Bronchial Mucosa Research Articles

Significance of detecting postmortem serum IgE in frozen corpses for the diagnosis of anaphylaxis in forensic.

The aim of this study was to detect the postmortem serum total IgE levels in frozen corpses and identify whether the death incident caused by an anaphylaxis in forensic medicine. Autopsy cases with pathological death (total, n=106; 4-214h postmortem) include cardiac disease (n=15), pulmonary infection (n=12), central nervous system disorder (n=6), pulmonary emboliszn (n=7), hapetic disease (n=5), kidney disease (n=6), enteric disease (n=10), necrotizing pancreatitis (n=7), diffuse peritonitis (n=6), MODS (n=6), toxicosis (n=5:), anaphylactic shock (n=7), bronchial asthma (n=8) and other disease (n=6) were examined. Results showed that there was no significant difference between serum IgE levels and ages, postmortem intervals (PMIs), gender as well as survival time. Serum IgE levels of deaths due to anaphylactic shock and bronchial asthma were higher than that of other groups. Forensic pathology examination results showed the main pathology changes of bronchial asthma were mucous congestion in bronchial lumen and eosinophils infiltration in bronchial mucosa. The main pathological features of anaphylactic shock were laryngeal edema and eosinophils infiltration in multiple organs (lung and spleen). This research proved that there was a great significance for IgE to infer whether the individual died due to an anaphylaxis even for a long PMI in frozen corpses. Furthermore, we can also preliminarily determine the type of allergic death combined with the examination of forensic pathology. These findings further verify the feasibility of postmortem serum IgE in the diagnosis of forensic causes of death and broaden the application scope of this marker.

Galacto-oligosaccharides alleviate lung inflammation by inhibiting NLRP3 inflammasome activation in vivo and in vitro

IntroductionThe lack of effective anti-inflammatory therapies for pneumonia represents a challenge for identifying new alternatives. Non-digestible galacto-oligosaccharides (GOS) are attractive candidates due to their anti-inflammatory and immunomodulatory effects both locally and systemically. ObjectivesThe anti-inflammatory properties of GOS were investigated in calves with lung infections and in calf primary bronchial epithelial cells (PBECs) and human lung epithelial cells (A549). To delineate the mechanism, the potential capacity of GOS to inhibit the NLR family pyrin domain containing 3 (NLRP3) inflammasome has been investigated. MethodsGOS were administrated orally to calves with naturally occurring lung infections during early life or used as pretreatments in cell cultures exposed to M. haemolytica, lipopolysaccharides (LPS), leukotoxin or ATP. The cell composition, cytokine/chemokine concentrations, and M. haemolytica-LPS lgG levels in broncho-alveolar lavage fluid (BALF) and blood were investigated, while the M. haemolytica positivity in BALF and bronchial mucosa was detected in vivo. Key markers of NLRP3 inflammasome activation were measured in vivo and in vitro. ResultsGOS reduced M. haemolytica positivity and M. haemolytica-LPS lgG levels in calves with lung infections. Regulation of immune function and suppression of inflammatory response by GOS is related to the inhibition of NLRP3 inflammasome as observed in bronchial mucosal tissue of infected calves. The M. haemolytica-induced IL-1β production in PBECs was lowered by GOS, which was associated with NLRP3 inflammasome inhibition caused by the decreased reactive oxygen species and ATP production. GOS inhibited leukotoxin-induced ATP production in PBECs. The LPS- and ATP-induced NLRP3 inflammasome activation in PBECs and A549 cells was suppressed by GOS. ConclusionGOS exert anti-inflammatory properties by inhibiting the NLRP3 inflammasome activation in vitro and in vivo, suggesting a potential role for GOS in the prevention of lung infections.

Diffuse Idiopathic Neuroendocrine Cell Hyperplasia (DIPNECH) on Electromagnetic Navigation Bronchoscopy (EMN) Guided Fine Needle Aspiration (FNA): A Case Report

