Subscribe: pubmed: 1073-449X
http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=00KaQC4svDBoCmEttsNSWu82uCxPJQr7JEIhoCQBrZ9
Preview: pubmed: 1073-449X

pubmed: 1073-449X



NCBI: db=pubmed; Term=1073-449X



 



Corticosteroid Therapy for Critically Ill Patients with the Middle East Respiratory Syndrome.

Corticosteroid Therapy for Critically Ill Patients with the Middle East Respiratory Syndrome.

Am J Respir Crit Care Med. 2017 Nov 21;:

Authors: Arabi YM, Mandourah Y, Al-Hameed F, Sindi AA, Al Mekhlafi GA, Hussein MA, Jose J, Pinto R, Al-Omari A, Kharaba A, Almotairi A, Al Khatib K, Alraddadi B, Shalhoub S, Abdulmomen A, Qushmaq I, Mady A, Solaiman O, Al-Aithan AM, Al-Raddadi R, Ragab A, Balkhy HH, Al Harthy A, Deeb AM, Al Mutairi H, Al-Dawood A, Merson L, Hayden FG, Fowler RA, Saudi Critical Care Trial group

Abstract
RATIONALE: Corticosteroid therapy is commonly used among critically ill patients with the Middle East Respiratory Syndrome (MERS), but its impact on outcomes is uncertain. Analyses of observational studies often do not account for patients' clinical condition at the time of corticosteroid therapy initiation.
OBJECTIVES: To investigate the association of corticosteroid therapy on mortality and on MERS coronavirus RNA clearance in critically ill patients with MERS.
METHODS: MERS ICU patients were included from 14 Saudi Arabian centers between September 2012 and October 2015. We carried out marginal structural modeling to account for baseline and time-varying confounders.
MEASUREMENTS AND MAIN RESULTS: Of 309 patients, 151 received corticosteroids. Corticosteroids were initiated at a median of 3.0 days (Quartile Q1, 3: 1.0, 7.0) from ICU admission. Patients who received corticosteroids were more likely to receive invasive ventilation (141/151 [93.4%] vs. 121/158 [76.6%], p≤0.0001) and had higher 90-day crude mortality (112/151 [74.2%] vs. 91/158 [57.6%], p=0.002). Using marginal structural modeling, corticosteroid therapy was not significantly associated with 90-day mortality (adjusted odds ratio 0.75, 95% CI 0.52, 1.07, p=0.12), but was associated with delay in MERS coronavirus RNA clearance (adjusted hazard ratio 0.35, 95% CI: 0.17, 0.72, p=0.005).
CONCLUSIONS: Corticosteroid therapy in patients with MERS was not associated with a difference in mortality after adjustment for time-varying confounders, but was associated with delayed MERS coronavirus RNA clearance. These findings highlight the challenges and importance of adjusting for baseline and time-varying confounders when estimating clinical effects of treatments using observational studies.

PMID: 29161116 [PubMed - as supplied by publisher]




B Cells Producing Type I Interferon Modulate Macrophage Polarization in Tuberculosis.

B Cells Producing Type I Interferon Modulate Macrophage Polarization in Tuberculosis.

Am J Respir Crit Care Med. 2017 Nov 21;:

Authors: Bénard A, Sakwa I, Schierloh P, Colom A, Mercier I, Tailleux L, Jouneau L, Boudinot P, Al-Saati T, Lang R, Rehwinkel J, Loxton AG, Kaufmann SH, Anton-Leberre V, O'Garra A, Del Carmen Sasiain M, Gicquel B, Fillatreau S, Neyrolles O, Hudrisier D

Abstract
RATIONALE: In addition to their well-known function as antibody-producing cells, B lymphocytes can markedly influence the course of infectious or non-infectious diseases via antibody-independent mechanisms. In tuberculosis, B cells accumulate in lungs, yet their functional contribution to the host response remains poorly understood.
OBJECTIVES: To document the role of B cells in tuberculosis in an unbiased manner.
METHODS: We generated the transcriptome of B cells isolated from Mycobacterium tuberculosis (Mtb)-infected mice, and validated the identified key pathways using in vitro and in vivo assays. The obtained data were substantiated using B cells from pleural effusion of tuberculosis patients.
MEASUREMENTS AND MAIN RESULTS: B cells isolated from Mtb-infected mice displayed a STAT1-centered signature, suggesting a role for interferons in B cell response to infection. B cells stimulated in vitro with Mtb produced type I interferon, via a mechanism involving the innate sensor STING, and antagonized by MyD88 signaling. In vivo, B cells expressed type I interferon in the lungs of Mtb-infected mice and, of clinical relevance, in pleural fluid from patients with tuberculosis. Type I interferon expression by B cells induced an altered polarization of macrophages towards a regulatory/anti-inflammatory profile in vitro. In vivo, increased provision of type I interferon by B cells in a murine model of B cell-restricted Myd88-deficiency correlated with an enhanced accumulation of regulatory/anti-inflammatory macrophages in Mtb infected lungs.
CONCLUSION: Type I interferon produced by Mtb-stimulated B cells favors macrophage polarization towards a regulatory/anti-inflammatory phenotype during Mtb infection.

PMID: 29161093 [PubMed - as supplied by publisher]




E-Cigarettes: Mucus Measurements Make Marks.

E-Cigarettes: Mucus Measurements Make Marks.

Am J Respir Crit Care Med. 2017 Nov 21;:

Authors: Evans CM, Dickey BF, Schwartz DA

PMID: 29161057 [PubMed - as supplied by publisher]




Reply to: Exosome Treatment of Bronchopulmonary Dysplasia. How Pure Should Your Exosome Preparation Be?

Reply to: Exosome Treatment of Bronchopulmonary Dysplasia. How Pure Should Your Exosome Preparation Be?

Am J Respir Crit Care Med. 2017 Nov 21;:

Authors: Mitsialis SA, Willis GR, Fernandez-Gonzalez A, Kourembanas S

PMID: 29160730 [PubMed - as supplied by publisher]




Gene-environment Interactions Associated with the Severity of Acute Asthma Exacerbation in Children.

Gene-environment Interactions Associated with the Severity of Acute Asthma Exacerbation in Children.

Am J Respir Crit Care Med. 2017 Nov 21;:

Authors: Kantor DB, Phipatanakul W, Hirschhorn JN

PMID: 29160726 [PubMed - as supplied by publisher]




Exosome Treatment of Bronchopulmonary Dysplasia. How Pure Should Your Exosome Preparation Be?

Exosome Treatment of Bronchopulmonary Dysplasia. How Pure Should Your Exosome Preparation Be?

Am J Respir Crit Care Med. 2017 Nov 21;:

Authors: Muraca M, Zaramella P, Porzionato A, Baraldi E

PMID: 29160724 [PubMed - as supplied by publisher]