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Background The need to follow a multidisciplinary strategy in chronic obstructive pulmonary disease (COPD) management and rehabilitation in community settings in Greece raises significant questions, given the severe austerity measures being imposed at present. The aim of this study was to investigate the clinical profile of patients with COPD along with the care provided in rural community settings in Greece. Methods Two primary health care centers and 200 newly diagnosed patients over a 12-month period were involved in the study. A self-assessment questionnaire, including questions about smoking habits, the presence of comorbidities and chronic respiratory symptoms, as well as the COPD Assessment Test were used. Spirometry was performed with a dry spirometer. Obstructive spirometry was defined as forced expiratory volume in 1 second/forced vital capacity ratio 10. Conclusion Patients with COPD dwelling in the community exhibit an overall mild-to-moderate type of COPD. General practitioner is in charge of COPD management. Informal caregiving is the major type of home care, with nonfamily members playing a significant role. The patients’ profile permits limited optimism about their future perspective and urges for immediate action at primary care level.

Introduction. Tuberculosis (TB) is a major disease worldwide, caused by Mycobacterium tuberculosis (MTB) infection. The Toll-Like Receptor (TLR) pathway plays a crucial role in the recognition of MTB. Aim. The present study aimed to investigate the involvement of myeloid differentiation primary response protein 88 (MYD88) gene polymorphisms in TB. Materials and Methods. A total of 103 TB cases and 92 control subjects were genotyped for the MYD88 -938C>A (rs4988453) and 1944C>G (rs4988457) polymorphisms. Results. The MYD88 -938CA and -938AA genotypes were associated with an increased risk for tuberculosis with odds ratio (OR) of 5.71 (95% confidence intervals [CIs] 2.89–11.28, p = 0.01). Conclusions. The MYD88 -938C>A genetic polymorphism is associated with increased susceptibility to TB and may serve as a marker to screen individuals who are at risk.

Current studies have not yet reached a definitive conclusion on the effects of singing and playing wind instruments professionally on an individual's respiratory function.The purpose of this study was to investigate the respiratory function of wind instrument players and opera singers in comparison with a group of healthy individuals.The experimental group comprised 45 men and 35 women, 58 opera singers and vocal soloists in total and 22 wind instruments players. Eighty controls were all non-smokers, healthy individuals, matched for age and sex. Spirometry was performed with a dry spirometer, according to the American Thoracic Society recommendations.The mean age of the experimental group was 47.9 (15.5) years for men and 46.6 (16.8) for women. Experimental group and controls differed (p0.01) in FVC [%predicted values: 98.69±13.07 vs 89.62±14.01 (men), 104.2±17.7 vs 93.8±13.9 (women)], FEV1[% predicted values: 98.69±13.07 vs 89.62±14.01 (men), 104.2±17.7 vs 93.8±13.9 (women)] and in PEFR values (p=0.001). [100.4±18.8 vs 76.7±19.8 (men)]. FEV1/FVC ratio significant differences were detected only in women (p=0.001, for predicted values).The findings of the present study provide evidence that professional involvement with wind musical instrument or monody might have beneficial effects on respiratory function. Future therapeutic perspectives, and associations between a documented improved respiratory function and performance by the musician should be examined.

