Treatment of respiratory failure due to respiratory syncytial virus pneumonia with natural surfactant

We describe two infants suffering from severe pneumonia caused by respiratory syncytial virus (RSV) infection and needing mechanical ventilation with both high ventilator settings and a high fraction of inspired oxygen. The severity of the respiratory failure and the possibility of decreased and/or altered surfactant production led us to treat these infants with intratracheal instillation of natural surfactant. This resulted in an improvement of lung compliance and a decrease in the amount of oxygen required to maintain acceptable oxygen saturations. Intratracheal surfactant instillation might, therefore, be useful in the treatment of severe RSV pneumonia. Pediatr Pulmonol 1996; 22:412–415. © 1996 Wiley-Liss, Inc.     

肺表面活性物质对哮喘小鼠模型树突细胞功能的调节机制

目的: 研究外源性肺表面活性物质对小鼠哮喘模型的免疫调节作用及其对树突细胞(DC)功能的影响.方法:BALB/c小鼠50只,分为3组:哮喘组15只[采用卵蛋白(OVA)致敏和激发]、对照组15只(以生理盐水代替OVA致敏和激发)、治疗组20只[每次OVA激发后10 min以肺表面活性物质(PS) 20 g/L雾化吸入,时间为2,5,10,15和20 min].用HE染色方法评定哮喘模型.分离培养脾脏DC,用流式细胞仪(FACS)检测DC表面共刺激分子CD80的表达变化.取DC培养液3 mL,加入OVA,调整OVA浓度至10 mg/L.分别在2,4,6,12,24 h取DC培养液,1300 r/min离心5 min,取上清液,ELISA法检测IL-12 P70.结果: 哮喘组小鼠的肺组织表现为嗜酸细胞及淋巴细胞浸润为主的炎症变化,治疗组和对照组无此变化.哮喘组DC阳性表达率明显高于治疗组(P<0.01);吸入PS对DC表面共刺激分子的抑制作用在2 min时最强.哮喘组DC上清液IL-12低于治疗组(P<0.01);治疗组DC上清液IL-12可以在高水平维持较长时间,而哮喘组的DC上清液IL-12含量降低,且维持时间较短.结论:小鼠哮喘模型中存在明显的DC功能缺陷;外源性吸入PS,能明显改善DC功能,从而保护哮喘发作时小鼠的肺功能.     

Nucleation of Surfactant–Alkane Mixed Solid Monolayer and Bilayer Domains at the Air–Water Interface

We investigated the wetting transitions of tetradecane and hexadecane droplets in dodecyltrimethylammonium bromide (C12TAB), tetradecyltrimethylammonium bromide (C14TAB), and hexadecyltrimethylammonium bromide (C16TAB) aqueous solutions. By varying the surfactant concentration, the formation of mixed monolayers of a surfactant and an alkane was observed at the air–water interface. Depending on the combination of surfactant and alkane, these wetting monolayers underwent another thermal phase transition upon cooling either to a frozen mixed monolayer (S1) or a bilayer structure composed of a solid monolayer of a pure alkane rested on a liquid-like mixed monolayer (S2). Based on the phase diagrams determined by phase modulation ellipsometry, the difference in the morphology of the nucleated S1 and S2 phase domains was also investigated using Brewster angle microscopy. Domains of the S1 phase were relatively small and highly branched, whereas those of the S2 phase were large and circular. The difference in domain morphology was explained by the competition of the domain line tension and electrostatic dipole interactions between surfactant molecules in the domains.     

Impact of Surfactant and Calcium Sulfate Type on Air-Entraining Effectiveness in Concrete

The paper presents the evaluation of the influence of calcium sulfate on the air void microstructure in concrete and its action mechanism depending on the character of the air-entraining agent. Gypsum dehydration has been previously proven to negatively influence the air void structure of air-entrained concrete. Ettringite, nucleating from tricalcium aluminate and calcium sulfate, influences the adsorption and mode of action of anionic-based polycarboxylate ether admixtures. The authors suspected the admixture’s air-entraining mechanism was also affected by these characteristics. Gypsum dehydration was confirmed to influence the air void structure. In the case of the anionic surfactant, the content of air bubbles smaller than 300 µm was lower compared to cement with gypsum and hemihydrate. On the other hand, the content of air voids with a diameter up to 60 µm, which are the most favorable, was higher. The results obtained led to the conclusion that the mechanism of air entrainment was twofold, and in most cases occurred through the lowering of surface tension and/or through the adsorption of surfactant on cement grains. The adsorptive mechanism was proved to be more effective in terms of the total air content and the structure of the air void system. The results and conclusions of the study provide guidelines to determine the proper surfactant type to reduce the risk of improper air entrainment of concrete, and emphasize the importance of gypsum dehydration of cement in the process of air entrainment.     

