Elfy B Chevretton

T cells producing the anti-inflammatory cytokine IL-10 regulate allergen-specific Th2 responses in human airways.

Murine models suggest a critical functional role for the anti‐inflammatory cytokine IL‐10 in local regulation of allergic airways inflammation. There is little corresponding information on human airway cells. This study aimed to investigate whether local IL‐10 production regulates responses by respiratory mucosal leucocytes isolated from nasal polyps.

Mastoidectomy packs: Xeroform® or BIPP?

A retrospective study comparing adverse events using bismuth iodoform paraffin paste (BIPP) and Xeroform as dressings for newly fashioned mastoid cavities after mastoidectomy was undertaken. There were 20 patients in each group. Adverse events were defined as offensive packs, mastoid cavity infections and systemic signs of infection. There were no adverse events using BIPP packs whether or not prophylactic antibiotics were used. Xeroform packs were associated with a significantly higher incidence of adverse events compared to BIPP when using no antibiotic prophylaxis (P less than 0.005) or amoxycillin (P less than 0.005). Adverse events with Xeroform packs were abolished using ciprofloxacin and metronidazole prophylaxis. We conclude that BIPP is the mastoid dressing of choice.

Counter regulation of the high affinity IgE receptor, FcεRI, on human airway dendritic cells by IL-4 and IL-10

Background:  Immunoglobulin E is a signalling molecule within the environment of the respiratory tract, the high affinity receptor for which, FcεRI, is expressed by dendritic cells (DC). Little is known, however, of the expression and function of FcεRI on DC in the human respiratory tract.

Vitamin D Counteracts an IL-23–Dependent IL-17A+IFN-γ+ Response Driven by Urban Particulate Matter

&NA; Urban particulate matter (UPM) air pollution and vitamin D deficiency are detrimentally associated with respiratory health. This is hypothesized to be due in part to regulation of IL‐17A, which UPM is reported to promote. Here, we used a myeloid dendritic cell (DC)‐memory CD4+ T cell co‐culture system to characterize UPM‐driven IL‐17A+ cells, investigate the mechanism by which UPM‐primed DCs promote this phenotype, and address evidence for cross‐regulation by vitamin D. CD1c+ myeloid DCs were cultured overnight with or without a reference source of UPM and/or active vitamin D (1,25[OH]2D3) before they were co‐cultured with autologous memory CD4+ T cells. Supernatants were harvested for cytokine analysis on Day 5 of co‐culture, and intracellular cytokine staining was performed on Day 7. UPM‐primed DCs increased the proportion of memory CD4+ T cells expressing the T helper 17 cell (Th17)‐associated cytokines IL‐17A, IL‐17F, and IL‐22, as well as IFN‐&ggr;, granulocyte‐macrophage colony‐stimulating factor, and granzyme B. Notably, a large proportion of the UPM‐driven IL‐17A+ cells co‐expressed these cytokines, but not IL‐10, indicative of a proinflammatory Th17 profile. UPM‐treated DCs expressed elevated levels of il23 mRNA and increased secretion of IL‐23p40. Neutralization of IL‐23 in culture reduced the frequency of IL‐17A+IFN‐&ggr;+ cells without affecting cell proliferation. 1,25(OH)2D3 counteracted the UPM‐driven DC maturation and inhibited the frequency of IL‐17A+IFN‐&ggr;+ cells, most prominently when DCs were co‐treated with the corticosteroid dexamethasone, while maintaining antiinflammatory IL‐10 synthesis. These data indicate that UPM might promote an inflammatory milieu in part by inducing an IL‐23‐driven proinflammatory Th17 response. Restoring vitamin D sufficiency may counteract these UPM‐driven effects without obliterating important homeostatic immune functions.

Multinodular thyroid goitre causing obstructive sleep apnoea syndrome

BACKGROUND Obstructive sleep apnoea syndrome has been linked to obesity, nasal obstruction and adenotonsillar hypertrophy, but rarely to large thyroid goitres. OBJECTIVE To study the possible association between multinodular retrolaryngo-pharyngeal or retrosternal goitres and obstructive sleep apnoea syndrome. SUBJECTS AND METHODS Retrospective case series at a tertiary referral centre (2000-2010). Study parameters included body mass index, Epworth sleep score and polysomnographic index. RESULTS Five patients were diagnosed with obstructive sleep apnoea syndrome and managed with nasal continuous positive airway pressure ventilation. Computed tomography showed a retrolaryngo-pharyngeal or retrosternal goitre with significant tracheal compression, displacement and laryngeal oedema. After total thyroidectomy, obstructive sleep apnoea resolved in all patients. CONCLUSION Large, multinodular goitres with retrolaryngo-pharyngeal extension can cause obstructive sleep apnoea syndrome due to laryngeal compression and oedema. In such cases, total thyroidectomy enables resolution of symptoms. Patients with obstructive sleep apnoea syndrome should be screened for thyroid goitre.