Adsorption of Surfactant to Bronchial Epithelium: Possible Role of Receptor ‘Unmasking’ in Asthma

Background.?In a recent study in animals it has been shown how surface-active phospholipid (SAPL) in the form of a commercially available micronized (5 µmφ) dry powder (ALEC^T/Pumactant^T) was able to reduce afferent neural feedback to the brainstem in response to a methacholine challenge by the same order of magnitude as drugs commonly prescribed for asthma. The underlying theory assumed that adsorption of SAPL to bronchial epithelium masked irritant receptors eliciting the bronchoconstrictor reflex, thus providing a barrier to noxious stimuli entering the lungs. Objective.?To test the underlying assumption that SAPL was actually adsorbed (i.e., bound to bronchial epithelium), especially the major and most surface-active component of lung surfactant, namely dipalmitoyl phosphatidylcholine (DPPC). A secondary objective was to investigate any role of phosphatidylglycerol (PG) in promoting the adsorption of DPPC. Methods.?Radiolabeled DPPC dispersed ultrasonically in saline was used to incubate excised sections of porcine bronchial epithelium. The adsorbed DPPC was then quantified by rigorously rinsing the tissue of adhering fluid and then digesting it for β-scintillation counting. Each test (n = 8 runs) was repeated for ratios of DPPC:PG of 9:1, 7:3 (as per ALEC^T/Pumactant^T) and 1:1 for both dipalmitoyl PG (DPPG) and EggPG (as incorporated in ALEC^T/Pumactant^T). Results.?Despite rigorous rinsing postincubation, bronchial epithelium was found to adsorb DPPC at a level roughly equivalent to one close-packed monolayer; whereas both DPPG and EggPG promoted the adsorption of DPPC in a dose-dependent manner, reaching an approximate threefold increase for 7:3 DPPC:PG. Conclusion.?DPPC adsorbs to bronchial epithelium in amounts necessary for the masking of receptors, and this adsorption (probably chemisorption) is quite strongly promoted by PG either in its indigenous state (DPPG) or in the form (EggPG) used in ALEC^T to suppress the sensitivity of bronchial irritant receptors in our previous study and in clinical trials just completed.     

Intraoperative bronchial blood flow evaluation using indocyanine green fluorescence for bronchoplasty: A case report

Introduction and importanceBlood flow evaluation of bronchial arteries using indocyanine green fluorescence (ICG-FL) is rarely reported during pulmonary resection. We present the case of a patient with bronchiectasis and a history of bronchial artery embolization (BAE) for hemoptysis. Bronchial artery blood flow was evaluated using ICG-FL during lobectomy with bronchoplasty.Case presentationA 63-year-old woman presented with right middle lobe bronchiectasis (due to nontuberculous mycobacteriosis) and repeated hemoptysis, which had previously been corrected each time with hemostasis by BAE. Bronchoscopy revealed a swollen blood vessel proximal to the right middle lobe bronchus that was suspected of being the origin of bleeding. Right middle lobectomy with bronchoplasty was performed to prevent hemoptysis. ICG-FL was used to detect the patency of the right bronchial arteries, and the arteries surrounding the right middle lobe bronchus were ligated. The proximal side of the right middle lobe bronchus was cut in a deep wedge shape, and the bronchus was anastomosed. ICG-FL revealed that the blood supply was maintained at the bronchial anastomosis. No bronchial anastomotic leakage was observed after the surgery.Clinical discussionThe key to successful bronchoplasty is the maintenance of blood flow. Bronchial artery blood flow theoretically decreases after BAE. In this case, ICG-FL was able to detect bronchial artery patency before cutting the bronchus as well as the maintenance of blood flow at the bronchial anastomosis after bronchoplasty.ConclusionIntraoperative blood flow evaluation of the bronchus using ICG-FL may reduce the risk of bronchial anastomotic leakage caused by ischemia after bronchoplasty.     

宣肺豁痰法治疗哮喘（冷哮证）的临床研究

目的：探讨宣肺豁痰法治疗冷哮证的临床效果及其改善肺功能的机制。方法：将125例冷哮证患者随机分为实验组和对照组，实验组（宣肺豁痰法，74例）采用三拗汤和华盖散加减治疗，对照组（51例）采用小青龙汤治疗。用药治疗7天后停药，比较两组拜药后的症状、体征、改善时间及疗效。结果：实验组在哮喘主要症状和体征（除咳嗽外）的控制率明显优于对照组，且这种差异在磋疗的早期即已体现并持续至治疗结束；实验组的起效日寸间明显短于对照组；治疗后随着两组患者临床症状的改善，气道高反应的状态多数得以纠正，治疗后丽组PEF均有显著增加，差异有显著性（P〈0．05），与对照组相比较，实验组在缓解气道痉挛、改善大气道∥能方面有明显优势。治疗后EOS绝对计数及百分比明显下降，实验组下降更显著（P〈0．05）。结论：宣肺豁痰法治疗冷哮证在扩张小气道、缓解其痉挛、消除痰栓、减轻其陶塞等方面较对照组有明显优势。     

Bronchoscopic management of airway obstruction in pediatric endobronchial tuberculosis

The present report describes a case of severe airway obstruction caused by endobronchial tuberculosis in an 11-year-old girl who was successfully treated by bronchoscopic balloon dilation. This case illustrates the insidious presentation and the increasingly important role of bronchoscopic intervention in the management of endobronchial tuberculosis. In addition, a brief literature review of the condition in the pediatric age group is included.     

