice de sobrevivência de L. braziliensis após 48 horas de cultivo no grupo Doente foi observada. Os resultados demonstraram que a DIVA nos animais de policiamento apresentou caráter assintomático e que os macrófagos alveolares provenientes destes animais, quando comparados aos do grupo Controle, não apresentaram alteração em sua capacidade fagocítica para Zymosan, mas sim para L. braziliensis e um maior estado de ativação, caracterizado pela maior redução no índice de sobrevivência deste parasita após 48 horas de cultivo. / The objectives were to characterize clinically the inflammatory airway disease (IAD), as well as to verify the behavior of the alveolar macrophages activity in the horses. Seventeen adult horses, from both sexes, from 11 to 24 years old, were used, eight from the Regimento Escola de Cavalaria Andrade Neves (Control group) and nine from the Polícia Militar do Rio de Janeiro (Diseased group, with IAD). These animals did not present recente previous history (two months) compatible with respiratory disease. In this period the horses did not undergo any kind of treatment and presented leucogram and plasmatic fibrinogen determination results under normality. Physical and endoscopic examination, measurement of the maximal intrapleural pressure (Ventigraphy) and bronchoalveolar cytology were done. For the Control group, the animals were selected considering the normal results of the exams. The Diseased group was selected considering abnormal findings compatible with inflammatory pulmonary alterations at least in two exams, obligatory the endoscopic examination and bronchoalveolar cytology. To evaluate the macrophagic activity, alveolar macrophages obtained through bronchoalveolar lavage were cultured under 37oC in a 7% CO2 atmosphere, adhered to 13 mm diameter sterile glass cover slips , in 24 wells polystyrene plates containing 300µL of RPMI 1640 enriched with 10% Foetal Calf Serum inactivated by heat. Assays for phagocytosis of Zymosan (for 1h) and for promastigotes of Leishmania braziliensis strain 3456 binding (for one until 48 hours post-infection) were done. The vital functions and the measurement of the maximal intrapleural pressure measurement analyses showed, even under physiological values, significant differences for body temperature and heart rate. There was not statistical difference between the groups for the physical examination findings. In relation to the bronchoalveolar lavage, the Diseased group presented an increase in total cell count, a moderate increase in neutrophil percentage, a discrete reduction in macrophage percentage, but with a higher number of foamy macrophages and epithelial cells, and also a discrete increase of eosinophil percentage. It was not observed any difference between groups in the phagocytic capability in relation to Zymosan. However, a significant difference in the phagocytic capability after one hour interaction and a reduction of the survival index of L. braziliensis after 48 hours of culture in the Diseased group was observed. The results demonstrated that IAD in the police horses presented an asymptomatic characterization and that the alveolar macrophages from these horses, when compared to the Control group, did not present alteration in their phagocytic capacity for Zymosan, but did for L. braziliensis, and a greater activation status, characterized by a greater reduction of the survival index of L. braziliensis after 48 hours of culture.

