Airway Narrowing Research Articles

Comparison of high-flow nasal cannula and conventional oxygen therapy for high-risk patients during bronchoscopy examination: protocol for a randomized controlled trial

IntroductionHigh-flow nasal cannula (HFNC) has been proven to improve oxygenation and avoid intubation in hypoxemic patients. It has also been utilized during endoscopy examination to reduce the incidence of hypoxia. However, little is known about the effects of HFNC versus conventional oxygen therapy (COT) on oxygenation during bronchoscopy examination via nasal route; particularly, no study has compared the use of HFNC with that of COT at similar FIO2 for patients who have high-risk factors of desaturation during bronchoscopy examination.Methods and analysisThis randomized controlled trial will be implemented in four academic centers in China. Patients who have high-risk factors including hypoxemia, hypercapnia, morbid obesity, and narrow airway will be enrolled to use HFNC or COT during bronchoscopy examination. In the HFNC group, the initial gas flow will be set at 50 L/min with a fraction of inspired oxygen (FIO2) at 0.45, if the patient tolerates, the flow can be increased to 60L/min at most, while in the COT group, oxygen flow will be set at 6 L/min via a conventional nasal cannula. After 5 min pre-oxygenation, the bronchoscope will be inserted via the nasal route. Vital signs, oxygenation (SpO2), and transcutaneous CO2 (PtCO2) will be continuously monitored. The primary outcome is the incidence of hypoxemia, defined as SpO2 < 90% for 10 s during bronchoscopy examination, and secondary outcomes include the need for treatment escalation and adverse events.DiscussionHypoxia is a common complication of bronchoscopy, our study attempted to demonstrate that HFNC may reduce the probability of hypoxia during bronchoscopy in high-risk patients. The results will be disseminated through peer-reviewed journals and national and international conferences.Trial registrationhttp://www.chictr.org.cn/: ChiCTR2100055038. Registered on 31 December 2021.

A Case of Laryngeal Amyloidosis with Dyspnea Triggered by Infection

Laryngeal amyloidosis is a relatively rare disease, and usually carries a good prognosis. However, if a patient with laryngeal amyloidosis develops inflammation of the larynx, airway narrowing and dyspnea may occur. In this article, we report the case of a patient with laryngeal amyloidosis who had a long clinical course and required two tracheostomies and microlaryngeal surgeries.The patient was a woman in her 30s at the time of her initial visit, who visited our hospital with the complaint of hoarseness. Laryngoscopy revealed a yellow lesion around the vocal cords. A tracheostomy and microlaryngeal surgery were performed for biopsy and reduction of the lesion. Histopathological examination of the resected lesion revealed the diagnosis of laryngeal amyloidosis, and after closure of the tracheotomy, the patient was followed up as an outpatient. Nineteen years later, the patient visited our hospital again with the chief complaint of dyspnea, and was hospitalized. She was diagnosed as having airway narrowing caused by recurrent laryngeal amyloidosis and laryngeal edema, and treated with antimicrobial agents. The laryngeal inflammation and edema subsided, however, the dyspnea due to airway narrowing caused by laryngeal amyloidosis failed to improve, so that a second tracheostomy and microlaryngeal surgery were performed.Although laryngeal amyloidosis is said to carry a good prognosis, dyspnea caused by edema of the larynx and recurrence of amyloidosis could be fatal, as in this case. Unlike in the case of other types of localized amyloidosis, otolaryngologists/head and neck surgeons should be aware that early amyloidosis reduction surgery under local anesthesia or microlaryngeal surgery is important for patients presenting with even mild clinical symptoms, such as hoarseness, to prevent the risk of development of airway obstruction due to infection.

A Case of Suspected Negative Pressure Pulmonary Edema after General Anesthesia.

Negative pressure pulmonary edema (NPPE) can occur rapidly after the release of an upper airway obstruction. In general anesthesia, NPPE can be caused by laryngospasm after extubation. This report describes a case in which NPPE was thought to have occurred after extubation during general anesthesia in a disabled person. The patient was a 28-yearold man, 160 cm in height and 56 kg in weight, who was scheduled for dental caries treatment under ambulatory general anesthesia due to intellectual disability. After induction of general anesthesia, nasal intubation was performed after sufficient oral suctioning to remove a large amount of serous secretion. After completion of dental treatment, pressurized extubation was performed after oral suctioning as sufficient spontaneous breathing and body movement were observed. Immediately after extubation, SpO2 dropped to 80%, subsequently recovering to 99% under oxygen administration at 5 liter/min with an oxygen mask. It dropped to approximately 85% again, however, when administration of oxygen was discontinued. Although communication with the patient was difficult, no expression of anguish or dyspnea was observed. A chest radiograph showed symmetric middle-lobe and lingular segment infiltrates, and the patient was transferred to the nearest general hospital. No obvious clinical findings other than a decrease in SpO2 were observed, suggesting NPPE as a result of airway narrowing due to secretions.