Abstract Introduction/Objective DIPNECH is a clinicopathological diagnosis characterized by abnormal proliferation of single or clusters of neuroendocrine cells in the bronchial mucosa. The World health organization includes DIPNECH as a preinvasive lesion to carcinoid tumors of the lung. Diagnosis is often delayed or missed due to insidious presentation and rarity of the disease. High degree of suspicion in the appropriate clinical and radiological context is important for early diagnosis. We describe a unique case of DIPNECH diagnosed by EMN guided aspiration cytology in the setting of multiple incidental lung nodules and confirmed on surgical resection. Methods/Case Report A 69-year-old female with history of insidious cough was referred to pulmonology clinic for multiple incidental bilateral lung nodules detected by CT scan, largest involving the right middle lobe. Although the main diagnostic consideration was pulmonary metastasis, several radiological features, including diffuse mosaic attenuation pattern, prompted the possibility of a diffuse neuroendocrine process. Electromagnetic navigation bronchoscopy (ENB) guided fine needle aspiration cytology was performed. Air-dried and Papanicolaou stained smears were scant but showed dispersed and clusters of small cells with fine chromatin with minimal cytoplasm. No necrosis or mitosis were seen. A cell block was prepared that showed rare clusters of tumor cells positive for immunostains synaptophysin, chromogranin, CD56, with a Ki-67 of 1%. In the appropriate clinical and radiological context findings were consistent with a well differentiated neuroendocrine process such as DIPNECH. Right middle lobe resection confirmed extensive DIPNECH with multiple typical carcinoid tumors and tumorlets. Results (if a Case Study enter NA) NA Conclusion It is essential to be familiar with the clinical and radiological findings of DIPNECH and include it in the differential diagnosis of its mimickers. Although the diagnosis is challenging on limited specimens, this report indicates that EMN guided aspiration cytology can be used as a valuable early tool for accurate diagnosis and timely management of DIPNECH.

B Cell Mobilization, Dissemination, Fine Tuning of Local Antigen Specificity and Isotype Selection in Asthma.

In order to better understand how the immune system interacts with environmental triggers to produce organ-specific disease, we here address the hypothesis that B and plasma cells are free to migrate through the mucosal surfaces of the upper and lower respiratory tracts, and that their total antibody repertoire is modified in a common respiratory tract disease, in this case atopic asthma. Using Adaptive Immune Receptor Repertoire sequencing (AIRR-seq) we have catalogued the antibody repertoires of B cell clones retrieved near contemporaneously from multiple sites in the upper and lower respiratory tract mucosa of adult volunteers with atopic asthma and non-atopic controls and traced their migration. We show that the lower and upper respiratory tracts are immunologically connected, with trafficking of B cells directionally biased from the upper to the lower respiratory tract and points of selection when migrating from the nasal mucosa and into the bronchial mucosa. The repertoires are characterized by both IgD-only B cells and others undergoing class switch recombination, with restriction of the antibody repertoire distinct in asthmatics compared with controls. We conclude that B cells and plasma cells migrate freely throughout the respiratory tract and exhibit distinct antibody repertoires in health and disease.

Clinical characteristics of patients with chronic eosinophilic pneumonia in a Chinese tertiary-care hospital: A 6-year retrospective study.

IntroductionChronic eosinophilic pneumonia (CEP) is a rare disease with unknown etiology. Due to lack of specificity of CEP symptoms, clinicians are not experienced in establishing its diagnosis.ObjectivesTo summarize the clinical data of CEP patients to improve the understanding of CEP and reduce misdiagnosis.MethodsData of patients pathologically diagnosed with CEP in the PLA General Hospital between May 2013 and May 2019 were collected, and clinical manifestations, imaging characteristics, pathological features, and treatment were retrospectively analyzed.ResultsTwenty patients, including 6 males and 14 females, were diagnosed with CEP. The average age was 47.0 ± 10.2 years. The main clinical manifestations were cough and dyspnea. The average duration of CEP was 15.5 ± 11.5 months. The average proportion of eosinophils in the peripheral blood was 18.9 ± 17.8%, and the average proportion of eosinophils in the bronchoalveolar lavage fluid was 41.5 ± 19.4%. The main imaging features were patchy shadows and consolidation shadows. The most common manifestations on bronchoscopic examination were congestion and edema of the bronchial mucosa. Two patients had granular protrusions of the endotracheal membrane. Histological examination indicated infiltration of numerous eosinophils. All patients improved after prednisone therapy.ConclusionCEP onset is insidious, and clinical manifestations lack specificity. Typical imaging features are peripheral and subpleural distribution of lung infiltrates. Some patients have a normal proportion of eosinophils in the peripheral blood, but most have an increased number of eosinophils in the BALF, which contributes to CEP diagnosis. A biopsy is necessary when differential diagnosis is difficult. A systemic glucocorticoid is effective.