As influências etárias do sistema imune de bezerros são descritas na primeira fase de vida desses animais e a hipótese de também ocorrerem ariações nos principais mecanismos de resposta inata do pulmão pode identificar períodos de maior suscetibilidade às principais doenças respiratórias que acometem os bezerros nesse período. Com a finalidade de minimizar os prejuízos econômicos associados às doenças respiratórias em bezerros, este estudo objetivou avaliar a dinâmica imunológica inata do sistema respiratório de bezerros sadios nos três primeiros meses de vida, no qual nove bezerros sadios foram acompanhados por três meses e submetidos a oito avaliações imunológicas. O material recuperado do lavado broncoalveolar colhido por broncoscopia foi submetido à avaliação funcional dos macrófagos alveolares utilizando as provas de fagocitose (SaPI e E.coli), burst oxidativo, quantificação de imunoglobulinas e expressão de CD14. Os dados foram avaliados pelo teste ANOVA oneway (unstacked) (paramétricos) e pelo teste Mann-Whitney (não paramétricos). Verificaramse alterações funcionais de fagócitos CD14+, que apesar de se manterem constantes em seus valores relativos durante todo o período, apresentou intensidade de fagocitose elevada pontual na terceira semana de vida e um aumento da fagocitose por mononucleares CD14+ aos 45 dias de idade com diminuição da intensidade da fagocitose por essas mesmas células a partir dessa idade. Conclui-se que a partir de 45 dias de vida os animais começam a montar uma resposta imune própria, porém pontual e que até os 90 dias não atingem a estabilidade necessária para atestar a conclusão do processo de maturação da resposta inata local. / The influences of age in calves\' immune system are described in their first phase of life. The hypothesis that variations occur in the main mechanisms of lung innate response can help to identify periods of greater susceptibility to the respiratory diseases that affect calves in the first stage of their life. With the purpose of minimizing the economic losses associated with respiratory disease in calves, this study aimed to evaluate the innate immune dynamics of the respiratory system of healthy calves in the first three months of life. Nine healthy calves were monitored for three months and eight immunologic evaluations were performed. Bronchoalveolar lavage samples were recovered by bronchoscopy. Then, the alveolar macrophages in samples were identified by protein expression of CD14 and undergone functional evaluation of phagocytosis (SAPI and E.coli) and oxidative burst. Immunoglobulin were also quantified in samples. Data was assessed by one-way ANOVA (unstacked) (parametric) and the Mann-Whitney test nonparametric). Functional alterations in phagocytes CD14 + were observed, and although their relative values were kept throughout the period, higher intensity of phagocytosis in the third week and increased phagocytosis by macrophages CD14 + at 45 days of life was observed. Decreased intensity of phagocytosis was observed after this age. It is concluded that from 45 days of life on, calves began to maintain their immune response, but until 90 days of life they did not achieve the stability to conclude the maturation of local innate response.

A Mannheimia haemolytica é uma importante bactéria relacionada ao Complexo Doença Respiratória dos Bovinos e a essa atribui-se uma evolução para uma forma grave de pneumonia fibrinonecrótica. É considerada um habitante comensal da nasofaringe que em situações de comprometimento da resposta imune adquire um perfil oportunista. O presente estudo buscou observar por meio de modelo de infecção experimental, as possíveis alterações locais e sistêmicas causadas pela M. haemolytica em bezerros experimentalmente inoculados. Dessa forma seria possível de maneira longitudinal, acompanhar a dinâmica dos principais aspectos de defesa das vias aéreas posteriores durante a infecção e após o tratamento com o antimicrobiano norfloxacina associado ou não à flunexina meglumina. Avaliou-se por exame físico acrescido de broncoscopia, alterações funcionais das células de defesa e mediadores inflamatórios, tanto séricos quanto locais e a atividade in vitro da norfloxacina sobre a função dos fagócitos sanguíneos e do lavado broncoalveolar (LBA). Para tal foram utilizados 12 bezerros sadios que foram experimentalmente infectados por M. haemolytica dos quais foram avaliadas as alterações clínicas e, quantitativamente e funcionalmente, as populações leucocitárias no sangue e no LBA, assim como o efeito da norfloxacina sobre a atividade funcional dos fagócitos no sangue e no LBA. Os resultados do presente estudo demonstraram o sucesso da infecção experimental por M. haemolytica pelos achados clínicos, broncoscópicos e citológicos. Ademais, a infecção experimental por M. haemolytica foi associada a alterações nas subpopulações de linfócitos T CD8+ e уδ, na produção intracelular de espécies reativas de oxigênio (ERO), fagocitose e viabilidade pelas células CD14+ sanguíneas e do LBA e granulócitos do sangue e, expressão de L-selectina pelos