Mesothelium is an important part of the peritoneal barrier for water and ion transport, essential for effective peritoneal dialysis (PD). Peritoneal fibrosis has been associated with PD treatment failure. Endothelin-1 (ET-1) is a potent vasoactive peptide, involved in pathologic fibrotic processes. Its action is mediated mainly by endothelin type A (ETA ) and type B (ETB ) receptors. The aim of this study was to investigate, by Ussing chamber experiments, the effect of ET-1 on the transmesothelial electrical resistance (RTM ) of the isolated visceral sheep peritoneum. Intact sheets of visceral peritoneum were obtained from 40 adult sheep and mounted in Ussing-type chambers. ET-1 (10(-7) M), BQ-123 (ETA receptor antagonist; 10(-6) M), BQ-788 (ETB receptor antagonist; 10(-6) M), and their combinations were added on the apical and the basolateral side of the peritoneum. RTM was measured before and serially after addition of the substances, and changes were registered as percentage (ΔRTM %). RTM increased within 1 min after addition of ET-1 apically (ΔRTM 65.03 ± 15.87%; P 0.05) or basolaterally (ΔRTM 85.5 ± 20.86%; P 0.05). BQ-123 and BQ-788 and their combination significantly reduced (P 0.05) the effect of ET-1 to a similar degree in all cases. These results clearly indicate that ET-1 reduces ionic permeability of the visceral sheep peritoneum in vitro. Additionally, it is obvious that this inhibitory effect is mediated through both ETA and ETB receptors.

Snoring is the most characteristic symptom of obstructive sleep-disordered breathing (SDB) and recurrent wheezing is the most common clinical manifestation of asthma. The purpose of the present review is to outline the impact of SDB and recurrent wheezing/asthma on sleep quality and to summarize the epidemiologic and pathophysiologic evidence supporting an association between the two disorders. Enlarged tonsils and adenoid or obesity predispose to obstructive sleep apneas and hypopneas which are accompanied by arousals, restless sleep, and frequently daytime sleepiness, inattention, hyperactivity, and academic difficulties. Subjects with history of wheezing are also at risk for sleep disturbance and daytime cognitive dysfunction. Asthmatic children have more frequent snoring, apneas, and hypopneas during sleep than non-asthmatic subjects and tonsillar hypertrophy mediates at least in part this epidemiologic association. In addition, preliminary evidence indicates that treatment of sleep apnea with adenotonsillectomy results in improved control of coexisting asthma. Elevated concentrations of leukotrienes and oxidative stress markers have been detected in the exhaled breath condensate of children with asthma and probably contribute to bronchoconstriction. Moreover, sleep apneic children have increased expression of leukotrienes and leukotriene receptors in adenotonsillar tissue. Viral respiratory infections may induce inflammation and oxidative stress in the asthmatic airway enhancing not only bronchospasm, but also biosynthesis of leukotrienes within pharyngeal lymphoid tissues, which promote adenotonsillar enlargement and sleep apnea. In conclusion, taking under consideration the epidemiologic association between obstructive SDB and asthma, when one of the two disorders is diagnosed, the possibility of the other disease being present should be entertained. Pediatr. Pulmonol. 2011; 46:1047-1054. © 2011 Wiley Periodicals, Inc.

Nocturnal urinary sodium excretion is related to blood pressure (BP) levels. Elevated BP and increased nocturnal natriuresis have been demonstrated in adults with sleep apnea. Although evidence indicates increased BP in children with obstructive sleep-disordered breathing (SDB), it is unknown whether these children have also enhanced urinary sodium excretion.To evaluate the effects of SDB and morning BP on urinary sodium excretion.Consecutive children with snoring (n = 95) underwent polysomnography and morning BP measurement. Fractional excretion of sodium (FE(Na)) was the primary outcome measure and was calculated using sodium and creatinine concentrations in early morning serum and urine specimens.Subjects with moderate-to-severe SDB had similar log-transformed FE(Na) to that of children with mild SDB and higher than children with primary snoring: -0.13 ± 0.53 versus -0.28 ± 0.41 versus -0.61 ± 0.65 (P = 0.657 and P = 0.003). Obstructive apnea-hypopnea index was significantly related to FE(Na) after adjustment for age, gender and body mass index z-score (P = 0.002). Children with moderate-to-severe SDB had similar systolic BP z-scores to those of subjects with mild SDB and higher than participants with primary snoring: 0.7 ± 1.2 versus 0.1 ± 1.0 versus -0.02 ± 1.0 (P = 0.074 and P = 0.046). In addition, participants with diastolic BP z-scores in the upper quartile of measured values had higher FE(Na) than subjects with z-scores in the lower quartiles: -0.08 ± 0.39 versus -0.41 ± 0.57 (P = 0.007).Morning natriuresis is related to severity of SDB in children and this association may be mediated in part by elevated BP.