Preoperative risk evaluation and perioperative management of patients with obstructive sleep apnea: a narrative review.

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.

Clinical application of a lung sound analysis in infants with respiratory syncytial virus acute bronchiolitis.

Objective investigation of the characteristics of acute bronchiolitis in infants is important for its diagnosis and treatment. Lung sound data of 50 patients diagnosed with respiratory syncytial virus (RSV) acute bronchiolitis (m:f = 29:21, median of age 7 months), 20 patients with RSV acute respiratory tract infections without acute bronchiolitis (m:f = 10:10, 5 months) and 38 age-matched control infants (m:f = 23:15, 8 months) were analyzed using a conventional method and compared. Furthermore, the relationships between lung sound parameters and clinical symptoms (clinical score, length of hospital stay and SpO2 level) in the bronchiolitis and the non-bronchiolitis patients were examined. Results of lung sound analysis showed that the inspiratory sound power of patients with RSV respiratory tract infections was low and the expiratory sound power was high compared with those of the controls. When the patients with RSV respiratory tract infections were divided into the bronchiolitis and non-bronchiolitis groups, the expiratory/inspiratory ratio of the bronchiolitis patients was greater than that of the non-bronchiolitis patients. There was no difference in the clinical symptoms, clinical score and length of hospital stay between the bronchiolitis and non-bronchiolitis patients, except for the SpO2 level on admission. Lung sound analysis confirmed that patients with RSV acute bronchiolitis present with marked airway narrowing. Considering these results as a characteristic of acute bronchiolitis, it would be meaningful to reflect it in the improvement of diagnosis, treatment and subsequent management.

Treatment of a Chronic Obstructive Pulmonary Disease Case with Regentime® Procedure

Chronic Obstructive Pulmonary Disease (COPD) is a common disease associated with high morbidity and mortality rates. It is characterized by airway and parenchymal inflammation leading to airway narrowing, decreased lung recoil, and eventual airflow limitation.

Anesthesia for Excision of Laryngeal and Tracheal Papillomatosis in a Pediatric Patient: A Case Report

Laryngeal papillomatosis is a rare disease of viral etiology that can obstruct the airway. Symptomatic treatment is essentially surgical. Anesthetic management needs special attention due to a narrow airway that will be shared with the surgical team. We discuss the perioperative management of a child with recurrent papillomatosis and possible strategies to manage similar cases.

The predictive association between radiological findings and lung cancer development in patients exposed to sulfur mustard gas: 4 decades follow up of 719 victims

BackgroundRespiratory diseases are the leading cause of morbidity and mortality in the survivors exposed to Sulfur Mustard (SM). The late abnormalities can be present as chronic bronchitis, tracheobronchial stenosis, asthma, bronchiectasis, airway narrowing, lung fibrosis, and lung cancers. This study aims to investigate the association between radiological findings and lung cancer development in patients exposed to sulfur mustard gas.MethodsWe entered 719 victims exposed to SM during the Iran–Iraq war into our follow-up study in a consensus manner. They were periodically followed with Chest HRCT scans from 2001 to an interval of 2014–2019. The mean year interval between exposure and the last follow-up was 38 years. For confirming the lung cancer in those with evidence of malignancy in their imaging, fine needle aspiration/biopsy and/or surgical intervention were done.ResultsAmong 719 patients, 57% were free from any pathologic findings in their HRCT scan. Among the subjects who had the abnormal radiologic findings, Air Trapping (AT), Lung Fibrosis (LF), Bronchiectasis (B), and the evidence of lung cancer were found in 265 (36.9%), 207 (28.8%), 151 (21.0%), and 42 (5.8%), respectively. Adenocarcinoma (38.1%) was the most common type of cancer. The right lung was involved more than the left one regarding LF, B, and cancer (p value < 0.05). Considering the laterality, a significant correlation was found between the side of LF and B and the tumor side. Furthermore, it was shown that the lung lobes with LF were statistically correlated to tumor-involved lobes. The relative risk of AT and B existence for tumor development was 11.73 [4.87–28.26] and 10.14 [5.12–20.090], respectively. The most predictive finding was LF which caused the risk of developing tumor 17.75 [7.35–42.86] times higher in the patient with this pathology. By each increment of the number of LF and B, the risk of developing tumors increased by 51% and 76%, respectively.ConclusionIn survivors exposed to Sulfur Mustard, those with bronchiectasis and lung fibrosis have a significantly higher risk of developing lung cancers, so a close follow-up of these victims is recommended.Trial registration This study was confirmed by the institutional review board and ethics committee at Shiraz University of Medical Sciences (SUMS) with the ethical code IR.SUMS.MED.REC.1399.637.