leucócitos polimorfonucleares do sangue. Nenhuma alteração evidente foi observada na expressão de citocinas IL-1β, IL-8 e TNF-α nas células sanguíneas e do LBA. O tratamento com antimicrobiano associado ou não ao anti-inflamatório foi capaz de curar a infecção e reestabelecer os parâmetros avaliados à sua condição basal. Portanto, não se observou benefícios com a utilização adicional do anti-inflamatório no reestabelecimento do quadro clínico e da resposta imune neste experimento. Contudo, apesar de algumas alterações na resposta sistêmica durante o quadro infeccioso, as alterações locais foram mais perceptíveis. Outro aspecto importante encontrado foi o efeito in vitro da norfloxacina na produção intracelular de ERO, fagocitose bacteriana pelas células CD14+ sanguíneas e do LBA e em leucócitos polimorfonucleares no sangue. Conclui-se que as alterações funcionais dos fagócitos apresentaram papel importante na patogenia da mannheimiose, que foram condizentes com os achados clínicos da mannheimiose e da evolução do tratamento quando realizado no início do processo nosológico. / Mannheimia haemolytica is an important bacterial pathogen associated with Bovine Respiratory Disease Complex (BRDC) and it is believed to be the predominant cause of the disease’s evolution into a fibrinonecrotic pneumonia. A commensal inhabitant of the nasopharynx, M. haemolytica acts as an opportunist when host defenses are compromised. This study used an experimental infection model to investigate the possible local and systemic changes caused by M. haemolytica in inoculated calves. It sought to linearly follow the dynamics of the lower respiratory tract defense mechanisms, during the course of infection and after treatment with the antibacterial norfloxacin, which was administrated both with and without the anti-inflammatory flunixin meglumine. With clinical examination followed by bronchoscopy, this study evaluated the physiological modifications in defense cells and mediators of inflammation, and the in vitro influence of norfloxacin on phagocytes from the peripheral blood and Bronchoalveolar Lavage Fluid (BLF). Twelve (12) healthy calves were infected with M. haemolytica and posteriorly physically examined, and had samples of white cells from the peripheral blood and BLF analyzed for changes in count and physiology, further, the norfloxacin effect on phagocytes from the peripheral blood and BLF was also studied. The experimental infection proved itself to be successful based on clinical, bronchoscopic and cytological findings. Furthermore, the M. haemolytica experimental infection was associated with modifications in the subpopulations of lymphocytes CD8+ and уδ T cells, in intracellular production of Reactive Oxygen Species (ROS), viability and phagocytosis activity of CD14+ cells from the peripheral blood and BLF and granulocytes from the peripheral blood. No obvious change was observed in the expression of cytokines IL-1β, IL-8 e TNF-α by cells from the peripheral blood or BLF. The treatment with the antibacterial agent, with or without the anti-inflammatory, was proved to be successful in curing the disease, thus, the addition of an anti-inflammatory was considered unnecessary to revert the clinical infection and in the immune response. Although there was a systemic response during the course of infection, the local response was more noticeable. Another key finding of the present study was the in vitro effect of norfloxacin on the intracellular production of ROS and on phagocytosis activity of CD14+ cells from the peripheral blood and BLF and granulocytes from the peripheral blood. In conclusion, the functional changes in phagocytes play an important role in the pathogenesis of pulmonary infection caused by M. haemolytica, as they were consistent with the clinical findings of mannheimiosis and with the treatment when it was administrated in the beginning of the infection.

Dans le cadre du développement des réacteurs de génération IV, une des voies de recherche concerne le développement des réacteurs à neutron rapide à caloporteur sodium. Le CEA a pour projet la construction d'un prototype de réacteur de ce type appelé " ASTRID ". En réponse aux besoins de développement de ce prototype, des recherches sont menées sur la disponibilité et, en particulier, sur la réduction des temps de lavage du sodium résiduel des assemblages de combustible, lors de leur déchargement. En effet, le lavage étant réalisé avec de l'eau, qui est très réactive avec le sodium, celle-ci est amenée de façon très progressive pour le traitement. Une solution alternative, actuellement à l'étude au CEA, et qui fait l'objet de ce mémoire de thèse, consiste en l'utilisation de solutions aqueuses salines permettant de ralentir la cinétique de la réaction du sodium avec l'eau. Ce travail de thèse présente les différents sels évalués et tente d'expliquer leur mécanisme d'action. / Within the framework of the development of generation IV reactors one of the research tracks is related to the development of fast neutron reactors using fluid sodium heat transfer...

