Acute Pulmonary Lesions Research Articles

IL-10 suppresses T cell expansion while promoting tissue-resident memory cell formation during SARS-CoV-2 infection in rhesus macaques.

The regulation of inflammatory responses and pulmonary disease during SARS-CoV-2 infection is incompletely understood. Here we examine the roles of the prototypic pro- and anti-inflammatory cytokines IFNγ and IL-10 using the rhesus macaque model of mild COVID-19. We find that IFNγ drives the development of 18fluorodeoxyglucose (FDG)-avid lesions in the lungs as measured by PET/CT imaging but is not required for suppression of viral replication. In contrast, IL-10 limits the duration of acute pulmonary lesions, serum markers of inflammation and the magnitude of virus-specific T cell expansion but does not impair viral clearance. We also show that IL-10 induces the subsequent differentiation of virus-specific effector T cells into CD69+CD103+ tissue resident memory cells (Trm) in the airways and maintains Trm cells in nasal mucosal surfaces, highlighting an unexpected role for IL-10 in promoting airway memory T cells during SARS-CoV-2 infection of macaques.

Gut Barrier in Critical States of the Body

The intestinal barrier (IB) is a system of diffusion barriers separating the intestinal chyme and blood. The aim of the review is to identify the role of IB dysfunction in the formation of critical states of the body and to substantiate ways to prevent these states. Toxic substances produced by normal intestinal microflora are characterized. The involvement of endotoxin and ammonia in the pathogenesis of sepsis, acute circulatory disorders, secondary acute pulmonary lesions, and acute cerebral insufficiency is shown. Approaches to protect the IB in critical states of the body are proposed.

Efficacy and Safety of Endobronchial Ultrasonography with a Guide-sheath for Acute Pulmonary Lesions in Patients with Haematological Diseases.

Objective Acute pulmonary lesions (APLs), defined as an acute infiltrate or nodular lung field, are a major complication in patients with haematological diseases. Recently, endobronchial ultrasonography with a guide-sheath (EBUS-GS) was established as a useful technique for diagnosing pulmonary lesions. This study aimed to evaluate the efficacy and safety of EBUS-GS for managing APLs in patients with haematological diseases. Methods Our single-centre, retrospective, observational, single-arm, descriptive study enrolled 22 consecutive adult (>20-year-old) patients with haematological diseases and concomitant APL who underwent EBUS-GS between January 2011 and June 2016 at Kameda Medical Center, Chiba, Japan. The primary endpoint was the contribution of EBUS-GS to clinical decision-making. Secondary endpoints were an adequate tissue collection rate, diagnostic yield, complication rate, and 30-day mortality. Results The median patient age was 70 years old, and 63.6% were men. Acute myeloid leukaemia was the most frequent underlying disease, accounting for 54.5% of patients. The contribution of EBUS-GS to clinical decision-making was recognised in 11 (50.0%) patients. Adequate tissue collection was achieved in 21 (95.5%) patients. The aetiology of the APL was identified in 9 (40.9%) patients. No complications, including severe haemorrhaging and pneumothorax, were observed in any patients, and the 30-day mortality rate was 0%. Conclusion EBUS-GS may be a suitable diagnostic option for APL in patients with haematological diseases. Further larger-scale and randomised controlled trials are needed to confirm our results.

Yindan Jiedu granules exhibit anti-inflammatory effect in patients with novel Coronavirus disease (COVID-19) by suppressing the NF-κB signaling pathway

