Vincent Heinen

Local and systemic cellular inflammation and cytokine release in chronic obstructive pulmonary disease

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammatory disease caused by repeated exposure to noxious gases or particles. It is now recognized that the disease also features systemic inflammation. The purpose of our study was to compare airway and systemic inflammation in COPD to that seen in healthy subjects and to relate the inflammation with the disease severity. METHODS Ninety-five COPD patients, encompassing the whole severity spectrum of the disease, were recruited from our outpatient clinic and rehabilitation center and compared to 33 healthy subjects. Induced sputum and blood samples were obtained for measurement of inflammatory cell count. Interleukin (IL)-4, IL-6, IL-10, TNF-α and IFN-γ produced by 24h sputum and blood cell cultures were measured. RESULTS Compared to healthy subjects, COPD exhibited a prominent airway neutrophilic inflammation associated with a marked IL-10, IL-6 and TNF-α release deficiency that contrasted with a raised IFN-γ production. Neutrophilic inflammation was also prominent at blood level together with raised production of IFN-γ, IL-10 and TNF-α. Furthermore, sputum neutrophilia correlated with disease severity assessed by GOLD stages. Likewise the extent of TNF-α release from blood cells also positively correlated with the disease severity but negatively with that of sputum cell culture. Blood release of TNF-α and IL-6 negatively correlated with body mass index. Altogether, our results showed a significant relationship between cellular marker in blood and sputum but poor relationship between local and systemic release of cytokines. CONCLUSIONS COPD is characterized by prominent neutrophilic inflammation and raised IFN-γ production at both bronchial and systemic level. Overproduction of TNF-α at systemic level correlates with disease severity and inversely with body mass index.

Effects of a progestogen on normal human breast epithelial cell apoptosis in vitro and in vivo

Many investigators have reported cyclic proliferation of normal human breast epithelial cells. A delicate balance between proliferation and apoptosis (programmed cell death) ensures breast homeostasis. Both the follicular and luteal phases of the menstrual cycle are characterized by proliferation, whereas apoptosis occurs only at the end of the latter phase. In this study, we observed that the withdrawal of a synthetic progestin (nomegestrol acetate or NOMAC), but not continuous treatment with it, induced apoptosis of normal human breast epithelial cells in vitro and in women who applied NOMAC gel to their breasts. Furthermore, this apoptotic response was specific to normal breast cells, since withdrawal of NOMAC did not induce apoptosis of tumoral T47D cells in vitro or of fibroadenoma cells in women. These observations open up new perspectives in the prevention of hyperplasia and breast cancer.

Progesterone Receptor Activation. An Alternative to SERMs in Breast Cancer

Data regarding the effects of progesterone and a progestagen on human normal breast epithelial cell proliferation and apoptosis are presented here. In postmenopausal women, adding progesterone to percutaneously administrated oestradiol significantly reduces the proliferation induced by oestradiol. In vitro and in premenopausal women, stopping the administration of nomegestrol acetate triggers a peak of apoptosis. Fibro-adenoma and cancerous cells do not show this regulation of apoptosis. Progesterone seems to be important in normal breast homeostasis.

Extensive Scalp Necrosis and Subepicranial Abscess in a Patient with Giant Cell Arteritis

To the Editor: Horn and colleagues affirm conventional wisdom that ‘‘nutrition plays an important role in pressure ulcer prevention and healing.’’ The data are actually a bit thin on this issue. Sick people often eat little, lose weight, have low albumin, and get bedsores. The critical question is whether giving them more to eat, whether they are hungry or not, helps with pressure ulcer outcome. The authors had a chance to provide some data on this, although it would be a post hoc analysis, liable to criticism regardless of the findings. Would the authors be willing to report whether the 20.1% of patients who were receiving tube feeding did better than those who were not tube fed with respect to pressure ulcers? Could they do so after adjusting for severity? My guess is that they will find no difference or a worse outcome in the tube-fed patients. I think that what sick people need is careful assistance in eating foods they like and that aggressive provision of food via tube will not reverse the underlying catabolism. If providing adequate nutrition is ineffective, would the authors be willing to question the standard dogma about the relationship between malnutrition and pressure ulcers?

Qualitative study of the expectations regarding a liaison team for patients with severe chronic respiratory diseases (SCRD)

Introduction: The benefits of integrated care are widely demonstrated in the literature. With that aim, the University Hospital of Liege wants to implement a liaison team for SCRD patients. A definition of function is required. Aims: To determine the needs and the expectations of SCRD patients and their healthcare providers. To elaborate a monograph describing the roles and modus operandi of this team. Method: Qualitative study based on an inductive approach using no probability sample. Interviews were conducted on: 3 GPs, 2 visiting nurses, 1 nurse of convalescent home, 9 nurses of the wards, 4 kinesiologists, 1 social worker, 3 pulmonologists, 5 inpatients and 5 outpatients. Results: The results are summarized in 4 axis: relational, organizational, clinical, emotional. We demonstrated communication problems, especially between professional outside and inside the hospital, and a lack of time to achieve a qualitative work. The difficulties and needs are consistent between the interviewed individuals. They suggest the implementation of a liaison team. It would be in charge of functional connections between the SCRD patients and each healthcare provider to improve an individualized support in different fields like patient education, administration (social needs), logistic, care continuum (helpline for patient and professional, telemedicine), but also to develop continued education for healthcare providers. Conclusion: There is a need of a liaison team for respiratory patients in the University Hospital of Liege. The different roles expected by our patients and their healthcare providers has been defined, and fit to the local reality.