INCIDENTAL FINDING OF PULMONARY MUCOSA-ASSOCIATED LYMPHOID TISSUE LYMPHOMA

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Primary pulmonary lymphomas (PPLs) comprise 1% of lung neoplasias, with pulmonary mucosa associated lymphoid tissue (MALT) lymphoma making up approximately 80% of these lesions. Pulmonary MALT lymphoma is a rare extranodal marginal zone B-cell lymphoma that is typically indolent in nature. Clinical manifestations of pulmonary MALT include fever, malaise, cough, dyspnea, and chest pain, although 30% of patients can be asymptomatic. We present a case of an incidental discovery and diagnosis of pulmonary MALT lymphoma. CASE PRESENTATION: 72-year-old male lifelong non-smoker with medical history of hypertension presented to pulmonology clinic due to incidental central left lower and perihilar ground glass density seen on CT performed for coronary calcium scoring. He denied symptoms, and his physical examination and laboratory values were normal. Follow-up CT chest with contrast showed a persistent 3.5 cm ground-glass lesion in the superior segment of the left lower lobe. Navigational bronchoscopy with biopsy and bronchoalveolar lavage was performed. The pathology revealed bronchial mucosa with a dense atypical lymphoid infiltrate and predominance of CD20 positive and CD5 negative B lymphocytes. These findings were consistent with a lymphoproliferative disorder of MALT lymphoma. FDG PET-CT demonstrated moderate uptake in the left lower lobe nodule with no other significant uptake elsewhere in the body. The patient was evaluated by medical oncology and is undergoing active surveillance with repeat CT anticipated in 3 months. DISCUSSION: Onset of PPL occurs around 50-60 years of age and the rate of smoking in these patients is not higher than that of the general population. Pulmonary MALT lymphoma is associated with chronic antigen stimulation, but unlike other MALT lymphomas, they have not yet been associated with chronic infection. They are often associated with cytogenetic abnormalities, 42% of cases having the translocation t(11;18)(q21;q21). Diagnosis is made by tissue biopsy, usually bronchoscopic versus CT guided. Pathology and immunohistochemistry are significant for lymphoid infiltrates expanding lymphoid follicle marginal zones with CD20 positive and CD5 negative cells. Treatment options include chemotherapy, radiation therapy, immunotherapy, surgical management, or an expectant approach in cases of limited disease. Overall five-year survival for patients is greater than 80%. CONCLUSIONS: The pathogenesis of pulmonary MALT lymphoma is not well understood. Due to its rare occurrence, there are limited studies of treatment of these lymphomas and therefore no true consensus regarding best treatment strategies. With slow growth rates, a watch and wait plan may be a suitable approach to isolated pulmonary lesions and has not been shown to negatively affect overall survival. However, a better understanding of the pathophysiology and optimal treatment of these lymphomas requires further studies. REFERENCE #1: Sanguedolce F, et al. Primary pulmonary B-cell lymphoma: A review and update. Cancers. 2021; 13(3): 415. REFERENCE #2: Borie R. Pulmonary mucosa-associated lymphoid tissue lymphoma revisited. Eur Respir J. 2016;47(4):1244-60 REFERENCE #3: Yan W. Watch-and-wait or immediate immunotherapy/immunochemotherapy in patients with phase IE primary pulmonary MALT lymphoma? A multicenter retrospective study. Annals of Hematology. 2021; 100(3): 709-714. DISCLOSURES: No relevant relationships by Nicole Bernskoetter, source=Web Response Speaker/Speaker's Bureau relationship with Astra Zeneca, GSK Please note: $1001 - $5000 by Daniel Gerardi, source=Web Response, value=Honoraria No relevant relationships by Simrina Sabharwal, source=Web Response

Current Status and Progress of the Treatment of Limited-Disease Small Cell Lung Cancer

Small cell lung cancer (SCLC) is a common pathological type of primary lung cancer originating from the bronchial mucosa or gland. SCLC is characterized by rapid growth, high degree of malignancy, and early metastasis, which poses a great threat to patients’ safety and quality of life. SCLC can be divided into two stages: localized disease and extensive disease. For limited-disease small cell lung cancer (LD-SCLC), radiotherapy and chemotherapy are often used in clinical treatment. In recent years, there are several new advances in the clinical treatment of SCLC, including the improvement of radiotherapy and chemotherapy methods, compatibility of first-line and second-line drugs, as well as immune-targeted therapy. This article discusses the current status of clinical treatment and the research progress of LD-SCLC in the past five years.