BackgroundCoronavirus disease 2019 (COVID-19) is a pandemic that has caused a high number of deaths worldwide. Inflammatory factors may play important roles in COVID-19 progression. Yindan Jiedu granules (YDJDG) can inhibit the progression of COVID-19, but the associated mechanism is unclear. PurposeTo evaluate the therapeutic effects of YDJDG on COVID-19 and explore its underlying mechanism. MethodsWe recruited 262 participants and randomly assigned 97 patients each to the YDJDG and control groups using one-to-one propensity score matching (PSM). Clinical effects were observed and serum inflammatory and immune indicators were measured. The target network model of YDJDG was established by predicting and determining the targets of identified compounds. The main constituents of the YDJDG extracts were identified and evaluated using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and molecular docking. Besides, the anti-inflammatory effects of YDJDG and its specific biological mechanism of action were studied. ResultsAfter PSM, the results showed that compared with the control group, the YDJDG group had a shorter time of dissipation of acute pulmonary exudative lesions (p < 0.0001), shorter time to negative conversion of viral nucleic acid (p < 0.01), more rapid decrease in serum amyloid A level and erythrocyte sedimentation rate (p < 0.0001), and a higher rate of increase in CD4+T cell count (p = 0.0155). By overlapping the genes of YDJDG and COVID-19, 213 co-targeted genes were identified. Metascape enrichment analysis showed that 25 genes were significantly enriched in the NF-κB pathway, which were mainly targets of luteolin, quercetin, and kaempferol as confirmed by MS analysis. Molecular docking revealed that the ligands of three compounds had strong interaction with NF-κB p65 and IκBα. In vivo, YDJDG significantly protected animals from lipopolysaccharide (LPS)-induced acute lung injury (ALI), decreasing the lung wet/dry weight ratio, ALI score, and lung histological damage. In LPS-treated RAW264.7 cells, YDJDG suppressed nuclear translocation of NF-κB p65. In vivo and in vitro, YDJDG exerted anti-inflammatory effects by inhibiting the production of inflammatory cytokines (IL-6, IL-1β, and TNF-α). These effects were accompanied by the inhibition of NF-ĸB activation and IκBα phosphorylation. ConclusionYDJDG may shorten the COVID-19 course and delay its progression by suppressing inflammation via targeting the NF-κB pathway.

Prevention of COVID-19-associated Haemostasis Failure in Patient with Stented Coronary Arteries: a Clinical Case

Introduction.In patients with COVID-19, acute pulmonary lesion grows on inflammation and microvascular thrombosis. Thromboinflammation may develop outside alveolar endothelium and affect endothelium of the heart, kidneys, intestine and other vital organs leading to a multiple-organ insufficiency and possible lethal outcomes. Treatment and prevention of SARS-CoV-2 in the Russian Federation should comply with the Interim Methodological Guidelines of the Russian Ministry of Health that support the global mainstream of COVID-19 containment measures and are updated regularly with new evidence on drug effectiveness, including anticoagulants.Materials and methods.We review a clinical case of effective treatment of a COVID19 patient with prior coronary surgery from the perspective of the Interim Methodical Guidelines of different editions and international clinical experience in anticoagulant therapy.Results and discussion.A retrospective analysis of the patient’s treatment demonstrated the efficacy of thromboelastography in rapid assessment of blood hypercoagulation and parnaparin sodium as a drug of choice among low-molecular heparins in a combined setting with dual antiplatelet therapy. Etiotropic therapy rendered to this patient is currently considered less effective.Conclusion.Combination of anticoagulants with antiaggregants is shown effective under high risks of thrombosis and a background COVID-19 infection, if justified clinically. In cases of complicated diff erential diagnosis, selection of optimal management strategy, anticoagulant and/or antiplatelet therapy monitoring, a good practice is to rely on both the available domestic guidelines and latest meta-analyses combined with international clinical experience.

Evaluation of systemic inflammatory response and lung injury induced by Crotalus durissus cascavella venom.