The peritoneal mesothelium is a barrier to ion transport in peritoneal dialysis. Cimetidine is an H2 receptor antagonist and a potent inhibitor of Na+/H+ antiporter, which is found in the plasma membranes of various cell types, including mesothelial cells. Recent reports linked Na+/H+ antiporter stimulation with increasing peritoneal fibroblast proliferation. The aim of the present study was to investigate by means of Ussing chamber experiments the effect of cimetidine on the transmesothelial electrical resistance (R) of isolated visceral sheep peritoneum. Peritoneal samples obtained from adult sheep were collected from the slaughterhouse and transferred in oxygenated Krebs-Ringer bicarbonate (KRB) solution to the laboratory within 30 minutes of the animal's death. The peritoneal tissue was transferred in a cooled KRB solution (4 degrees C, pH 7.5) bubbled with 95% O2/5% CO2. A planar sheet of the visceral peritoneum was mounted in an Ussing-type chamber and cimetidine (10(-3) mol/L) was added to the solution on the apical and basolateral sides. The R was measured before and for 15 minutes serially after addition of the cimetidine. Results presented are the means +/- standard error of the mean of 12 experiments. Addition of cimetidine basolaterally induced, within 1 minute, an increase in the deltaR of 35.97% +/- 12.01% (p0.05), which returned to baseline after 15 minutes. The action of cimetidine on the apical side of the membrane was similar, with a rapid rise in the deltaR of 47.3% +/- 16.4% (p0.05) and a subsequent decline to control values. The R is inversely correlated with membrane permeability. The results of the present study indicate a rapid action of cimetidine on the permeability of visceral sheep peritoneum, probably through inhibition of mesothelial Na+/H+ antiporter. The increase in R observed after addition of the cimetidine clearly indicates the existence of Na+/H+ antiporter on both sides of visceral sheep peritoneum. The clinical implications of our results should be further investigated.

Aldosterone is a key component of the renin-angiotensin-aldosterone system, and spironolactone, an aldosterone receptor blocker, shows beneficial effects in patients with end-stage renal disease and heart failure. The aim of the present study was to investigate by means of Ussing chamber technique the effect of spironolactone on the transmesothelial permeability of visceral sheep peritoneum in vitro. Peritoneal samples from the omentum of adult sheep were collected immediately after slaughter in a cooled and oxygenated Krebs-Ringer bicarbonate (KRB) solution. Isolated intact sheets of peritoneum were mounted in an Ussing-type chamber. Spironolactone (10(-5) mol/L) was added apically and basolaterally to the KRB solution. The transmesothelial resistance (R) was measured before and serially for 30 minutes after the addition of the substances. Data present the mean +/- standard error of 6 experiments in each case. The control R was 19.8 +/- 0.36 omega x cm2. The addition of spironolactone resulted in a reduction in the R, which became significant on both sides of the membrane within 10 minutes and remained significantly different thereafter. The maximum reduction of R (deltaR%) reached 24.8% +/- 2.3% (p0.01) apically and 26.3% +/- 3.2% (p0.01) basolaterally. Our data clearly show that spironolactone increases the permeability of visceral sheep peritoneum in a lasting manner. Increased peritoneal permeability could result in increased sodium removal, which has acknowledged beneficial effects both in patients undergoing peritoneal dialysis and in patients with heart failure. Further clinical studies investigating the effect of spironolactone on sodium removal in peritoneal dialysis are justified.