Computer-based airway stenosis quantification from bronchoscopic images: preliminary results from a feasibility trial.

Airway Stenosis (AS) is a condition of airway narrowing in the expiration phase. Bronchoscopy is a minimally invasive pulmonary procedure used to diagnose and/or treat AS. The AS quantification in a form of the Stenosis Index (SI), whether subjective or digital, is necessary for the physician to decide on the most appropriate form of treatment. The literature reports that the subjective SI estimation is inaccurate. In this paper, we propose an approach to quantify the SI defining the level of airway narrowing, using depth estimation from a bronchoscopic image. In this approach we combined a generative depth estimation technique combined with depth thresholding to provide Computer-based AS quantification. We performed an interim clinical analysis by comparing AS quantification performance of three expert bronchoscopists against the proposed Computer-based method on seven patient datasets. The Mean Absolute Error of the subjective Human-based and the proposed Computer-based SI estimation was [Formula: see text] [%] and [Formula: see text] [%], respectively. The correlation coefficients between the CT measurements were used as the gold standard, and the Human-based and Computer-based SI estimation were [Formula: see text] and 0.46, respectively. We presented a new computer method to quantify the severity of AS in bronchoscopy using depth estimation and compared the performance of the method against a human-based approach. The obtained results suggest that the proposed Computer-based AS quantification is a feasible tool that has the potential to provide significant assistance to physicians in bronchoscopy.

Standardised Sonneratia apetala Buch.-Ham. fruit extract inhibits human neutrophil elastase and attenuates elastase-induced lung injury in mice.

Chronic obstructive pulmonary disease (COPD) along with asthma is a major and increasing global health problem. Smoking contributes to about 80%-90% of total COPD cases in the world. COPD leads to the narrowing of small airways and destruction of lung tissue leading to emphysema primarily caused by neutrophil elastase. Neutrophil elastase plays an important role in disease progression in COPD patients and has emerged as an important target for drug discovery. Sonneratia apetala Buch.-Ham. is a mangrove plant belonging to family Sonneratiaceae. It is widely found in the Sundarban regions of India. While the fruits of this plant have antibacterial, antifungal, antioxidant and astringent activities, fruit and leaf extracts have been shown to reduce the symptoms of asthma and cough. The aim of this study is to find whether hydro alcoholic fruit extracts of S. apetala inhibit neutrophil elastase and thus prevent the progression of neutrophil elastase-driven lung emphysema. The hydroalcoholic extract, ethanol: water (90:10), of the S. apetala Buch.-Ham. fresh fruits (SAM) were used for neutrophil elastase enzyme kinetic assay and IC50 of the extract was determined. The novel HPLC method has been developed and the extract was standardized with gallic acid and ellagic acid as standards. The extract was further subjected to LC-MS2 profiling to identify key phytochemicals. The standardized SAM extract contains 53μg/mg of gallic acid and 95μg/mg of ellagic acid, based on the HPLC calibration curve. SAM also reversed the elastase-induced morphological change of human epithelial cells and prevented the release of ICAM-1 in vitro and an MTT assay was conducted to assess the viability. Further, 10mg/kg SAM had reduced alveolar collapse induced by neutrophil elastase in the mice model. Thus, in this study, we reported for the first time that S. apetala fruit extract has the potential to inhibit human neutrophil elastase in vitro and in vivo.