This study investigated the systemic inflammatory response and mechanism of pulmonary lesions induced by Crotalus durissus cascavella venom in murine in the state of Bahia. In order to investigate T helper Th1, Th2 and Th17 lymphocyte profiles, we measured interleukin (IL) -2, IL-4, IL-6, IL-10, IL-17, tumor necrosis factor (TNF) and interferon gamma (IFN-γ) levels in the peritoneal fluid and macerated lungs of mice and histopathological alterations at the specific time windows of 1h, 3h, 6h, 12h, 24h and 48h after inoculation with Crotalus durissus cascavella venom. The data demonstrated an increase of acute-phase cytokines (IL-6 and TNF) in the first hours after inoculation, with a subsequent increase in IL-10 and IL-4, suggesting immune response modulation for the Th2 profile. The histopathological analysis showed significant morphological alterations, compatible with acute pulmonary lesions, with polymorphonuclear leukocyte (PMN) infiltration, intra-alveolar edema, congestion, hemorrhage and atelectasis. These findings advance our understanding of the dynamics of envenomation and contribute to improve clinical management and antiophidic therapy for individuals exposed to venom.

Epidemiología, diferencias clínicas y desenlaces de pacientes con SDRA en unidades de cuidado intensivo de Colombia

IntroductionAcute respiratory distress syndrome (ARDS) is an acute inflammatory pulmonary lesion, associated with increased vascular permeability, increased lung weight, and loss of lung tissue. In Colombia there is no real representative data on the prevalence of ARDS, therefore, the aim of this study is to provide an overview of the current care of patients with ARDS in the intensive care units of Colombia. Materials and methodsAn observational, multicentre, prospective cohort study was conducted on patients over 18 years of age with a medical diagnosis of ARDS in different intensive care units in Colombia, from 1 January to 31 December 2016. Descriptive statistics were performed with the statistical software SPSS version 2.0. Results and conclusionsTo the knowledge of the authors, this is the first multicentre study that seeks to determine the real data on of the epidemiology of ARDS in Colombia. A total 6 intensive care units with 70 patients participated in the study. The clinical characteristics, demographic data and outcomes of these patients are described. More emphasis should be placed on seeking information on local epidemiology in order to widen the knowledge of the behaviour of this syndrome, as well as to establish appropriate strategies that will help reduce the impact on morbidity and mortality in Colombia.

Congenital cleft sternum with diaphragmatic hernia and radial hemimelia in a kitten

A four-month-old male intact domestic shorthair kitten was presented for deformity of the right thoracic limb. Severe carpal varus was noted, and palpation of the ventral thorax revealed the sternum...

Video-assisted thoracic surgery ( conventional and single-port ) - place and role in the improved management of malignant pleural effusions: review article

MPE management has been changing over the years as this is due both to the technological advancement of mini-invasive surgical methods and to the change in our knowledge about this manifestation of oncology disorder. Advanced cancer disease and poor general condition in most cases do not allow large-volume and duration of surgical procedures. VATS is becoming an increasingly large share of the operating methods of treatment of spontaneous pneumothorax, thoracic trauma, acute pleural empyema, pleural effusion, benign pleural and pulmonary lesions, secondary metastatic and primary malignant lesions - pleural, pulmonary, mediastinal and bilateral location. Diagnostic and therapeutic capabilities of VATS for simultaneous diagnosis and palliative surgical treatment make it the optimal procedure in MPE management. It should be noted that the preliminary assessment of the patient’s condition and local status with an estimate of survival time often undergoes a radical change after the video-assisted surgical procedure. Improvement is reported with an increase of predetermined survival time and improved performance status, which supports the application of more minimally invasive, non-intubated, “awake” single-port VATS.

Subchronic toxicity and cardiovascular responses in spontaneously hypertensive rats after exposure to multiwalled carbon nanotubes by intratracheal instillation.