Особливості цитологічного складу індукованого мокротиння в дітей шкільного віку, хворих на бронхіальну астму фізичного навантаження

На базі обласної дитячої клінічної лікарні м. Чернівці в 41 школяра, які хворі на персистуючу бронхіальну астму (БА), вивчався характер запалення дихальних шляхів (ДШ) із метою диференційованого вибору протизапальної базисної терапії. Першу (І) клінічну групу сформували 22 дитини з фенотипом БА фізичного навантаження, а решта 19 хворих без наявності фенотипу БА фізичного навантаження увійшли до складу другої (ІІ) клінічної групи. Цитологічний аналіз індукованого мокротиння проводився за методом I.D. Pavord (1996 р.).Хворим на БА фізичного навантаження притаманне гіпогранулоцитарне запалення ДШ із переважанням еозинофілопосередкованої реакції, асоційованої з гіперлімфоцитарною інфільтрацією бронхів. Так, бронхіальна еозинофілія (≥ 2 % еозинофілів у мокротинні) зареєстрована в 81,8 % школярів І групи та в 63,2 % — ІІ групи (Рϕ > 0,05). Водночас гіперлімфоцитарна (кількість лімфоцитів у клітинному осаді мокротиння ≥ 11 %) запальна реакція ДШ удвічі частіше реєструвалася у хворих на БА фізичного навантаження (22,7 % дітей) порівняно з пацієнтами ІІ групи (10,5 %) (Рϕ > 0,05). У хворих без наявності фенотипу БА фізичного навантаження втричі частіше (36,8 % випадків) відмічалася значна нейтрофільна запальна відповідь ДШ (відносний вміст нейтрофілів в індукованому мокротинні ≥ 69 %) порівняно з пацієнтами І клінічної групи (13,6 %) (Рϕ < 0,05). Водночас нейтрофільний варіант запальної реакції ДШ асоціювався з вираженішим пошкодженням слизової оболонки бронхів, що проявлялося збільшенням кількості (≥ 40 % циліндричних епітеліоцитів в індукованому мокротинні) злущеного епітелію в даної когорти хворих (68,4 %) порівняно з І групою (40,9 % дітей; Рϕ < 0,05).

Circulating Secretoglobin Family 1A Member 1 (SCGB1A1) Levels as a Marker of Biomass Smoke Induced Chronic Obstructive Pulmonary Disease.

Secretoglobin family 1A member 1 (SCGB1A1) alternatively known as club cell protein 16 is a protective pneumo-protein. Decreased serum levels of SCGB1A1 have been associated with tobacco smoke induced chronic obstructive pulmonary disease (TS-COPD). Exposure to biomass smoke (BMS) is an important COPD risk factor among women in low and lower-middle income countries. Therefore, in a cross-sectional study (n = 50/group; total 200 subjects) we assessed serum SCGB1A1 levels in BMS-COPD subjects (11 male, 39 female) compared to TS-COPD (all male) along with TS-CONTROL (asymptomatic smokers, all male) and healthy controls (29 male, 21 female) in an Indian population. Normal and chronic bronchitis like bronchial mucosa models developed at the air–liquid interface using human primary bronchial epithelial cells (3 donors, and three replicates per donor) were exposed to cigarette smoke condensate (CSC; 0.25, 0.5, and 1%) to assess SCGB1A1 transcript expression and protein secretion. Significantly (p < 0.0001) decreased serum SCGB1A1 concentrations (median, interquartile range, ng/mL) were detected in both BMS-COPD (1.6; 1.3–2.4) and TS-COPD (1.8; 1.4–2.5) subjects compared to TS-CONTROL (3.3; 2.9–3.5) and healthy controls (5.1; 4.5–7.2). The levels of SCGB1A1 were positively correlated (r = 0.7–0.8; p < 0.0001) with forced expiratory volume in 1 s, forced vital capacity, their ratios, and exercise capacity. The findings are also consistent within the BMS-COPD sub-group as well. Significantly (p < 0.03) decreased SCGB1A1 concentrations were detected with severity of COPD, dyspnea, quality of life, and mortality indicators. In vitro studies demonstrated significantly (p < 0.05) decreased SCGB1A1 transcript and/or protein levels following CSC exposure. Circulating SCGB1A1 levels may therefore also be considered as a potent marker of BMS-COPD and warrant studies in larger independent cohorts.

Relationship between nitric oxide levels and the activity of fibrogenic cytokine TGF-β1 and their role in diagnostics of the development of irreversible morphofunctional changes in bronchi of smoking adolescents