Treatment activity of budesonide-loaded poly(lactic-co-glycolic acid) microspheres in infant bronchiolitis

Bronchiolitis is a common respiratory disease in infants with poor autoimmune function and narrow airways, resulting in a higher incidence. Despite great advances in medical technology, infants remain vulnerable to complications affecting the effectiveness of treatments. Therefore, suitable drug carriers for long-term local administration are the key to improve treatment efficiency. In this study, budesonide-loaded PLGA microspheres were successfully prepared by emulsification–solvent volatilization method. The microspheres had smooth and nearly spherical surfaces, and the size was 8.0–11.8 μm, with a high encapsulation rate and drug loading capacity. The slow degradation of PLGA allows enables budesonide to exert long-term and sustained effects, representing a novel method for treating infant bronchiolitis. The application value of the method for infant bronchiolitis was determined, and the relevant mechanism was explored.

Surgical Techniques for Glottal Airway Enlargement -Laterofixation of the Vocal Fold-

Glottal airway enlargement is required to manage dyspnea due to bilateral vocal fold paralysis (BVFP). The method of vocal fold laterofixation reported by Ejnell et al. is relativly non-invasive and has been considered the first choice in cases of BVFP in recent years. We used a video-laryngoscope to obtain a better endolaryngeal view and a GORE-TEX® Soft Tissue Patch as a spacer between the thyroid lamina and the nylon knot to prevent loosening. Laryngeal pacing is a more dynamic and physiologic treatment approach than static airway enlargement procedures, such as laterofixation of the vocal fold. Laryngeal pacing is the application of functional electrical stimulation (FES) of the laryngeal abductor muscles. We evaluated the efficacy of FES in restoring glottal opening, ventilation, and exercise tolerance in a BVFP canine model. An implantable stimulator and deep brain stimulation electrodes were surgically implanted into both posterior cricoarytenoid (PCA) muscles in the animal, and the bilateral recurrent laryngeal nerves were sectioned and repaired. Beyond three months postoperatively, there was passive airway narrowing and further closure of the glottis during hypercapnia. The animal showed severe stridor and could only walk for one to two minutes on a treadmill. With the stimulation-on condition, the glottal area increased considerably, equaling that of a normally innervated animal. Exercise tolerance also returned to normal. Bilateral PCA stimulation offers a physiologic approach to restore ventilation to a normal level in cases of BVFP.

Depression in Childhood Asthma vs. Adult-Onset Asthma: A Cross-Sectional Study from the National Health and Nutrition Examination Survey (NHANES).

asthma, a chronic respiratory disease caused by inflammation and narrowing of the small airways in the lungs, is the most common chronic childhood disease. Prevalence of childhood asthma in the United States is 5.8%. In boys, prevalence is 5.7% and it is 6% in girls. Asthma is associated with other comorbidities such as major depressive disorder and anxiety disorder. This study explores the association between asthma and depression. we conducted a retrospective cross-sectional study using NHANES data from 2013 to 2018. Asthma and childhood onset asthma were assessed using questionnaires MCQ010 and MCQ025, respectively. Sociodemographic variables were summarized, and univariate analysis was performed to determine the association between asthma and major depressive disorder and its individual symptoms. there were 402,167 participants from 2013-2018 in our study: no asthma in 84.70%; asthma in 15.30%. Childhood onset asthma (COA) included 10.51% and adult-onset asthma (AOA) included 4.79%. Median age of COA is 5 years and AOA is 41 years. Among the asthma groups, most AOA were females (67.77%, p &lt; 0.0001), most COA were males (52.16%, p &lt; 0.0001), and ethnicity was predominantly White in AOA (42.39%, p &lt; 0001) and in COA (35.24%, p &lt; 0.0001). AOA mostly&amp;nbsp;had annual household income from $0-24,999 (35.91%, p &lt; 0.0001), while COA mostly had annual household income from $25,000-64,999 (36.66%, p &lt; 0.0001). There was a significantly higher prevalence of MDD in COA (38.90%) and AOA (47.30%) compared to NOA (31.91%). Frequency of symptoms related to MDD were found to have a significantly higher prevalence and severity in the asthma groups compared to no asthma, and slightly greater and more severe in AOA than in COA. Symptoms include having little interest in doing things (COA 18.38% vs. AOA 22.50% vs. NOA 15.44%), feeling down, depressed, or hopeless (COA 20.05% vs. AOA 22.77% vs. NOA 15.85%), having trouble sleeping or sleeping too much (COA 27.38% vs. AOA 23.15% vs. NOA 22.24%), feeling tired or having little energy (COA 39.17% vs. AOA 34.24% vs. NOA 33.97%), having poor appetite or overeating (COA 19.88% vs. AOA 20.02% vs. NOA 15.11%), feeling bad about yourself (COA 13.90% vs. AOA 13.79% vs. NOA 10.78%), having trouble concentrating on things (COA 12.34% vs. AOA 14.41% vs. NOA 10.06%), moving or speaking slowly or too fast (COA 8.59% vs. AOA 9.72% vs. NOA 6.09%), thinking you would be better off dead (COA 3.12% vs. AOA 4.38% vs. NOA 1.95%) and having the difficulties these problems have caused (COA 21.66% vs. AOA 26.73% vs. NOA 19.34%, p &lt; 0.0001). MDD and related symptoms were significantly higher and more severe in participants with asthma compared to no asthma. Between adult-onset asthma compared to childhood onset asthma, adult-onset asthma had slightly greater and more severe MDD and related symptoms compared to childhood onset asthma.