The tremendous demand of the market for carbon nanotubes has led to their massive production that presents an increasing risk through occupational exposure. Lung deposition of carbon nanotubes is known to cause acute localized pulmonary adverse effects. However, systemic cardiovascular damages associated with acute pulmonary lesion have not been thoroughly addressed. Four kinds of multiwalled carbon nanotubes (MWCNTs) with different lengths and/or iron contents were used to explore the potential subchronic toxicological effects in spontaneously hypertensive (SH) rats and normotensive control Wistar-Kyoto (WKY) rats after intratracheal instillation. MWCNTs penetrated the lung blood-gas barrier and accumulated in the liver, kidneys, and spleen but not in the heart and aorta of SH rats. The pulmonary toxicity and cardiovascular effects were assessed at 7 and 30 days postexposure. Compared to the WKY rats, transient influences on blood pressure and up to 30 days persistent decrease in the heart rate of SH rats were found by electrocardiogram monitoring. The subchronic toxicity, especially the sustained inflammation of the pulmonary and cardiovascular system, was revealed at days 7 and 30 in both SH and WKY rat models. Histopathological results showed obvious morphological lesions in abdominal arteries of SH rats 30 days after exposure. Our results suggest that more attention should be paid to the long-term toxic effects of MWCNTs, and particularly, occupationally exposed workers with preexisting cardiovascular diseases should be monitored more thoroughly.

Manifestación de leucemia promielocítica aguda en el embarazo

Acute promyelocytic leukemia, also known as M3 in the French-American-British classification, presents as severe hemorrhagic syndrome in 80% of affected pregnant women, posing a lethal threat to both mother and fetus. The results of multicenter studies suggest that the most effective treatment consists of the concomitant use of all -trans retinoic acid plus idarubicin. We present the case of a 32-year-old woman at 33 weeks of pregnancy with severe coagulation abnormalities due to acute promyelocytic leukemia, who was admitted to the intensive care unit for respiratory insufficiency due to an acute pulmonary lesion. The interest of this case lies in its infrequency. We describe the therapeutic management and initial course of the disease, as well as the prognostic implications of treatment during pregnancy.

1336 Acute Pulmonary Lesion Caused by Mechanical Ventialtion

Introduction: mechanical ventilation is a necessarytherapy in critical pathologies with respiratory failure, producing acute pulmonary injury. Objectives: To identify an acute pulmonary injuryby bronchioalveolar lavage cytology and determinecausal relations with the Fraction of inspired Oxygen(FiO2), the pressure of the airways, positive endexpiratorypressure (PEEP), oxygen saturation andexposure time. Methods: Longitudinal, prospective clinicalinvestigation from January to July 2007, whichincluded 51 patients that received mechanicalventilation. 153 bronchioalveolar lavage citologieswere obtained and processed. Results: Several alterations in citologies wereobserved at 12, 72 and 144 hours after mechanicalventilation was started, which shows a simpleand meaningful statistic association with fractionof given oxygen at 12 and 74 hours, PEEP at 12hours, Pressure in air ways and and oxygen. Discussion: It becomes evident that alterationsproduced by mechanical ventilation are connectedwith FiO2, oxygen saturation, absence or low PEEPand elevated airway pressure. Conclusion: Alterations in citologies of thebronchioalveolar epithelium present themselves inthe presence of FiO2 and low PEEP.

Community-Acquired and Nosocomial Pneumonia: Clinical and Morphological Features

Objective: to reveal the clinical and morphological features of acute community-acquired and nosocomial pneumonia (NP). Materials and methods. The results of treatment were retrospectively assessed and those of autoptic studies were analyzed in 43 dead patients with pneumonia. There were two groups: 1) 13 subjects with community-acquired pneumonia; 2) 30 subjects with NP. Results. A clinicomorphological study revealed different stages of acute respiratory distress syndrome (ARDS) in both groups. The probability of its development increases if microbial associations are identified as an etiological factor. In community-acquired pneumonia, ARDS was detected in 6 of the 13 cases in which 5 (83.3%) cases were in the presence of progressive pulmonary inflammation. In Group 2, ARDS was recorded in 21 of the 30 cases and it followed the occurrence of pneumonic infiltration. On days 2 and 3 of ARDS, there were hyaline membranes and a preponderance of interstitial edema. Five days later, inflammatory changes were prevalent, severe alveolar edema (subtotal and total) and multiple hemorrhages were noted, and the number of hyaline membranes increased. Conclusion: The analysis has indicated that ARDS, including acute pulmonary lesion, as the first stage of respiratory distress syndrome in patients with pneumonia of varying genesis is more frequently detectable than traditionally thought. Acute respiratory failure in 27 (62.8%) of the 43 patients was caused by different stages of ARDS, which alone or in combination with other complications was as a cause of death. Key words: acute community-acquired pneumonia, nosocomial pneumonia, respiratory distress syndrome.