The aim is to study the relationship between the level of exhaled nitric oxide (FeNO) and the activity of the fibrogenic cytokine TGF-β1 in blood serum and brush biopsy samples of bronchial mucosa in order to determine their role in the development of irreversible morphological and functional changes in smoking adolescents. Materials and methods. 20 adolescent smokers with chronic bronchitis (CB) (average age – 17.5 ± 0.2 years) were exa­mined. The comparison group consisted of 37 adolescent smokers without respiratory symptoms (average age – 15.9 ± 0.2 years) and 15 healthy adolescents, who never smoked (average age – 15.9 ± 0.4 years). In adolescent smokers the tobacco smoking status was assessed. To confirm active smoking, the nicotine metabolite cotinine was determined in urine. Instrumental methods included spirometry, chest X-ray, tracheobronchoscopy. The FeNO level was measured using a Niox Mino. TGF-β1 level was determined in the blood serum and brush biopsy samples of the bronchial mucosa. Results. The FeNO levels were significantly lower in adolescent smokers with CB in comparison with adolescent smokers without respiratory symptoms (6.1 ± 0.3 ppb versus 8.8 ± 0.6 ppb, P &lt; 0.05). The relationship between the FeNO levels and indicators of the tobacco smoking status has been established in patients with CB and in asymptomatic smokers. There was a significant increase in the TGF-β1 levels in the blood serum in patients with CB compared with asymptomatic smokers (478.7 ± 57.9 pg/ml versus 231.5 ± 23.5 pg/ml, P &lt; 0.05). In smoking adolescents a relationship between a FeNO level and an increased activity of the fibrogenic cytokine TGF-β (r = -0.63; P &lt; 0.05) has been established. In one third of patients the TGF-β1 factor was identified in the bronchial endothelium. The presence of this factor in the bronchial endothelium is a serious prognostic criterion for the risk of developing “inadequate” pneumofibrosis, which can lead to irreversible remodeling processes in the bronchi. Conclusions. Determination of FeNO levels and TGF-β1 in the blood serum in smoking adolescents has a reliable diagnostic value for determining the risk group for the development of irreversible morphological and functional changes in the bronchi and can improve the efficiency of early diagnosis of chronic respiratory pathology.

Cytological research of exophytic tumors of the bronchi and the growth pattern of lung cancer

Background. The study of the growth of lung cancer (LC) has an important clinical significance for morphological verification, the choice of the treatment method, and the determining of prognosis. Investigation of this question allows to clarify the histogenesis of LC. The aim of our study was to compare the results of cytological studies of the material obtained during flexible bronchoscopy (FBS) and scrapings from the operated tumors of the bronchi to clarify the nature of LC growth. Design. To study the growth of tumors in the bronchi in relation to the bronchial mucosa, the cytological examination of the material obtained by FBS and scrapings from the surface of the operated bronchial tumors of 31 patients has been performed. Results. In the preoperative period, in the material of FBS, tumor cells were found only in 1/3 of patients. To obtain the optimal material from exophytic tumors of the bronchus, scrapings were carried out from the entire surface surgical material of the same patients. Cytological preparations of the obtained scrapings confirmed the presence of cancer cells in more than 1/3 of patients. In the rest of the observations, scrapings from the tumor surface contained only cells of the cylindrical epithelium. Conclusions. The cytological investigations made it possible to state that in 2/3 scrapings from surfaces of exophytic tumors of the bronchus contained only cells of the cylindrical epithelium; therefore, the tumors grow under it.

Computed Tomography Image Segmentation Using Edge Correction Algorithm for Refractory Mycoplasma Pneumonia in Children

Objective. It is to study the application of edge correction algorithm (ECA) in computed tomography (CT) medical image segmentation, explore its guiding significance in the analysis of clinical characteristics of children with refractory mycoplasma pneumoniae (RMPP), and discuss the therapeutic value of fiberoptic bronchoscopy bronchoalveolar lavage (BAL) for RMPP. Methods. The accuracy of ECA in CT medical image segmentation of children with RMPP was compared with that of the watershed segmentation algorithm (WSA) and swarm intelligence optimization algorithm (SIOA). The clinical characteristics and the imaging characteristics of 80 children with RMPP admitted to hospital from January 2018 to January 2020 were retrospectively analyzed based on the ECA. All children were divided into a lavage group (BAL group, n = 69) and a nonlavage group (non-BAL group, n = 11) according to whether fiberoptic bronchoscopy and BAL were performed. Bronchoscopy was adopted to analyze the cytological characteristics of BAL fluid (BALF) in children, and the recovery rate and the total effective rate of the two groups of children were observed and compared. Results. The overall accuracies (OAs) of the three ECAs (Roberts operator (RO), Sobel operator (SO), and Prewitt operator (PO)) were higher than that of WSA and SIOA, their false negative rate (FNR) and false positive rate (FPR) were small, and their denoising performance was superior to that of WSA and SIOA. The main clinical manifestations of all children were high fever, irritating dry cough, and few early signs. The results of chest CT examination were mainly manifested as patchy or large-scale consolidation, two lung mesh or small nodular shadows, and atelectasis. 69 cases with fiberoptic bronchoscopy showed swelling and congestion of the bronchial mucosa at the lesion site with visible viscous secretions, which was consistent with the imaging changes. The total number of cells in the BALF of children increased ( P &lt; 0.05 ), which mainly represented the increase of neutrophils ( P &lt; 0.05 ). The recovery rate of children with lavage (81.16%) was higher dramatically than that of the nonlavage group (45.45%). Conclusion. The ECA had good accuracy and denoising performance in lung CT image segmentation. The clinical characteristics, imaging characteristics, and cytological components of children had changed when they suffered from the RMPP, and fiberoptic bronchoscopy lavage had a therapeutic effect on it.