Doctor of Philosophy / Department of Anatomy and Physiology / David C. Poole / Exercise-induced pulmonary hemorrhage (EIPH) or epistaxis has been recognized in racehorses since the 16th century. Since this time, great strides have been made in terms of identifying the lungs as the source of the hemorrhage via the endoscope, utilization of bronchoalveolar lavage to quantify the hemorrhage, and the discovery of successful treatments such as furosemide and the nasal strip that ameliorate, but do not abolish EIPH. It has been determined that, in addition to extremely high pulmonary arterial pressures and the negative intrapleural pressures being the major physiologic forces causing pulmonary capillary stress failure, other factors have the potential for influencing the severity of EIPH including locomotory impact trauma, inflammatory airway disease (IAD), upper airway obstruction, coagulation anomalies, and high blood viscosity. It has been hypothesized that EIPH is detrimental to performance and this was recently confirmed by Hinchcliff et al. in 2004. EIPH is a complex multi-factorial condition with much still unknown about the etiology, best method for diagnosis, and most effective form of treatment. Chapter one of this dissertation determined the effectiveness of a novel treatment, concentrated equine serum, in ameliorating EIPH via reduction of IAD. Chapter two refuted the hypothesis that herbal formulations commonly used in the field with anecdotal success would decrease EIPH by correcting coagulation deficits during exercise, as scientific efficacy was not evident, at least at the dose and duration used in our investigation. Chapter three addressed the dogma that EIPH only occurs during maximal intensity exercise, and in demonstrating significant EIPH during sub-maximal exercise, emphasized the role that the airways play in contributing to the initiation and severity of EIPH. Chapter four examined the occurrence and severity of EIPH in the horse’s canine counterpart, the racing Greyhound. The demonstrated presence of mild EIPH in the Greyhound, a physiologically similar yet different athlete in comparison to the horse sheds new light on the etiology of this condition in both species. The results of these investigations have advanced the frontiers of our knowledge concerning EIPH. Specifically, they have generated novel information on the mechanistic bases of EIPH and have provided evidence supporting additional treatment options for reducing the severity of EIPH in horses.

Ce travail de recherche porte sur l'optimisation des procédés de lavage de sol permettant le traitement des sites contaminés par des métaux lourds. Cette étude se concentre sur le cycle complet de ce type de traitement, incluant la possibilité de réutilisation et un traitement adapté de la solution de lavage de sol utilisée. La conception et l'exploitation d'un procédé de lavage de sol sont étudiées dans le but d'optimiser leur coût et leur efficacité. Dans ce but, les paramètres et la configuration du réacteur utilisé pour ce procédé sont étudiés en détail à travers des tests à l'échelle du laboratoire, et les cinétiques sont simulées par une modélisation mathématique. Les échantillons de sol utilisés au cours de cette étude proviennent de terres agricoles présentant une forte contamination en cuivre. Parmi plusieurs agents chélateurs de la famille des aminopolycarboxylates, il a été choisi d'utiliser l'acide éthylènediamine-N, N'-disuccinique (EDDS) pour sa biodégradabilité - largement rapportée dans la littérature – et son efficacité importante d'extraction des métaux lourds, y compris du cuivre. Le travail bibliographique a permis d'identifier les deux paramètres cruciaux pour l'optimisation du procédé de lavage de sol : le rapport molaire EDDS : Cu et le rapport liquide-solide (L/S). Des tests réalisés dans un réacteur à agitation continue (RAC) en fonctionnement discontinu ont permis d'étudier l'influence de ces deux paramètres sur le rendement et la cinétique d'extraction du cuivre. L’augmentation du rapport molaire EDDS : Cu a permis une meilleure amélioration de l'efficacité du procédé, comparée à l'augmentation du rapport L/S. Par ailleurs, les tests réalisés en discontinu ont clairement mis en évidence une première étape cinétique rapide au début du traitement, suivie d'une seconde étape d'extraction plus lente jusqu'à la fin du traitement. Il a donc été formulé un modèle empirique basé sur deux termes cinétiques. Les paramètres du modèle ont été calibrés puis validés grâce à deux séries de données expérimentales différentes. Ce modèle permet d'abord d'évaluer la validité de l'hypothèse d'un procédé reposant sur deux étapes