Pulmonary Morphological Changes in the Simulation and Treatment of Lower Limb Ischemic and Perfusion Lesions

Objective: to investigate pulmonary morphological changes in animals with limb ischemic and reperfusion lesions, which were treated with hemocarboperfusion on sodium hypochlorite-modified sorbents. Materials and methods. The investigation was conducted on 94 mature mongrel male dogs with 4-hour limb ischemia and subsequent reperfusion. Limb ischemia was induced by applying a tourniquet to the isolated vascular fascicle of an experimental limb proximal to the origin of the deep artery of the thigh. Following 4 hours, reperfusion was made, by removing the tourniquet. Three hours of the initiation of reperfusion, one-hour hemocarboperfusion was performed thrice for 72 hours. Lung biopsy samples were used for morphological studies. Morphological changes were evaluated, by employing the hematoxylin- and eosin-stained semifine sections. The visceral histological pattern was assessed by a light trinocular microscope (OLYMPUS, Japan) (microscope objective 10). Results. The development of 4-hour limb ischemia is accompanied by significant microcirculatory disorders in the lungs that exhibit dyscirculatory and dystrophic processes concurrent with the signs of tissue dyscomplexation without the signs of an inflammatory reaction. In the reperfusion period, there was a significant progression of lung tissue morphological changes corresponding to the pattern of phase 2 respiratory distress syndrome. Sodium hypochlorite-modified CKN-1K sorbent hemocarboperfusion resulted in a virtually complete restoration of the lung architectonics in the presence of insignificant microcirculato-ry and ventilatory disorders. After standard hemocarboperfusion, the lung tissue may be defined as a slightly reduced pattern of acute pulmonary lesion. Conclusion. Sodium hypochlorite-modified CKN-1K sorbent hemocarboperfusion is an effective technique in abolishing ischemic and reperfusion lesions.

Validez de los criterios diagnósticos del síndrome de distrés respiratorio agudo

Acute respiratory distress syndrome (ARDS) is defined according to the criteria of the 1994 consensus conference. These criteria aim to <<bring clarity and uniformity to the definition of this clinical entity>>. However, the histological criteria that correspond to ARDS are the criteria of diffuse alveolar damage described in 1976 by Katzenstein et al., which are still valid at present. In the last decade, different studies have been published that have tried to correlate the clinical syndrome with the histological findings. These studies have been basically done in experimental animals, but also by the description of the pulmonary biopsy findings and post-mortem study findings. The present article aims to show discrepancy between clinical and histological diagnosis of the acute pulmonary lesion, basically having an effect on the difficulty of the ARDS diagnosis when its origin is pulmonary and the implications of this discrepancy in the clinical practice and research.

Early Hemodynamic Disorders and Their Association with the Development of Acute Pulmonary Lesion in Severe Concomitant Injury

Early changes in the parameters of central hemodynamics and pulmonary extravascular fluid were studied in patients who had sustained a severe concomitant injury in combination with acute massive blood loss. Early postoperative monitoring of these parameters by a «Pulsion Picco Plus» invasive monitoring apparatus was ascertained to verify the early stages on non-cardiogenic pulmonary edema, to assess a risk for acute lung lesion and acute respiratory distress syndrome in the phase of reperfusion lesions, and to perform an adequate correction of therapy.