Less-invasive surfactant administration (LISA)

Less-invasive surfactant administration (LISA) is a technique whereby surfactant is given via a thin catheter inserted in the trachea. Although some current guidance has been to administer LISA in preterm infants with respiratory distress syndrome (RDS) without endotracheal intubation, the use of LISA differs across the world. The LISA technique allows the infant to remain on non-invasive ventilation support and avoids intubation and therefore mechanical ventilation. Practicalities around the procedure such as the use of premedication or the administration on delivery suite as prophylaxis are yet to be fully studied. Through recent meta-analyses, LISA has been shown to reduce the combined outcome of bronchopulmonary dysplasia (BPD) and mortality in preterm infants. This article summarises the evidence and discusses the practicalities of LISA in a clinical setting.     

Identification of novel prognostic factors focusing on clinical outcomes in patients with non-small cell lung cancer after stereotactic body radiotherapy

Stereotactic body radiotherapy (SBRT) has attracted extensive attention as an effective treatment for patients with early-stage non-small cell lung cancer. However, the factors affecting prognosis after SBRT have not been fully elucidated. The aim of the present study was to investigate the prognostic factors associated with overall survival (OS) and local control (LC) after SBRT. Between March 2003 and March 2020, 497 patients with primary or oligo-metastatic lung cancer who underwent SBRT treatment were retrospectively reviewed. Univariate analysis was performed against various factors related to patient and tumor characteristics using Kaplan-Meier method. Furthermore, the factors with statistically significant differences identified via univariate analysis underwent a stratified Cox proportional hazard regression analysis. The median follow-up period for all patients was 26.17 months (range, 0.36-194.37), and the 5-year OS and LC rates were 66.3 and 86.0%, respectively. Multivariate analysis showed that surfactant protein-D (SP-D), tumor CT values (TCTV) and iodine density values (IDV) were independent prognostic factors for OS, and histology, TCTV and IDV were for LC. Although histology was not selected as a prognostic factor related to OS, it was indicated that patients with squamous cell carcinoma were associated with the SP-D high group compared with the SP-D normal group. In addition, TCTV was correlated to water density values, which tended to decrease with increasing IDV. From these findings, SP-D and TCTV were identified as potential new candidate prognostic factors after SBRT, and it is possible that combining SP-D and histology, and TCTV and IDV may improve the accuracy of prognostic prediction.     

肺表面活性物质相关蛋白-D与肺部天然免疫及临床意义

肺表面活性物质相关蛋白-D（surfactantprotein-D,SP-D）系C型凝集素超家族成员,是肺部重要的天然防御分子。参与病原体的清除和免疫、炎症、过敏反应的调节,与多种人类肺部疾病有关。血清SP-D的水平可作为某些疾病的标志。人工重组的SP-D对新生儿慢性肺病、囊性纤维化和肺气肿有潜在的治疗作用。     

肺泡表面活性物质相关蛋白A在慢性心源性肺水肿大鼠肺组织中的表达

目的观察慢性心源性肺水肿大鼠肺组织病理形态学改变,研究其肺泡表面活性物质相关蛋白A及肺泡灌洗液中TNF-α、IL-1、IL-6的表达,阐述它们在慢性心源性肺水肿发病机制中的作用。方法 14只自发性高血压大鼠高脂饮食饲养1年,建立慢性心源性肺水肿模型,14只血压正常大鼠以正常饮食饲养1年,为正常对照组,分别以免疫组织化学染色检测各组大鼠肺组织中SP-A的表达。RT-PCR法检测各组大鼠肺组织SP-A mRNA的表达,ELISA法检测各组大鼠支气管肺泡灌洗液中TNF-α、IL-1、IL-6的水平。结果试验组肺组织中SP-A mRNA的表达较对照组明显上调(P<0.05),肺泡灌洗液中TNF-α、IL-1、IL-6水平明显高于对照组,差异有统计学意义(P<0.05)。SP-A mRNA表达与支气管肺泡灌洗液中TNF-α、IL-1、IL-6的水平呈显著正相关(r=0.612、r=0.702、r=0.824,P<0.05)。结论慢性心源性肺水肿大鼠的肺组织中SP-A mRNA的表达较对照组明显上调,且与支气管肺泡灌洗液中TNF-α、IL-1、IL-6的水平呈显著正相关。SP-A及TNF-α、IL-1、IL-6均与慢性心源性肺水肿的发生发展过程密切相关,但因果关系不明。