cinétiques différentes. Cela représente aussi un nouvel outil pour prévoir l'efficacité du procédé en fonction de l'évolution du ratio molaire EDDS : Cu et du temps de traitement. Les coûts d'exploitation du procédé ont été minimisés en étudiant différentes configurations de traitement. En particulier, deux configurations en réacteur piston ont été analysées et comparées à celle en RAC. Les réacteurs pistons ont été simulés en utilisant plusieurs réacteurs en série et en variant les temps de rétention et le fractionnement de l'injection de la solution de lavage de sol. Comparés à la configuration en RAC, les résultats obtenus en réacteur piston ont montré une amélioration du rendement et de la cinétique d'extraction du cuivre, ainsi qu'une réduction de la quantité de solution de lavage utilisée. Pour finir, un procédé électrochimique a été mis en place pour le traitement et la récupération de la solution d'EDDS utilisée. Des tests en réacteur discontinu ont permis d'optimiser les paramètres de ce procédé (densité de courant, pH et conductivité de la solution de lavage de sol). La solution récupérée a ensuite été utilisée pour d'autres étapes de lavage de sol. Les résultats obtenus ont prouvé l'efficacité du traitement électrochimique pour la récupération de la solution d'EDDS, et permettent d'envisager l'application de cette technique pour réduire le coût des procédés de lavage de sol utilisant l'EDDS / The object of the present research work is the optimization of soil-washing processes applied to heavy metal contaminated soils. The work focuses on the whole cycle of these treatments, including the possible recovery and the proper disposal of the used washing solution. Both the design and the exploitation of a soil washing treatment are investigated, in order to maximize their efficacy, in terms of cost and process efficiency. At this aim process parameters and reactor configurations are studied in details through lab-scale tests, and the observed kinetics are simulated through mathematical modeling. Soil samples used for the experimental activity were collected from an agricultural field located in Southern Italy, mainly contaminated by copper. Among several Aminopolycarboxylate (APC) chelating agents, Ethylenediamine-N,N'-disuccinic acid (EDDS) was selected, for its recognized biodegradability, widely reported in literature works, and its efficiency as extracting agent towards several heavy metals, including Cu. Literature review allowed determining the two most important process parameters to be investigated for washing optimization. The two parameters were identified as EDDS : Cu molar ratio and liquid to soil ratio (L/S). In order to investigate the effect of these parameters on process kinetics and Cu extraction yield, batch washing tests in continuous-stirred tank reactor configuration (CSTR) were carried out. EDDS : Cu molar ratio increase was found to be able to enhance process efficiency more than L/S increase. Batch tests clearly displayed a first fast kinetic step at the beginning of the treatment, followed by a second slower kinetic extraction step, which lasted until the end of the treatment. According to this observation, an empirical mathematical model based on two-kinetic terms was formulated. Model parameters were firstly calibrated and then validated using two different sets of experimental data. The derived mathematical model was useful to assess the validity of the two-kinetic steps process hypothesis, and to provide a tool for process efficiency prediction depending on EDDS : Cu molar ratio and treatment time length. Exploitation costs of the process were minimized studying different treatment configurations. In details two Plug-Flow configurations were analyzed and compared to the CSTR one. The two Plug-Flow configurations were simulated using several reactors in series, varying the detention time of the reactors, and fractionating the injection of the washing solution. Achieved results displayed improvements in terms of Cu extraction yield and process kinetic for the tested Plug-Flow conditions compared to the CSTR one, and showed that the use of a Plug-Flow reactor allows to reduce the amount of required washing solution. Finally, an electrochemical process was tested for the treatment and the recovery of the spent EDDS solution. Batch tests were carried out to optimize electrochemical process parameters (e.g. current density, washing solution pH and conductivity). The recovered solution was also used for a multi-washing test. Results proved the effectiveness of the electrochemical treatment for EDDS solution recovery and its potential application as technique for EDDS-enhanced soil washing costs reduction