Acute Pulmonary Lesion: Pathogenesis and Morphology

Morphological studies were used to examine the lungs from 92 persons who had died from brain and concomitant injuries and massive blood loss and from 117 experimental animals (rats) in systemic circulatory disorders and vascular thrombosis of the pulmonary microcirculatory bed. The purpose of the study was to assess the nature, intensity, and developmental periods of the morphological signs characterizing acute pulmonary lesion. Disorders of circulation (including microcirculation), damages to bronchial and bronchiolar mucosae, the development of atelectases, dyst-electases, and focal emphysema were found to be early structural changes in injury and massive blood loss. Pulmonary edema and the signs of a systemic inflammatory reactions form within the first hours following injury and massive blood loss. Experimental studies confirm that microcirculatory disorders and individual traits play an important role in the development of acute pulmonary lesion.

Pulmonary oedema in Swedish hunting dogs.

A syndrome of acute dyspnoea after hunting in 16 Swedish hunting dogs is characterised. Radiographic pulmonary infiltrates interpreted as pulmonary oedema were found in the acute stage. In 12 dogs, the infiltrates regressed after five to 14 days. Subendocardial necrosis and pulmonary oedema were found at postmortem examination in four other dogs with acute and recurrent dyspnoea after hunting, and myocardial fibrosis in a further three dogs with a history of recurrent dyspnoea after hunting; none of these pathological changes was seen in dogs which had no previous history of dyspnoea after hunting. A pathogenetic mechanism is proposed whereby high catecholamine levels, present during hunting due to the stress of excitement and exercise, cause acute cardiac and pulmonary lesions in some susceptible dogs, similar to neurogenic or postictal pulmonary oedema.

PARTICLE CLEARANCE AND HISTOPATHOLOGY IN LUNGS OF C3H/HeJ MICE ADMINISTERED BERYLLIUM/COPPER ALLOY BY INTRATRACHEAL INSTILLATION

Beryllium/copper (BeCu) alloys are commonly used in the electronics, automotive, consumer, defense, and aerospace industries. Some individuals exposed occupationally to BeCu alloys have developed chronic beryllium disease. However, little is known of the toxicity and fate of BeCu alloys in the respiratory tract. To begin to address this question, we investigated the pulmonary toxicity and clearance of BeCu alloy (2% Be; 98% Cu) in mice. Groups of 40 female C3H/HeJ mice were administered 12.5, 25, and 100 µg BeCu alloy or 2 and 8 µg Be metal by intratracheal instillation. Mice were sacrificed at 1h and 1, 7, 14, and 28 days postinstillation. Left lungs were evaluated for histopathological change. Right lungs were analyzed for Be and Cu content. Twentyfive percent of the high-dose BeCu mice and 7.5% of the mid-dose BeCu mice died within 24h of dosing. Acute pulmonary lesions included acute alveolitis and interstitial inflammation. Type II epithelial cell hyperplasia and centriacinar fibrosis were present by 7 days after dosing. Lesions persisted through 28 days after instillation. No lesions attributable to alloy exposure were present in liver or kidney. Be metal instillation caused no deaths and minimal pulmonary changes over the time studied, indicating that the pulmonary lesions were due to Cu rather than Be. Cu cleared the lung with a half-time of 0.5-2 days. Be cleared with a half-time of several weeks or longer. Results of this study suggest that exposure to BeCu alloy is more acutely toxic to lung than Be metal. The results of tissue analyses also indicate that, while the Cu component of the alloy clears the lung rapidly, Be is retained and may accumulate upon repeated exposure.

Initial lung lesions in two calves experimentally infected with Haemophilus somnus.

SummaryThe initial lung lesions in two calves intrabronchially inoculated with Haemophilus somnus are described. The animals were euthanized within 7 h after challenge. The in situ location of H. somnus and accompanying lesions were examined by light microscopy, immunohistochemistry and transmission electron microscopy (TEM).Inoculation with H. somnus resulted in the development of acute pulmonary lesions within 3.5 h. H. somnus antigen was demonstrated only within the luminal spaces of the airways and in one area of bronchio‐associated lymphoid tissue (BALT). As observed by TEM, the bacteria were phagocytized by both neutrophils and alveolar macrophages. Antigen was never demonstrated in the pulmonary intravascular macrophages.