Role of Animal Danders as Inhalant Allergens in Bronchial Asthma in India

The etiological significance of animal danders in Indian patients with nasobronchial disorders has not yet been investigated. In the present study, the role of animal danders in the etiology of bronchial asthma was studied. Extracts of danders from 6 animals along with guinea pig whole pelt were prepared. Intradermal and bronchial provocation tests with these extracts were performed on (i) 68 asthmatics and (ii) 20 nonallergic healthy volunteers. In patients, significant positive skin reactions (2+ to 4+) ranged from 1.4% each with guinea pig whole pelt and ox dander to 8.8% with dog dander extracts. None of the healthy volunteers elicited such a response. On bronchial provocation, 20% and 53.8% of the tests were positive in asthmatics showing 1 +and 2+skin reactivity, respectively. All the patients as well as controls eliciting negative intradermal responses demonstrated uniformly negative bronchial provocation tests to different dander extracts. Analysis of various clinical features of asthmatics with respect to skin positivity to dander/pelt extract was also carried out. Radioallergosorbent tests (RASTs) were performed to estimate dander-specific IgE levels in the sera of patients showing different grades of skin response to dander extracts of dog, horse, and goat. Sixty percent of sera from the patients showing 2+ to 4+ skin reactivity to various animal dander extracts showed positive RASTs. RAST positivity as well as RAST ratio increased with increase in the intensity of skin response. All the patients with positive cutaneous as well as positive bronchial responses also showed positive RASTs. Similarly, all the patients with positive skin and positive RASTs showed positive bronchoprovocation tests. These results suggested that animal danders play an important role in the etiology of bronchial asthma. Some of the clinical characteristics of asthmatics, such as (i) early age at onset of asthma, (ii) positive family history, and (iii) asthma with associated allergies, have significant bearing on the cutaneous response to various dander extracts.     

支气管腔内放疗治疗肺癌的疗效

目的：探讨支气管腔内后装近距离腔内放疗的方法、剂量和疗效。方法：用导丝导入法行支气管腔内放疗，可达亚段支气管。参考点20mm，单次剂量6-7GY，5-7日/间隔，2-4次/人。治疗中央型肺癌（均侵犯支气管）76例212人次。结果：病灶消失22例，缩小39例，稳定12例，进展3例，总有效率85.5％。起效时间均短于3周。结论：支气管腔内后装放疗是治疗腔内肿瘤及缓解伴随症状的有效方法。疗效及起效优于外照射和化疗。对复治患者仍然有效。     

CTLA4-Ig对老年支气管哮喘病人CD4+ CD45 RO+ T细胞功能的影响

目的研究老年支气管哮喘病人周围血CD4 CD45RO T细胞表达IL-4及IL-13的情况及CTLA4-Ig对其影响。方法用ELISA方法测定老年支气管哮喘病人CD4 CD45RO T细胞产生IL-4和IL-13的水平及CTLA4-Ig对其影响。结果老年支气管哮喘病人CD4 CD45RO T细胞分泌IL-4、IL-13增多,IL-13增多较IL-4更为明显(P<0.01),CTLA4-Ig可有效抑制老年哮喘病人CD4 CD45RO T细胞分泌IL-4和IL-13(P<0.01)。结论CD4 CD45RO T细胞产生的IL-4和IL-13在老年哮喘发病中起重要作用,CTLA4-Ig可有效抑制IL-4和IL-13的分泌。     

中西医结合序贯治疗支气管哮喘64例疗效观察

目的：观察中西医结合序贯治疗对支气管哮喘患者的临床疗效。方法将128例支气管哮喘患者随机分为观察组与对照组,均分发作期、缓解期、稳定期三期序贯治疗。对照组64例予西医常规治疗,观察组64例在对照组基础上配合中药,应用中西医结合疗法,每一期疗程结束评价疗效。结果观察组在发作期病情平均缓解时间,以及肺功能指标、症状体征积分、临床总有效率、1年内复发率等方面与对照组比较,差异有统计学意义（P ﹤0.05,P ﹤0.01）。结论中西医结合序贯疗法能有效改善哮喘患者肺功能,临床近期、远期疗效高,复发率低,提高患者生活质量,值得推广应用。     

机动车尾气对大鼠气道高反应性的影响

目的 :本研究旨在观察机动车尾气对大鼠气道高反应性的影响。方法 :取30只SD大鼠,随机分5组:正常对照组;吸入尾气2天组;吸入尾气4天组;吸入尾气6天组;吸入尾气8天组,每组6只。采用小动物呼吸机,肺组织切片PAS和HE染色,检测各组大鼠呼吸道反应性,肺组织杯状细胞化生指数、上皮粘液储备指数和炎症细胞数量。结果 :随着尾气吸入时间的延长,大鼠出现越来越明显的气道高反应性,同时,呼吸道粘液分泌量显著增加,气道炎症明显加重。结论 :吸入机动车尾气能引发并加重气道高反应性。