Air and saline P-V curves were run on the excised lungs of rats starved 1-4 days. Stability estimates based on % of maximum volume retained on deflation tended toward decreases, but atelectasis was not increased according to buoyancy measurements. Compliance was not significantly affected, with whatever trend existed being toward increases. Average air P-V curves for day 3 and 4 of starvation were essentially superimposable on control curves. Surface tension of lung lavage fluid was measured (Surfactometer) during cyclic compression and expansion of the film. Min and max γ were elevated, and the activity index (s) depressed, but the area of the hysteresis loop was relatively unchanged. It is concluded that despite increases in γ of lung washings, pulmonary mechanics was little affected by 1-4 days of food deprivation. The effects on surface tension may be due to a decrease in quantity of surfactant extractable, without any change in composition.

Background The use of peritoneal lavage with antiseptic solutions after bowel surgery remains controversial. This study compared peritoneal lavage using chlorhexidine gluconate at low concentrations and normal saline in mice with cecal ligation and perforation. Methods A total of 180 mice were randomized to six groups. Groups A, B, and C received one-time intraperitoneal injections of normal saline, chlorhexidine gluconate 0.05%, and chlorhexidine gluconate 0.025%, respectively. Groups D, E, and F were all subject to cecal ligation and perforation, then underwent partial cecectomy and peritoneal lavage with normal saline only, chlorhexidine gluconate 0.05% followed by normal saline, and chlorhexidine gluconate 0.025% followed by normal saline, respectively. Animals were followed postoperatively then sacrificed and examined at necropsy for occurrence of intra-abdominal abscesses, adhesions, or other pathology. Results A total of 48 mice (26.7%) developed postoperative intra-abdominal abscesses. Group E mice that had chlorhexidine gluconate 0.05% lavage had significantly lower incidence of postoperative intra-abdominal abscesses compared with that of group D mice that had saline lavage only (P = 0.0113). There was no significant difference in occurrence of macroscopic adhesions among mice groups that had or did not have surgery. (P = 1 and P = 0.3728). Microscopic peritoneal fibrosis occurred significantly more among group E mice that had chlorhexidine gluconate 0.05% lavage compared with group D mice that had saline lavage only (P = <0.005). There was no significant difference in postoperative mortality between surgical groups (P = 0.8714). Conclusions Chlorhexidine gluconate 0.05% peritoneal lavage after partial colectomy (cecectomy) in mice reduces postoperative intra-abdominal infection without significant macroscopic adhesion formation.

In cystic fibrosis (CF) therapy, the recent approval of CF-transmembrane conductance regulator (CFTR) channel modulators is considered to be the major breakthrough. However, the current first-line approach based mainly on pulmonary function to measure effects of the novel therapy, tested by forced expiratory volumes in one second (FEV1), provides restricted sensitivity to detect early structural damages. Accordingly, there is a need for new sensitive surrogate parameters. Most interestingly, these should quantify inflammation that precedes a decline of pulmonary function. We present a novel method assessing inflammatory markers in the upper airways’ epithelial lining fluid (ELF) obtained by nasal lavage (NL). In contrast to broncho-alveolar lavage, ELF sampling by NL is an attractive method due to its limited invasiveness which allows repeated analyses, even performed in a home-based setting. In a longitudinal cohort study (ClinicalTrials.gov, Identifier: NCT02311140), we assessed changes of inflammatory mediators in 259 serially obtained nasal lavages taken up to every second day before and during therapy with ivacaftor from ten CF patients carrying a G551D mutation. Patients were trained to sample NL-fluid at home, to immediately freeze and transfer chilled secretions to centers. Neutrophil Elastase, Interleukins IL-1b, IL-6 and IL-8 in NL were quantified. During 8-12 weeks of ivacaftor-treatment, median values of IL-1b and IL-6 significantly declined 2.29-fold (2.97!1.30 pg/mL), and 1.13-fold (6.48!5.72 pg/mL), respectively. In parallel, sweat tests and pulmonary function improved considerably. This is the first study assessing changes of airway inflammation on a day-to-day basis in CF patients receiving a newly administered CFTR-modulator therapy. It proves a decline of airway inflammation during ivacaftor-therapy.

