Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability internationally. Alveolar hypoxia and consequent hypoxemia increase in prevalence as disease severity increases. Ventilation/perfusion mismatch resulting from progressive airflow limitation and emphysema is the key driver of this hypoxia, which may be exacerbated by sleep and exercise. Uncorrected chronic hypoxemia is associated with the development of adverse sequelae of COPD, including pulmonary hypertension, secondary polycythemia, systemic inflammation, and skeletal muscle dysfunction. A combination of these factors leads to diminished quality of life, reduced exercise tolerance, increased risk of cardiovascular morbidity, and greater risk of death. Concomitant sleep-disordered breathing may place a small but significant subset of COPD patients at increased risk of these complications. Long-term oxygen therapy has been shown to improve pulmonary hemodynamics, reduce erythrocytosis, and improve survival in selected patients with severe hypoxemic respiratory failure. However, the optimal treatment for patients with exertional oxyhemoglobin desaturation, isolated nocturnal hypoxemia, or mild-to-moderate resting daytime hypoxemia remains uncertain.

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BackgroundThe alarmin cytokines IL-25 and IL-33 are key promoters of type 2 inflammation. Basophils respond to alarmin cytokines, however the relationship of these cytokines with basophil activation and recruitment in human studies of allergic asthma has not been well characterized. This study investigated the effect of IL-25 and IL-33 on basophils in a model of allergic asthma.Methods10 mild allergic asthmatics underwent allergen and diluent inhalation challenges. Bone marrow aspirates were collected at pre-challenge and 24 h (h) post challenge. Peripheral blood and sputum samples were collected at pre-challenge, 7 h, and 24 h post-challenge to measure basophil expression of IL-17RB, ST2, and intracellular IL-25. Freshly isolated peripheral blood basophils from allergic donors were incubated overnight with IL-25 and IL-33, or sputum supernatant collected post-allergen to assess pro-inflammatory effects of mediators released in the airways.ResultsThere were increased percentage of basophils expressing IL-17RB, ST2, and intracellular IL-25 collected from bone marrow, peripheral blood, and sputum after allergen inhalation challenge. In vitro stimulation with IL-25 and IL-33 increased the percentage of basophils expressing intracellular type 2 cytokines and surface activation markers, and primed eotaxin-induced migratory potential of basophils, which was mediated directly through IL-17RB and ST2, respectively. Stimulation of basophils with sputum supernatants collected post-allergen challenge up-regulated the percentage of basophils expressing markers of activation and intracellular type 2 cytokines, which was reversed following blockade of the common β chain (βc).ConclusionsOur findings indicate that the alarmin cytokines IL-33 and IL-25 increase basophil activation and migratory potential, and may pose as a novel therapeutic targets for the treatment of allergic asthma.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-016-0321-z) contains supplementary material, which is available to authorized users.

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Object The pediatric neurosurgery practice over 2 years was reviewed at a tertiary neurosciences center. The intention was to establish the frequency of unplanned reoperations at the center, investigate the factors responsible, and consider using unplanned reoperations as a quality indicator. Methods All pediatric neurosurgical operations done between January 2008 and January 2010 were reviewed using data from operation theater logs and hospital records. Data were recorded as per the standard requirements of the Society of British Neurological Surgeons for incorporation into the national database. “Unplanned reoperation” was defined as any unscheduled secondary procedure required for a complication resulting directly or indirectly from the index operation or as an unscheduled return to the operating theater for the same condition. Operations were defined as “urgent” if they had to be performed out of hours (that is, outside the hours of 8:00 a.m. to 5:00 p.m.), “emergency elective” if they were included on the emergency list but within working hours, and “routine elective” if they were on the scheduled operations list. Both overall and 30-day unplanned reoperation rates were considered. Factors influencing unplanned reoperations were explored using a logistic regression model. Results Four hundred ten operations were analyzed. The overall unplanned reoperation rate was 28%. The median time to an unplanned reoperation was 9 days. Risk factors for unplanned reoperations included a CSF diversion procedure (OR 7, p < 0.0001) and an urgent procedure (OR 2.5, p = 0.02, higher unplanned reoperations for urgent procedures relative to routine electives). The 30-day unplanned reoperation rate was 17%. Urgent cases composed 32% of all operations. Trainees performed 52% of the urgent operations. Forty-four percent of all operations were related to CSF diversion. Sixty-four percent of patients had reoperations during the course of the study period, and 44% of these reoperations were unplanned. Conclusions An unplanned return to the operation theater is common in the authors' pediatric neurosurgical practice and is procedure specific. Unplanned reoperation rates may be useful for monitoring quality across hospitals and identifying opportunities for quality improvement. The authors propose the use of this index as a quality indicator and advocate its validation in a prospective multicenter study.

Rapid needle-out patient-rollover time during percutaneous CT-guided transthoracic lung biopsy reduces the rate of overall pneumothorax and pneumothorax necessitating a drainage catheter. Use of this technique attenuates the influence of traditional risk factors for pneumothorax.