The mesothelium is part of the peritoneal barrier that manages the water and ion transport essential for peritoneal dialysis (PD) treatment. In addition, it has a central role in the pathogenesis of peritoneal fibrosis and the resulting ultrafiltration failure observed in many PD patients. Endothelin-1 (ET-1) is a potent vasoactive peptide originally described as an endothelial cell-derived factor In addition, ET-1 has been shown to stimulate fibrogenic activity in various organs by regulating the production and turnover of matrix components. The aim of the present study was to investigate, by means of Ussing chamber experiments, the effect of ET-1 on the transmesothelial electrical resistance (RTM) of isolated visceral sheep peritoneum. Intact sheets of visceral sheep peritoneum were obtained from 12 adult sheep. The samples were collected from the slaughterhouse immediately after the deaths of the animals and, within 30 minutes, were transferred in oxygenated Krebs-Ringer bicarbonate (KRB) solution at 4 degrees C to the laboratory to be mounted in an Ussing-type chamber. Endothelin-1 (10(-7) mol/L) was then added to the KRB solution apically or basolaterally, and the RTM was measured before and serially for 10 minutes after the addition of the ET-1. The control RTM (before addition of ET-1) was 22.8 +/- 0.56 Omega x cm2. Addition of ET-1 apically significantly increased the RTM by 63.82% +/- 16.93% (p0.05) within 1 minute. After addition of ET-1 basolaterally, the RTM also increased significantly by 90.91% +/- 57.31% within 1 minute (p0.05). In both cases, these values persisted throughout the experiment. These results clearly indicate an inhibitory effect of ET-1 on the ionic permeability of visceral sheep peritoneum. The rapid increase in RTM observed after the addition of ET-1 suggests the existence of endothelin receptors (ET-A or ET-B, or both) on visceral sheep peritoneum. Previous studies demonstrated that ET-1, acting on ET-B receptors, potently inhibits epithelial sodium channels in mammalian cell cultures. Nevertheless, the exact pathways that underlie these findings remain unclear; their elucidation requires further investigation.

The peritoneal mesothelium is one of the main barriers to ion transport in peritoneal dialysis. In a previous study, we showed the existence of a micro-opioid influence on the in vitro ionic permeability of serosal membranes (specifically, pleura and pericardium), which become less permeable to ionic currents after the action of morphine. In the present study, we used Ussing chamber experiments to investigate the effect of morphine on the transmesothelial electrical resistance (RTM) of isolated parietal sheep peritoneum. Peritoneal samples from the diaphragm of adult sheep were isolated directly after the death of the animals and were transferred to the laboratory within 30 minutes in a cooled Krebs-Ringer bicarbonate solution (4 degrees C, pH 7.5) bubbled with 95% O2/5% CO2. A planar sheet of parietal peritoneum was mounted in an Ussing-type chamber and morphine (10(-9) mol/L) was added apically and basolaterally. The RTM was measured before and serially for 30 minutes after the addition of morphine. Because active ion transport is temperature dependent, the Ussing chamber was held at 37 degrees C. Results presented are the mean +/- standard error of 6 experiments. The control RTM (before the addition of morphine) was 20.26 +/- 0.57 Omega x cm2. Addition of morphine basolaterally induced, within 1 minute, an increase in RTM of 24% +/- 4.8%, which declined thereafter (p0.01). When morphine was added apically, the results were not similar, because no significant change occurred in the RTM. The RTM is an established surrogate of peritoneal permeability. The results of the present study indicate rapid action of basolaterally added morphine on the permeability of the parietal peritoneum. The observed increase in the RTM indicates the existence in the parietal peritoneum of micro-opioid receptors that seem to prevail basolaterally. The clinical implications of these results should be further investigated.