Clinicopathological features and molecular genetic changes of lung salivary gland-type clear cell carcinoma

Objective: To investigate the clinicopathological features, immunophenotype, differential diagnosis, molecular genetic changes and prognosis of salivary gland-type clear cell carcinoma (CCC) of the lung. Methods: Eight cases of salivary gland-type CCC of the lung diagnosed at Fudan University Shanghai Cancer Center and Shanghai Pulmonary Hospital, China from March 2017 to December 2020 were retrieved and analyzed. The pathological sections of these cases were studied using immunohistochemical staining, fluorescence in situ hybridization (FISH), and RNA-seq fusion gene detection based on next generation sequencing technique. The patients were followed up and the relevant literature was reviewed. Results: The 8 patients included 3 males and 5 females, with age ranging from 43 to 64 years (average, 58 years). All patients underwent radical lobectomy and lymph node dissection, while only one had lymph node metastases. The eight patients were followed up for 6 to 45 months, and were all recurrence-free. Histopathologically, the tumor was mainly composed of eosinophilic and clear cells arranged in trabecular, ribbon and nest patterns. Hyalinization was often observed in the stroma around the nest. Immunohistochemical staining showed that 8/8 cases were positive for EMA and CK7; 5/8 cases were positive for p63 and p40; 4/8 cases were positive for SOX10; and the cases were all negative for S-100, SMA and calponin. EWSR1 gene fusion was detected in all cases by FISH. RNA-seq fusion gene was detected in 6 cases based on next generation sequencing. The EWSR1-ATF1 gene fusion was detected in 5 cases, among which one case also had the ATF1-SPTLC2 gene fusion. All 5 cases with EWSR1-ATF1 gene fusion showed that EWSR1 exon 12/13 fused with ATF1 exon 3. And EWSR1-CREM gene fusion was detected in one case. Conclusions: Salivary gland-type CCC of the lung is an extremely rare primary lung tumor arising from the bronchial mucosa. The diagnosis and differential diagnosis of this tumor depend on classic histomorphology, especially the auxiliary detection of EWSR1 fusion gene. The primary treatment choice of this tumor is complete surgical resection. Lymph node metastases may occur, but the overall prognosis is good.

Компьютерная томография в диагностике синдрома Мунье-Куна

The article presents a clinical case of tracheobronchomegaly (Mounier-Kuhn syndrome). This is a congenital malformation characterized by dilatation of trachea and major bronchi due to underdevelopment of elastic and muscular elements of the tracheobronchial tree. The first manifestations appear as symptoms of recurrent bronchitis. A full-scale clinical picture in most cases appears at the age of 20-40, when infection adds, periodic recurrences become more frequent, and respiratory failure gradually builds up, which is associated with impairment of draining function of bronchi, and further leads to purulent bronchitis, bronchiectasis and pneumosclerosis. Traditional chest X-ray has limited capacities and cannot be used for diagnosis of Mounier-Kuhn syndrome, which is demonstrated in the described case. Thus, a female patient for a long time was observed for tracheobronchitis, but the conducted treatment did not give any significant improvement. Conclusion. Mounier-Kuhn syndrome is a rather rare pathology that can be diagnosed with multislice X-ray computed tomography permitting to more distinctly localize the pathological process and to determine its spread, dimensions of trachea and major bronchi in different anatomical planes, the condition of the neighboring tissues and structures and existence of complications. Also of importance is bronchoscopy that permits to identify alterations of bronchial mucosa in tracheobronchomegaly.

Interactions via α2β1 Cell Integrin May Protect against the Progression of Airway Structural Changes in Asthma.