Syftet med denna studie var att jämföra tre års resultat av enbart lokalanestesi jämfört mot lokalanestesi ochspolning i käkledenpå patienter som lider av smärtande diskdisplacering utan reduktionStudien utfördes från 2003 till 2007 och 45 patienter valdes från sammanlagt 55 utvalda patienter för behandling av TMD till avdelningen för Klinisk bettfysiologi, Odontologiska fakulteten, Malmö högskola, Sverige.Frågeformulär och klinisk undersökning enligt Research Diagnostic Criteria(RDC/TMD), panorama röntgenbilder och magnetisk resonanstomografi utfördes vid start av studien. Tre år efter behandling, sändes ett frågeformulär till 37 patienter.Intensiteten av smärta, fysisk funktion, känslomässig funktion och global förbättring utvärderades.Tjugofyra patienter randomiserades till behandling med lokalanestesi och tjugo patienter randomiserades till behandling med lokalanestesi och spolning. Trettiofyra patienter besvarade enkäten vid 3-års uppföljningen. I en intention-to-treat analys visade det huvudsakliga resultatet att 28/45(62%) hade fått 30% smärtlindring vid uppföljningen. Inga signifikanta skillnader fanns mellan grupperna lokalanestesi och lokalanestesi och spolning avseende smärtlindring, fysisk funktion, känslomässig funktion och global förbättring. Det fanns signifikanta förbättringar (P< 0.05) inom båda grupperna avseendesmärtintensitet, fysisk funktion och emotionell funktion och global förändring vid uppföljning jämfört med start av studien.Eftersom det inte fanns någon skillnader mellan grupperna lokalanestesi och spolningoch enbart lokalanestesii käkleden tre år efter behandling av smärtsam diskdisplacering utan återgång, kan spolning av käkleden ifrågasätts. / The aim of this prospective and longitudinal study was to compare three-year outcomes of local anesthetics compared to anesthetics, arthrocentesis and lavage on patients suffering from painful jaw locking in the TMJThe study was performed from 2003 until 2007 and 45 patients were selected from altogether 55 eligible patients referred for the treatment for TMD to the Department of Stomatognathic Physiology, Faculty of Odontology, Malmö University, Sweden. History questionnaire and clinical examination according toResearch Diagnostic Criteria, panoramic radiographs and Magnetic Resonance Imaging were completed at baseline. A questionnaire was sent three years after treatment to 37 patients. Pain intensity, physical functioning, emotional functioning and global improvement were evaluated.Twenty-five patients were randomised to group anesthetics and 20 patients were randomised to group anesthetics, arthrocentesis and lavage. Thirty-four patients answered the questionnaire at the 3-year follow-up. In an intention-to-treat analysis the primary outcome, showing a ≥30% pain relief, was reported by 28 of 45(62%) patients at the follow-up. No significant differences in improvement were found between group local anesthetics and group anesthetics, arthrocentesis and lavage regarding pain relief, physical functioning, emotional functioning, and global improvement. Significant improvements(P<0.05) were found within both groups regarding pain intensity, physical functioning, emotional functioning and global changes at the follow-up compared to baseline.Since no differences were found between local anesthetics, arthrocentesis and lavage compared to local anesthetics alone of the TMJ three years after treatment of painful disc displacement without reduction, the use of arthrocentesis and lavage can be questioned.