The permeability for small solutes and the ultrafiltration capacity of the peritoneum are essential for effective peritoneal dialysis (PD) treatment. Elucidation of the factors that regulate these two properties is therefore of great importance. Ouabain, a potent inhibitor of the Na+-K+ pump has been shown to reduce fluid absorption in animal models of PD. In the present study, we used Ussing chamber experiments to investigate the effect of ouabain on the transmesothelial electrical resistance (RTM) of isolated visceral sheep peritoneum. Peritoneal samples from the omentum of adult sheep were isolated immediately after the deaths of the animals and were transferred to the laboratory in cooled Krebs-Ringer bicarbonate solution (4 degrees C, pH 7.5) bubbled with 95% O2/5% CO2. A planar sheet of visceral peritoneum was mounted in an Ussing-type chamber, and ouabain (10(-3) mol/L) was added apically and basolaterally. The RTM was measured before and serially for 30 minutes after the addition of ouabain. Because active ion transport is temperature-dependent, all measurements were taken at 37 degrees C. The results presented are the mean +/- standard error of 6 experiments. Before the addition of ouabain, the control RTM was measured as 21.26 +/- 0.57 Omega x cm2. Addition of ouabain basolaterally induced an increase in the RTM to 27.62 +/- 0.72 Omega x cm2 within 1 minute (p0.05), and this level persisted throughout the experiment. The effect of ouabain, when added apically, was similar, characterized by a rapid rise in the RTM to 24.66 +/- 0. 76 Omega x cm2 at 1 minute (p0. 05), with subsequent persistence at that level. A clear association between RTM and active ion transport has been shown in previous studies. The results of the present study, showing a rapid effect of ouabain on the RTM of visceral peritoneum, therefore clearly suggest that cell membrane Na+K+-ATPase is important for peritoneal ionic transport. In addition, ouabain was previously shown to reduce vasodilation and intraperitoneal sodium or to increase intraperitoneal volume, especially in the presence of conventional acidic solutions. Those findings, combined with the results of the present study, clearly indicate that intraperitoneal administration of digitalis glycosides may have some beneficial effect in PD patients; however the specific clinical implications need further investigation.

The peritoneal mesothelium is a barrier to ion transport in peritoneal dialysis. In this study, we used Ussing-chamber experiments to investigate the effect of HgCl2, an aquaporin-1 inhibitor, on the transmesothelial electrical resistance (RTM) of isolated sheep parietal peritoneum. Peritoneal samples from the diaphragm of adult sheep were isolated immediately after the death of the animal and were transferred within 30 minutes to the laboratory in a cooled Krebs-Ringer bicarbonate solution (4 degrees C, pH 7.5) bubbled with 95% O(2)/5% CO2. A planar sheet of the parietal peritoneum was mounted in an Ussing-type chamber and HgCl2 (10(-4) mol/L) was added apically or basolaterally. The RTM was measured before and serially after the addition of the HgCl2. The entire experimental apparatus was held at 37 degrees C, because active ion transport is temperature-dependent. The results presented are the mean +/- standard error of 12 experiments. The control RTM (that is, before the addition of HgCl) was 19.3 +/- 0.38 omega x cm2. Addition of HgCl2 apically induced a decrease in the RTM to 16.25 +/- 0.86 omega x cm2 within 1 minute. When added basolaterally, HgCl2 action was similar, with a rapid reduction in the RTM to 18.1 +/- 0.51 omega x cm2 (p0.05). A clear association between the RTM and the active transmesothelial ion transport was shown in previous studies. In the present study, rapid action of HgCl2 on the permeability ofthe parietal peritoneum was observed, resulting in a reduction in the RTM Taken together, these findings indicate that inhibition of aquaporin-1 alters the ionic permeability of the parietal peritoneal membrane.