Ventilator-Assisted Inspiratory and Expiratory Breath-Hold Thoracic Computed Tomographic Scans Can Detect Dynamic and Static Airway Collapse in Dogs with Limited Agreement with Tracheobronchoscopy.

Airway collapse (AC) in dogs includes a tracheal collapse, mainstem and lobar bronchial collapse, and bronchomalacia (i.e., segmental/subsegmental bronchial collapse). The clinical presentation of AC may overlap with non-collapsible airway disease (NCAD) or another non-lower airway respiratory disease (NLARD). This study determined whether paired inspiratory (I)/expiratory (E)-breath-hold computed tomography (I/E-BH CT) can detect a static and dynamic AC in dogs with spontaneous respiratory disease and it compared the CT-derived metrics of the AC to the tracheobronchoscopy metrics. The CT-acquired I and E diameter and cross-sectional area (CSA) for the trachea, mainstem and lobar bronchi in dogs with an AC (n = 16), NCAD (16), and NLARD (19) served for a dynamic percent of the airway narrowing (%AN) calculation. A scoring system assessed the bronchomalacia. The circularity was calculated for each airway. The results were compared to the tracheobronchoscopy collapse grading. In the dogs with an AC, the %AN was larger for the trachea, right mainstem bronchus and right middle lobar bronchus when they were compared to the dogs with NCAD and NLARD. Flattening was only identified for the trachea of the AC dogs. The agreement between the CT and tracheobronchoscopy scores was 20% from trachea to the lobar bronchi and 47% for the segmental/subsegmental bronchi. Paired I/E-BH CT can detect static and dynamic AC with limited agreement with the tracheobronchoscopy metrics. Independent scoring systems that are tailored to the clinical manifestations of functional impairments are needed.

Ketone body augmentation decreases methacholine hyperresponsiveness in mouse models of allergic asthma.

Individuals with allergic asthma exhibit lung inflammation and remodeling accompanied by methacholine hyperresponsiveness manifesting in proximal airway narrowing and distal lung tissue collapsibility, and they can present with a range of mild-to-severe disease amenable or resistant to therapeutic intervention, respectively. There remains a need for alternatives or complements to existing treatments that could control the physiologic manifestations of allergic asthma. Our aim was to examine the hypothesis that because ketone bodies elicit anti-inflammatory activity and are effective in mitigating the methacholine hyperresponsiveness associated with obese asthma, increasing systemic concentrations of ketone bodies would diminish pathologic outcomes in asthma-relevant cell types and in mouse models of allergic asthma. We explored the effects of ketone bodies on allergic asthma-relevant cell types (macrophages, airway epithelial cells, CD4 T cells, and bronchial smooth muscle cells) in vitro as well as in vivo by using preclinical models representative of several endotypes of allergic asthma to determine whether promotion of ketosis through feeding a ketogenic diet or providing a ketone precursor or a ketone ester dietary supplement could affect immune and inflammatory parameters as well as methacholine hyperresponsiveness. In a dose-dependent manner, the ketone bodies acetoacetate and β-hydroxybutyrate (BHB) decreased proinflammatory cytokine secretion from mouse macrophages and airway epithelial cells, decreased house dust mite (HDM) extract-induced IL-8 secretion from human airway epithelial cells, and decreased cytokine production from polyclonally and HDM-activated T cells. Feeding a ketogenic diet, providing a ketone body precursor, or supplementing the diet with a ketone ester increased serum BHB concentrations and decreased methacholine hyperresponsiveness in several acute HDM sensitization and challenge models of allergic asthma. A ketogenic diet or ketone ester supplementation decreased methacholine hyperresponsiveness in an HDM rechallenge model of chronic allergic asthma. Ketone ester supplementation synergized with corticosteroid treatment to decrease methacholine hyperresponsiveness in an HDM-driven model of mixed-granulocytic severe asthma. HDM-induced morphologic changes in bronchial smooth muscle cells were inhibited in a dose-dependent manner by BHB, as was HDM protease activity. Increasing systemic BHB concentrations through dietary interventions could provide symptom relief for several endotypes of allergic asthmatic individuals through effects on multiple asthma-relevant cells.

