Aloe vera affects changes induced in pulmonary tissue of mice caused by cigarette smoke inhalation

This study was undertaken to determine the influence of Aloe vera (AV) on changes induced in pulmonary tissue of cigarette smoke (CS) inhaling mice. CS inhalation for 4 weeks caused pulmonary damage as evident by histoarchitectural alterations and enhanced serum and tissue lactate dehydrogenase (LDH) activities. CS inhalation also led to increased mucin production as revealed by mucicarmine and Alcian Blue‐Periodic Acid Schiff (AB‐PAS) staining. Studies on bronchoalveolar lavage fluid (balf) of CS exposed animals revealed structural changes in phospholipids and increase in surface tension when compared with control counterparts. These changes were accompanied by enhanced nitric oxide (NO) levels, citrulline levels, peroxidative damage, and differential modulation of antioxidant defense system. AV administration (seven weeks, 500 mg/kg b.w. daily) to CS inhaling mice led to modulation of CS induced pulmonary changes as revealed by lesser degree of histoarchitectural alterations, lesser mucin production, decreased NO levels, citrulline levels, peroxidative damage, and serum LDH activity. AV treatment to CS inhaling mice was associated with varying response to antioxidant defense system, however balf of CS + AV treated animals did not exhibit appreciable changes when compared with that of CS exposed animals. These observations suggest that AV has the potential to modulate CS induced changes in the pulmonary tissue which could have implications in management of CS associated pulmonary diseases, however, further investigations are required to explore its complete mechanism of action. © 2014 Wiley Periodicals, Inc. Environ Toxicol 30: 999–1013, 2015.     

Role of bronchoalveolar lavage fluid and serum interleukin-27 in the diagnosis of smear-negative pulmonary tuberculosis

Background:To evaluate the value of interleukin (IL)-27 measured in serum and bronchoalveolar lavage fluid (BALF) for the diagnosis of smear-negative pulmonary tuberculosis (TB).Methods:This was a prospective study of patients planned to undergo bronchoscopy at Wuxi No.5 People''s Hospital between January 2017 and September 2018. The patients were grouped as the TB and control groups. BALF and serum IL-27 were measured by ELISA. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value and calculate the optimal cutoff values.Results:There were 40 patients in the control group and 87 in the TB group. In the TB group, 20 had positive sputum smear results and 67 were negative. The area under the ROC curve (AUC) of BALF IL-27 for pulmonary TB was 0.897 (95% CI: 0.830–0.944) (P < .001). The AUC of serum IL-27 for pulmonary TB was 0.703 (95% CI: 0.616–0.781) (P < .001). In patients with negative sputum smear results, the AUCs of BALF IL-27 and serum IL-27 for pulmonary TB was 0.882 (95% confidence interval [CI]: 0.805–0.936) (P < .001) and 0.679 (95% CI: 0.601–0.782) (P < .001), respectively.Conclusions:BALF IL-27 can be used for the diagnosis of pulmonary TB, particularly in those with a negative sputum smear result. Serum IL-27 could be an auxiliary method for TB screening.     

Where is Chlamydophila pneumoniae pneumonia?

BackgroundMolecular diagnostic methods have recently gained widespread use, and consequently, the importance of viral pathogens in community-acquired pneumonia (CAP) has undergone re-evaluation. Under these circumstances, the role of Chlamydophila pneumoniae as a pathogen that causes CAP also needs to be reviewed.MethodsWe reviewed articles that contained data on the frequency of identification of C. pneumoniae pneumonia as a causative pathogen for CAP. The articles were identified by performing a search in PubMed with the keywords “community-acquired pneumonia” and “pathogen”.ResultsSixty-three articles were identified. The reviewed articles demonstrated that the rates of identification of C. pneumoniae as the causative pathogen for CAP were significantly lower in assessments based on polymerase chain reaction (PCR) methods than in those based on serological methods. In some studies, it was possible to compare both serological and PCR methods directly using the same set of samples.ConclusionsThe use of PCR methods, including multiplex PCR assays, has revealed that C. pneumoniae may play a limited role as a pathogen for CAP.     