The peritoneal mesothelium is a barrier to ion transport in peritoneal dialysis. In the present study, we used Ussing chamber experiments to investigate the effect of amiloride on the transmesothelial electrical resistance (R(TM)) of isolated visceral sheep peritoneum. Peritoneal samples from the omentum of adult sheep were isolated directly after the death of the animals and were transferred to the laboratory within 30 minutes in a cooled Krebs-Ringer bicarbonate solution (4 degrees C, pH 7.5) bubbled with 95% O2/5% CO2. A visceral peritoneal planar sheet was mounted in an Ussing-type chamber and amiloride (10(-3) mol/L) was added apically and basolaterally. The R(TM) was measured before and serially for 30 minutes after the addition of amiloride. Because active ion transport is temperature dependent, the Ussing chambers were held at 37 degrees C. The results presented are the means + standard error of 12 experiments. The control R(TM) (before the addition of amiloride) was 21.86 +/- 0.46 omega x cm2. Basolateral addition of amiloride induced, within 1 minute, an increase in R(TM) to 27.26 +/- 0.39 omega x cm2, a level that persisted throughout the experiment. When amiloride was added apically, the results were similar with a rapid rise of R(TM) to 24.18 +/- 0.9 omega x cm2 and subsequent value persistence (p0.05). A clear association between R(TM) and active ion transport was shown in previous studies. The results of the present study indicate rapid action of amiloride on the permeability of the visceral peritoneum. The observed increase in the R(TM) indicates the existence of amiloride-sensitive sodium channels in the visceral peritoneal membrane. The clinical implications of these results should be further investigated.

The possible causes and genetic mechanisms of pulmonary carcinoid tumor development are unclear. In this study, we examined genetic alterations at the MEN1 locus in archival material from 15 pulmonary carcinoids. We employed, for the first time in this setting, real-time PCR with melting curve analysis in order to identify loss of heterozygosity (LOH) or microsatellite instability (MI) in two polymorphic markers (PYGM, D11S449) at the MEN1 locus and one additional marker (D11S906) of a putative oncosuppressive region distal to the MEN1 gene. Sequencing data were available in a selected subset of tumors in order to verify the reliability of real-time PCR analysis. We observed LOH at PYGM in 38% of the cases and MI in 13.3% of the cases. Our data indicate that real-time PCR with melting curve analysis is a reliable technique for LOH and MI detection and indicate that genetic errors at the MEN1 locus but also distal to it may be involved in the development of sporadic pulmonary carcinoid tumors.

The peritoneal mesothelium is a barrier to ion transport in peritoneal dialysis. In the present study, we investigated, by means of Ussing chamber experiments, the effect of adrenaline on the electrical transepithelial resistance (R(TE)) of isolated visceral sheep peritoneum. Peritoneal samples from the omentum of adult sheep were isolated within 30 minutes of the animal's death and were transferred to the laboratory in a cooled Krebs-Ringer bicarbonate solution (4 degrees C, pH 7.5) bubbled with 95% O2/5% CO2. A visceral peritoneal planar sheet was mounted in an Ussing-type chamber and adrenaline (10(-7) mol/L) was added to the apical and the basolateral side in turn. We measured R(TE) before and serially for 30 minutes after addition of the adrenaline. Because active ion transport is temperature-dependent, all experiments were performed at 37 degrees C. All results are presented as mean and standard error (x +/- SE) of 6 experiments. The control R(TE0 (before adrenaline) was 20.05 +/- 0.61 omega x cm2. Within 1 minute after the addition of adrenaline to the basolateral side of the membrane, R(TE) increased to 21.8 omega x cm2, a rate that thereafter progressively decayed, returning to the control value. Adrenaline action on the apical side of the membrane was similar, with a rapid rise of R(TE) to 22.5 omega x cm2 and a subsequent decrease (p0.05). Previous studies provide evidence for a clear association between R(TE) and active ion transport. The results of the present study indicate rapid action of adrenaline on the permeability of the visceral peritoneum.

Medical education in Greece is government-funded by constitution. Tuition fees are therefore not payable by students. This investigation aims to identify the sources of income of medical students in Greece.This is a questionnaire-based analysis of a sample of 488 students who were asked to state their sources of income.Mean contributions to total student income are parental financial support (93.2%), part-time employment (2.4%), scholarships (2.5%) and other sources including loans (1.9%).The income of medical students in Greece is mostly dependent on parental contributions. Other sources do not represent popular options. This situation differs to that in other countries, where loans make significant contributions to the total income of medical students.