LBSAT310 A Rare Disease Engulfing Thyroid And Masquerading As Common Thyroid Disorders

Abstract Introduction – Langerhans cell histiocytosis (LCH) is a rare clonal disorder caused by the CD207+ Langerhans cells derived from the myeloid origin. We present a case of LCH where it mimicked Hashimoto's and Riedel's thyroiditis and completely infiltrated the thyroid gland. Case description – A 54-year-old female was initially diagnosed with hypothyroidism, goiter, and bilateral parotid and submandibular glands enlargement. CT imaging revealed a diffuse goiter which imposed infraglottic airway narrowing and a suspicious left inferior thyroid nodule. Biopsy revealed atypia of undetermined significance. GSC showed a 50% suspicion of malignancy with a negative BRAF. Follow up imaging revealed increased infiltrative masses within the salivary glands, enlarging thyroid gland, and increased infiltration of the superior component of the right thyroid lobe into the submandibular space. A core needle biopsy revealed a background of acute and chronic inflammation without evidence of malignancy. Sjogren's, sarcoidosis and IgG4 diseases were ruled out. She was then referred to us after a myriad of work up. She had a diffusely enlarged goiter with a crusted area of skin over the thyroid gland and significant bilateral parotid swelling. We repeated a thyroid ultrasound which revealed diffusely enlarged and heterogeneous thyroid glands with pseudo-nodules and 3 suspicious nodules greater than 1cm on right and left lobes. She also had prominent reactive lymphadenopathy. Her submandibular glands were hypoechoic, avascular, markedly enlarged and abnormal appearing. She underwent total thyroidectomy. Pathology revealed proliferation of histiocytes, few islands of lymphoid tissue, and eosinophilic micro abscesses without any identifiable thyroid parenchyma in the entire resected specimens. Immunohistochemistry confirmed the diagnosis of Langerhans Cell Histiocytosis with atypical features. BRAF (V600E/V600K) mutation was again not detected. Flow cytometry showed no evidence of neoplastic myeloid blast population. She was referred to an oncologist for further management of LCH. Discussion – Our patient had a remarkably diffuse goiter with a sonographic appearance mimicking Hashimoto's thyroiditis or Riedel's thyroiditis. Initial thyroid FNA failed to reveal LCH. The diagnosis was reached only after total thyroidectomy. Treatment depends on single or multi-system involvement, presence or absence of risk organ involvement, and presence or absence of BRAF mutation. Conclusion In the cases of infiltrated thyroid diseases, Langerhans cell histiocytosis should be on the differential diagnosis, especially if there is concomitant infiltrative process in other organs. The sonographic finding can mimic Hashimoto's or Riedel's thyroiditis which may lead to misdiagnosis and treatment delay. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Anti-inflammatory effect of Gyeji-tang in a chronic obstructive pulmonary disease mouse model induced by cigarette smoke and lipopolysaccharide

Context Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease associated with respiratory symptoms and narrowing of airways. Gyeji-tang (GJT) is a traditional Asian medicine that has been used to relieve early-stage cold symptoms, headache, and chills. Objective We examined the effect and potential molecular action mechanism of GJT in a mouse model of COPD induced by cigarette smoke (CS) plus lipopolysaccharide (LPS). Materials and methods COPD was induced in C57BL/6J mice via daily exposure to CS for 1 h for 8 weeks and intranasal administration of LPS on weeks 1, 3, 5, and 7. GJT (100 or 200 mg/kg) or roflumilast (5 mg/kg) was administrated daily for the final 4 weeks of COPD induction. Results Administration of GJT significantly suppressed the CS/LPS-induced increases in: the numbers of total cells and macrophages in bronchoalveolar lavage fluid; the expression levels of tumour necrosis factor-α, interleukin (IL)-6, IL-1β, and IL-8; the activities (phosphorylation) of nuclear factor kappa B and signal transducer and activator of transcription 3; and the expression levels of the structural remodelling markers, transforming growth factor beta, matrix metallopeptidase (MMP)-7, and MMP-9. Discussion and conclusions These results demonstrate that GJT prevents the lung inflammation and airway remodelling induced by CS plus LPS exposure in mice, suggesting that GJT may have therapeutic potential for the treatment of COPD.