Increased airway wall thickness and remodeling of bronchial mucosa are characteristic of asthma and may arise from altered integrin signaling on airway cells. Here, we analyzed the expression of β1-subfamily integrins on blood and airway cells (flow cytometry), inflammatory biomarkers in serum and bronchoalveolar lavage, reticular basement membrane (RBM) thickness and collagen deposits in the mucosa (histology), and airway geometry (CT-imaging) in 92 asthma patients (persistent airflow limitation subtype: n = 47) and 36 controls. Persistent airflow limitation was associated with type-2 inflammation, elevated soluble α2 integrin chain, and changes in the bronchial wall geometry. Both subtypes of asthma showed thicker RBM than control, but collagen deposition and epithelial α1 and α2 integrins staining were similar. Type-I collagen accumulation and RBM thickness were inversely related to the epithelial expression of the α2 integrin chain. Expression of α2β1 integrin on T-cells and eosinophils was not altered in asthma. Collagen I deposits were, however, more abundant in patients with lower α2β1 integrin on blood and airway CD8+ T-cells. Thicker airway walls in CT were associated with lower α2 integrin chain on blood CD4+ T-cells and airway eosinophils. Our data suggest that α2β1 integrin on inflammatory and epithelial cells may protect against airway remodeling advancement in asthma.

Platycodin D attenuates airway inflammation via suppression Th2 transcription factor in a murine model of acute asthma

Introduction: Bronchial asthma is a common chronic inflammatory condition of the airway tissue. Platycodin D (PLD) has antiinflammatory effects in a mouse model of allergic asthma. In this work, the anti-asthma potential of PLD was studied by investigation of its effect to suppress airway inflammation and mucin production, a murine model of asthma and the possible mechanisms. Methods: Mice were randomly assigned to five experimental groups: control, ovalbumin (OVA), OVA+ICS (intranasal fluticasone), OVA+PLD and OVA+PLD/ICS. Airway histological studies were evaluated by the H&E staining; IL-4, IL-5, and IL-13 in bronchoalveolar lavage fluid were evaluated by ELISA; GATA3 and IRF4 mRNA of airway were measured by RT-PCR and their protein level were measured by Western blotting. Results: Our study showed that PLD suppressed eosinophilic inflammation and mucin production in bronchial mucosa. Moreover, PLD inhibited production of Th2 cytokines such as IL-4, IL-5, and IL-13. Protein production of GATA3 and IRF4, were also decreased in PLD treated OVA asthma model. Taken together, our results provided evidence that PLD inhibits the airway inflammation via suppression of Th2 transcription factor production. Conclusion: These findings suggest that PLD may effectively ameliorate the progression of asthma. These results suggest that PLD could be used as a therapy for allergic asthma.

Abnormal Pulmonary Lymphatic Flow on Novel Lymphangiographic Imaging Supports a Common Etiology of Lymphatic Plastic Bronchitis and Nontraumatic Chylothorax.

Background: This study evaluates whether dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) and thoracic duct lymphangiography (TDL) findings in adults with lymphatic plastic bronchitis (PB) and/or nontraumatic chylothorax (NTC) support a shared pathophysiology. Materials and Results: Retrospective review of clinical and imaging findings in patients who underwent DCMRL and TDL at a single institution from March 2017 to March 2019. Categorical variables were compared with Fisher's exact test. Twenty-eight patients (median age 61 ± 21 years, 15 women) presenting with lymphatic PB (n = 13), NTC (n = 10), or both (n = 5) were included. Lymphatic imaging demonstrated pulmonary lymphatic perfusion (PLP) in all patients. A patent thoracic duct (TD) with retrograde flow was seen in 53.4% (7/13) of patients with PB, 60% (6/10) of patients with NTC, and 20% (1/5) of patients with both (p = 0.69). An occluded TD with retrograde flow was seen in 30.8% (4/13) of patients with PB, 30% (3/10) of patients with NTC, and 80% (4/5) of patients with both (p = 0.12). Similar patterns of PLP between DCMRL and TDL were seen in 96.2% (25/26) of patients. Conclusions: DCMRL and TDL demonstrated similar findings in patients with lymphatic PB and/or NTC, supporting a common etiology. This supports the hypothesis that the clinical presentation depends on the proximity of abnormal lymphatic vessels to the pleural cavity, resulting in chylothorax, or bronchial mucosa, resulting in PB.