乌司他丁对体外循环患者肺灌洗液中炎性因子和肺功能的影响

目的:探讨丝氨酸蛋白酶抑制剂乌司他丁对体外循环下心脏直视手术患者肺灌洗液中炎性因子和肺功能的影响。方法:将30例拟行瓣膜置换术患者随机分为乌司他丁组和对照组,各15例。左心室射血分数<0．45、左心室舒张末直径>70 mm、心胸比率>0．7、血流动力学不稳定以及肝、肾功能障碍和急症手术的患者不选。乌司他丁组:在劈胸骨和升主动脉开放前分别给予乌司他丁0．6 KIU／kg;对照组:与乌司他丁组同时点只给予等量生理盐水。在术前和升主动脉开放后30分钟进行右肺中叶灌洗,采集肺灌洗液,用酶联免疫法测定中性粒细胞弹性蛋白酶和白细胞介素-8浓度,并在术前、升主动脉开放后30分钟、2小时和6小时记录呼气末二氧化碳(PETCO2)、采集桡动脉血行血气分析,计算肺功能指标:肺泡-动脉氧分压差[P(A-a)DO2]、氧合指数(PaO2／FiO2)和死腔率(VD／VT)。结果:①对照组肺灌洗液中白细胞介素-8浓度在升主动脉开放后30分钟升高,与术前比较差异有统计学意义(P< 0．05);乌司他丁组肺灌洗液中白细胞介素-8浓度在升主动脉开放后30分钟也较术前升高,但无显著差异(P>0．05),但乌司他丁组低于对照组同时点水平,差异有统计学意义(P<0．05);②对照组体外循环后各时点P(A-a)、DO2、VD／VT均较术前升高。P(A-a)DO2在升主动脉开放后30分钟、升主动脉开放后2小时升高与术前相比有统计学意义(P<0．05), VD／VT在升主动脉开放后30分钟升高达峰值(P<0．05);乌司他丁组在体外循环后各时点P(A-a)DO2、VD／VT也较术前升高,但无显著差异(P>0．05),在升主动脉开放后30分钟均低于对照组,差异有统计学意义(P<0．05);③对照组PaO2／FiO2体外循环后各时点与术前相比均降低,在升主动脉开放后30分钟降到最低值(P<0．05);乌司他丁组PaO2／FiO2在体外循环后各时点也降低,但无显著差异(P>0．05),在升主动脉开放后30分钟显著高于对照组(P<0．05)。结论:体外循环下心脏直视手术可致肺功能损伤,乌司他丁可抑制肺内炎性因子白细胞介素-8和弹性蛋白酶释放而具有肺保护作用。     

经纤维支气管镜局部冲洗治疗支气管扩张症53例报告

目的探讨经纤维支气管镜（以下简称纤支镜）局部灌洗注药治疗支气管扩张症的疗效。方法53例支气管扩张病人除常规治疗外，还采用纤维支气管镜反复气道灌洗和注药，在纤维支气管镜治疗前后常规监测患者临床情况、通气换气功能及血气指标。结果灌洗注药后患者体温迅速下降，外周血白细胞、痰液量明显减少，X线胸片明显改善。灌洗后血气指标（PaO2，SaO2及PaO2／FiO2）改善；肺通气功能检测（VC、FEVI、FEVI％、VS0、V25及MVV）明显改善（P〈0．05）。结论经纤维支气管镜肺泡灌洗和注药能有效清除痰痂和气道分泌物，解除支气管的阻塞，改善患者通气换气功能，是一种安全、简便实用的治疗支气管扩张的有效手段。     

纤维支气管镜肺泡灌洗治疗对急诊重症肺炎合并呼吸衰竭患者血清学指标的影响

目的:研究纤维支气管镜肺泡灌洗治疗对急诊重症肺炎合并呼吸衰竭患者血清学指标的影响.方法:将2012年9月～2014年8月期间我院收治的重症肺炎合并呼吸衰竭患者40例纳入研究,随机分为两组,观察组患者接受纤维支气管镜肺泡灌洗联合常规治疗,对照组患者接受常规治疗,比较两组患者的呼吸功能指标、血清炎症指标以及外周血信号通路.结果:(1)呼吸功能:观察组患者的氧合指数(PaO2/FiO2)、动态顺应性(Cdyn)水平高于对照组,呼吸做功(WOB)水平低于对照组(P＜0.05);(2)炎症指标:观察组患者的CD11b+中性粒细胞比例、可溶性髓系细胞触发受体-1(sTREM-1)、高迁移率族蛋白B1(HMGB 1)含量低于对照组(P＜0.05);(3)信号通路:观察组患者外周血中JAK、PI3K、ERK、JNK、p38、BMK1的mRNA含量低于对照组(P＜0.05).结论:纤维支气管镜肺泡灌洗治疗有助于改善呼吸功能,缓解炎症反应,抑制炎症相关信号通路的激活.     

Diagnostic yield of bronchoscopy with bronchoalveolar lavage in febrile patients with hematologic malignancies and pulmonary infiltrates