Multifocal bronchial stenosis and extensive lobar atelectasis as a rare radiologic feature of severe eosinophilic asthma

Bronchial abnormalities on high-resolution computed tomography (CT) are frequent but heterogeneous in severe asthma,1 with airway wall thickening, diffuse airway narrowing, or, conversely, mild bronchiectasia and mucus pluggings being the most frequently observed.2 Focal bronchial stenosis has also been described.3 Although some degree of air trapping is frequently observed on expiratory CT, lung atelectasis is scarcely observed, is considered reversible,4 and is related to mucus plugging, only in the setting of asthma exacerbation.

Assessment of air quality, health status and lung function of workers from selected poultry management systems in Ogun State, Nigeria

Background/ObjectivesThis study assessed the air quality, health status and lung function of workers from intensive poultry production systems in selected areas of Ogun State. MethodsAir samples were monitored monthly between November 2017 and April 2018 from six pens in three selected poultry zones of Ogun State. The air pollutants (CO2, CH4, NO2, NH3, H2S, SO2, PM2.5) and the microclimatic parameters around the poultry pens were determined. Copies of structured questionnaires were administered to assess the impacts of air pollutants on the health status of the poultry workers. Lung function parameters [Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), FEV1/FVC and Peak Expiratory Flow Rate (PEFR)] were measured to assess the pulmonary health of the poultry workers and the control group. ResultsThe levels of NH3, PM2.5, CO2 and CH4 were higher than the permissible standards while NO2, H2S and SO2 were below the permissible limits of the World Health Organization. Regression analysis between pollutants and microclimatic parameters showed that relative humidity and windspeed had negative effects on PM2.5, NO2, H2S and SO2. FEV1/FVC measured for poultry workers was 86.84 ± 18.32% with 10.0% having obstructive lung function, while the control group had 98.82 ± 1.52% with 100% normal lung function pattern. The predicted PEFR for poultry workers was significantly lower at 61.12 ± 27.85% with 13.3% having severe airway restrictions, while the predicted PEFR for the control group was significantly higher at 88.41 ± 21.76% with no severe airway narrowing. ConclusionsThis study established that air quality around the poultry operations affected the workers’ health.

The cumulative effect of methacholine on large and small airways when deep inspirations are avoided.

The effect of serial incremental concentrations of methacholine is only slightly cumulative when assessed by spirometry. This limited cumulative effect may be attributed to the bronchodilator effect of deep inspirations that are required between concentrations to measure lung function. Using oscillometry, the response to methacholine can be measured without deep inspirations. Conveniently, oscillometry can also dissociate the contribution of large versus small airways. Herein, oscillometry was used to assess the cumulative effect of methacholine in the absence of deep inspirations on large and small airways. Healthy and asthmatic volunteers underwent a multiple-concentration methacholine challenge on visit 1 and a single-concentration challenge on visit 2 using the highest concentration of visit 1. The maximal response was compared between visits to assess the cumulative effect of methacholine. The lung volume was also measured after the final concentration to assess hyperinflation. In both healthy and asthmatic subjects, increases in resistance at 19 Hz (Rrs19 ), reflecting large airway narrowing, did not differ between the multiple- and the single-concentration challenge. However, increases in resistance at 5Hz (Rrs5 ) minus Rrs19 , reflecting small airway narrowing, were 117 and 270% greater in the multiple- than the single-concentration challenge in healthy (p= 0.006) and asthmatic (p < 0.0001) subjects, respectively. Hyperinflation occurred with both challenges and was greater in the multiple- than the single-concentration challenge in both groups. Without deep inspirations, the effect of methacholine is cumulative on small airways but not on large airways. Lung hyperinflation and derecruitment may partially explain these different responses.