Diagnostic and Prognostic DNA-Karyometry for Cancer Diagnostics

Diagnostic and prognostic DNA-karyometry represents an automated computerized microscopical procedure, designed to improve cancer diagnostics at three different aspects: Screening for cancer cells, e.g. in body cavity effusions, urines or mucosal smears Specifying the risk of dysplasias or borderline lesions to progress to manifest cancer, e.g. of oral, bronchial or cervical mucosa, or the ovary. Grading the malignancy of certain tumors, like prostate cancer. It combines an automated diagnostic classification of Feulgen-stained nuclei with precise nuclear DNA-measurements. DNA-aneuploidy is used as a specific marker of malignancy and its degree for grading. All types of cytological specimens can be used after (re-)staining specific for DNA according to Feulgen. Histological specimens are subjected to enzymatic cell separation before Feulgen-staining. A video-slide scanner is used for automated scanning of microscopical slides. Diagnostic nuclear classifiers have tissue-specifically been trained by an expert-cytopathologist (A. B.), based on Random Forest Classifiers, applying 18 different morphometric features. They achieve an overall accuracy of 91.1% to differentiate 8 differents types of objects/nuclei. Nuclear DNA-measurements of diploid nuclei achieve a CV of &lt;3%. DNA-stemline-aneuploidy, applied as a 100% specific marker for malignancy, is detected and quantified, using internationally accepted algorithms (ESACP 1995-2001). Suspicion of malignancy is raised in the absence of DNA-aneuploidy but presence of &gt;1% morphometrically abnormal nuclei. Time needed for loading, scanning and validation of results per slide is about 10 minutes. Results of digital diagnostic nuclear classification can be verified by a cytopathologist, using image galleries. Likewise automated diagnostic interpretation of nuclear DNA-distributions can be checked on the monitor, before a pathologists validated diagnoses are issued. Screening-results are presented for body cavity effusions and urines. Evaluations of dysplasias are reported for oral, bronchial and cervical smears. Results of grading malignancy are shown for prostate cancers.

Technologies of medical rehabilitation of children with bronchial asthma

Review purpose: the presentation of modern technologies of medical rehabilitation of children with bronchial asthma. Basic provisions: Recently, the increasing significance is attached to non-drug methods of treatment of bronchial asthma owing to the high frequency of undesirable effects when using medicinal preparations. The main objectives of medical rehabilitation in bronchial asthma are normalizing respiratory function, rendering anti-inflammatory and anti-edematous effect on bronchial mucosa, normalizing the state of the central and autonomic nervous system, increasing tolerance to an exercise stress, and strengthening protective forces of an organism. Conclusion: The treatment of children with bronchial asthma with the use of non-drug technologies is applied at all stages of medical rehabilitation.

Assistant role of manifestations under tracheoscopy in the diagnosis of invasive pulmonary aspergillosis in severe patients

To evaluate the assistant role of manifestations under tracheoscopy in the diagnosis of invasive pulmonary aspergillosis (IPA) in severe patients. A retrospective study was conducted. The patients with suspected IPA admitted to intensive care unit (ICU) of Affiliated Hospital of Binzhou Medical College from January 2015 to December 2019 were enrolled. The diagnosis, clinical diagnosis and suspected diagnosis were made according to the grading criteria of Guidelines for the diagnosis and treatment of invasive fungal infection in severe patients (2007). Those who met the criteria were enrolled in the IPA group, and those who did not meet the criteria or other pathogens were enrolled in the non-IPA group. The general data of the patients were collected, and the changes of tracheal and bronchial mucosa under tracheal microscope before and after treatment were recorded, as well as the results of galactomannan (GM) test and aetiology culture of bronchoalveolar lavage fluid (BALF). The baseline, bronchoscopy and pulmonary CT manifestations and their dynamic changes were compared in each group. A total of 142 patients with suspected IPA were finally enrolled. Among them, 12 were pathologically proven IPA, 77 were probable IPA, 22 were possible IPA, and 31 were undefined IPA. Of the 142 patients, 60 had typical manifestations of mucosal injury under bronchoscopy, including 7 proven IPA patients (58.3%), 52 probable IPA patients (67.5%), and 1 possible IPA patient (4.5%), but none undefined IPA patient. The patients undergoing lung CT scan were 12 proven IPA patients (100%), 73 probable IPA patients (94.8%), and 21 possible IPA patients (95.5%), respectively. Most of the Chest CT showed patchy or strip density increasing and other non-specific manifestations. There were 3 proven IPA patients (25.0%), 7 probable IPA patients (9.0%), and 0 possible IPA patient (0%) who had typical IPA CT manifestations (halo sign and cavity or crescent sign). Among the patients of proven IPA and probable IPA (89 cases), there were a total of 35 cases with endoscopic airway mucosal injury and tracheoscopy reexamination ≥ 3 times. All the 35 patients received anti-aspergillus treatment, among which 16 survived and 19 died. Among the 16 patients who survived, the microscopic appearance of mucosal injury was gradually reduced and the clinical manifestations were gradually improved. Of the 19 patients who died, 16 had deteriorated endoscopic airway mucosal injury. The specific manifestations of severe patients with bronchial mucosal injury are of great significance in the diagnosis of IPA. In the case of severe patients who cannot receive pathological examination or chest CT in time, dynamic observation of the changes of airway mucosal injury is a simple auxiliary method to discover the changes of patients' condition in time, evaluate the effect of antifungal therapy and the prognosis of IPA.