Infectious complications are a major cause of morbidity and mortality in immunosuppressed patients. Febrile patients with hematologic malignancies and pulmonary infiltrates have high mortality rates, especially if mechanical ventilation is required. The diagnostic value of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) in these patients is controversial. We retrospectively analyzed the microbiological results of BAL samples obtained during 249 FOB examinations from 199 febrile patients with hematologic malignancies and pulmonary infiltrates (underlying diseases: acute leukemia 103 patients, lymphoma 84 patients, other malignancies 12 patients). Two hundred forty-six examinations could be evaluated. Seventy-three out of 246 BAL samples were sterile; 55 samples showed microbiological findings classified as contamination or colonization. One hundred eighteen samples showed positive microbiological results of bacteria and/or fungi classified as causative pathogens. Thereof, in 70 samples, only bacterial pathogens were detectable (Gram-positive, 35; Gram-negative, 30; mixed Gram-positive and Gram-negative, 5). Thirteen samples showed both fungi and bacterial pathogens. In 33 samples, only fungi were detectable, thereof, in 15 samples Aspergillus species, in 16 samples Candida species, and in 2 both. In two samples, a viral pathogen could be detected. Three nonlethal complications (bleeding, arrhythmia) occurred that required early termination of FOB. In 94 (38.2%) patient episodes, antibiotic treatment was modified as a result of microbiological findings in BAL samples. Our results show that FOB with BAL is a valuable diagnostic tool with low complication rates in high-risk febrile patients with hematologic malignancies and pulmonary infiltrates, contributing crucial results for the individual case, and also improving epidemiologic knowledge.     

New procedure of bronchoalveolar lavage using a balloon catheter in diffuse lung diseases

BackgroundVarious procedures for bronchoalveolar lavage (BAL) have been developed. BAL needs a wedge between the bronchoscope and the inner surface of the bronchus. The feasibility of performing BAL at the targeted position cannot be determined until immediately before the procedure. We examined BAL performed using a balloon catheter to evaluate the stability of the procedure itself and quality of the specimen obtained.MethodsThe main inclusion criteria were diffuse lung disease with a shadow in the B⁵a area. The tip of a disposable balloon catheter was passed through the orifice of the B⁵a bronchus, and the balloon was expanded at the B⁵a bronchus. A 50-mL syringe containing saline was instilled, and gentle hand suction was performed. This procedure was repeated two more times (total: 150 mL).ResultsIn all the 13 patients, the balloon of the catheter was inflated at the B⁵a bronchus. The median recovery rate was 34.92% ± 13.22%. These values were comparable to previously obtained BAL data (control group, N = 56) from our facility. The BAL fluid findings and final diagnosis, with the exception of one undiagnosed case, were consistent. Overall, four patients suffered an adverse event during BAL (hypoxemia). All cases were managed by increasing the oxygen flow rate, and the adverse event did not affect the subsequent examinations.ConclusionsUsing a balloon catheter enabled us to perform BAL at the intended bronchus. The quality of the obtained specimen was also acceptable.     

Acute lung injury due to parvovirus pneumonia

Wardeh A, Marik P, (Department of Critical Care, St. Vincent Hospital, Massachusetts, USA and the University of Massachusetts and Medical Intensive Care Unit St. Vincent Hospital, Massachusetts, USA). Acute lung injury due to parvovirus pneumonia (Case Report). J Intern Med 1998; 244 : 257–60.  

Objective

Human parvovirus B19 is responsible for the common childhood exanthematous illness, erythema infectiosum. Adults infected with B19 have been reported to develop a febrile illness associated with arthritis. Life threatening parvovirus infections in non-immunocompromised adults have not been reported to date. We report a previously healthy middle aged female who developed severe parvovirus pneumonia. The patient recovered with supportive care provided in the ICU. Parvovirus may represent an under diagnosed cause of community acquired pneumonia.     

肺炎支原体肺炎患儿支气管肺泡灌洗液中肺炎支原体耐药基因和13种病原检测结果分析北大核心CSCD

目的:了解肺炎支原体肺炎(MPP)患儿支气管肺泡灌洗液(BALF)中肺炎支原体(MP)耐药基因和13种呼吸道病原的分布情况。方法:回顾性选择2018年1月至2019年1月北京大学第三医院和北京大学第一医院100例MPP患儿的BALF标本,采用荧光定量PCR法检测MP核酸及其耐药基因,采用多重PCR核酸检测技术测定甲型流感病毒、甲型流感病毒H_(1)N_(1)、甲型流感病毒H_(3)N_(2)、乙型流感病毒、人副流感病毒、腺病毒、人博卡病毒、人鼻病毒、肺炎衣原体、人偏肺病毒、MP、人冠状病毒和呼吸道合胞病毒核酸,采用 χ^(2)检验进行分析。 结果:100例BALF标本,荧光定量PCR法检测MP及耐药基因,83例(83.00%)MP阳性,其中78例(93.98%)耐药,均为23S rRNA结构域V区A2063G的点突变。多重PCR法检测13种呼吸道病原,89例(89.00%)阳性。79例(79.00%)检测到MP,其中74例(74.00%)仅检出MP,5例(5.00%)同时检出MP合并其他病原。10例(10.00%)检测出其他病原。0~4岁组病毒检出率高于>4~6岁组( P=0.042)和>6岁组( P=0.002),差异均有统计学意义。 结论:MPP患儿的BALF标本绝大部分可检测到MP,耐药现象严重,以A2063G的点突变为主。少数BALF标本中可检测到其他呼吸道病原和2种或3种病原。