Bronchoalveolar Lavage In Patients Research Articles

Shifted focus of bronchoalveolar lavage in patients with suspected thoracic malignancy: an analysis of 224 patients.

Bronchoscopies are extensively adopted for diagnosing and staging thoracic malignancies, but studies are missing as how to keep the process streamlined and more efficient. To evaluate current role of bronchoalveolar lavage (BAL) for cancer and possible infection diagnosis when practicing comprehensive bronchoscopy for patients suspected with thoracic malignancy, and provide foundation for possible practice modification. We retrospectively analyzed a prospectively kept database of immunocompetent patients undergoing bronchoscopy for suspected non-hematologic malignancies. Clinical, radiographic data, bronchoscopic sampling techniques and diagnostic results were recorded. Initially undiagnostic patients were followed up for 2 years for a definitive diagnosis. Of 224 patients included, 179 (79.9%) were confirmed with active thoracic malignancies. BAL diagnostic yield of cancer based on different radiographic characters of target lesion are as follow: isolated lymphadenopathies 0%, central lesions 45.5%, peripheral masses (diameter ≥3 cm) 21.4%, peripheral large nodules (2≤ diameter <3 cm) 15.8%, and peripheral small nodules (diameter <2 cm) 7.1%, while composite bronchoscopy achieved diagnostic yield of 93.3%, 95.5%, 91.7%, 76.9%, and 66.7% in corresponding lesion types. No cancer was diagnosed solely by BAL-cytology. Proportions of patients with positive BAL culture did not differ significantly between patients with and without pre-test suspicion for infections (P=0.199). In multivariable analysis, infections were associated with age ≥75 (OR 3.0; 95% CI: 1.29-7.06), chronic obstructive pulmonary disease (COPD) (OR 2.7; 95% CI: 1.14-6.26) and diabetes mellitus (DM) (OR 4.5; 95% CI: 1.90-10.44). Omitting BAL cytology in settings of comprehensive bronchoscopy may not compromise cancer diagnosis. For patients primarily suspected with thoracic malignancy, performing BAL culture only based on clinical suspicion could miss important infectious etiology.

Club cell secretory protein in serum and bronchoalveolar lavage of patients with asthma

Club cell secretory protein in serum and bronchoalveolar lavage of patients with asthma

Neutrophilic inflammation promotes bacterial growth during Tuberculosis

Abstract Nitric oxide is generally assumed to protect from tuberculosis by inhibiting the growth of Mycobacterium tuberculosis (Mtb), thereby preventing tissue damage. In contrast, we report that nitric oxide protects the host by repressing a neutrophil recruitment cascade that requires IL-1, CXCR2 and 12-lipoxygenase (12-LOX)-derived eicosanoids. Inhibition of the neutrophil recruitment alone enables the susceptible NOS2 KO mice to control Mtb growth, suggesting that neutrophilic inflammation, not an intrinsic anti-bacterial defect, drives susceptibility. By using a library of bacterial transposon mutants as reporters of host derived stress conditions, we show that granulocytic inflammation generates a nutrient-replete growth-permissive environment for Mtb which obviates the need for essential virulence factors, including the siderophore, mycobactin, and the virulence-related lipid, phthiocerol dimycocerosate, that are otherwise indispensable for establishing infection. A similar inflammatory pathway promotes TB in humans, as human genetic polymorphism that increases 12-LOX expression is associated with TB risk. The concentration of 12-LOX products correlates with neutrophil numbers and bacterial burden in the bronchoalveolar lavage of patients with pulmonary tuberculosis. We propose that Mtb exploits the inflammatory response to preferentially replicate at sites of tissue damage that promote contagion.

Molecular diagnostics for bacterial infections in bronchoalveolar lavage--a case-control, pilot study.

The differentiation between infectious and noninfectious pulmonary complications is challenging. Rapid, accurate microbiological results may allow appropriate antibiotic therapy, withholding or adapting antibiotics, and thus reducing costs and risks of empirical antibiotic therapy. The objective of this proof-of-concept pilot study was to investigate the diagnostic yield of a new polymerase chain-reaction (PCR) and microarray-based rapid molecular diagnostic assay and compare the results to conventional microbiology cultures and clinical judgment. Bronchoalveolar lavage specimens were obtained from 35 patients undergoing bronchoscopy for diagnostic reasons. Cases (n = 22) consisted of patients with suspicion of pulmonary bacterial infection. Controls (n = 13) were identified among patients undergoing bronchoscopy for indications other than suspicion of infection. Demographics were similar in cases and controls. The majority (73%) of patients with pulmonary infection were on empirical antibiotic therapy. Among the 22 cases, bacteria were identified by means of PCR in 77% (n = 17) as compared with 41% (n = 9) by culture (p = 0.030). In contrast, controls yielded a PCR positive result in 45% (n = 7), as compared with no positive cultures (p = 0.005). Compared with culture results, PCR had a sensitivity of 87.5% (95% confidence interval [CI] 47.4-97.9) and specificity of 28.6% (95% CI 8.6-58.1) to diagnose bacterial infection. Compared with clinical judgment, corresponding figures were 77.3% (95% CI 54.5-91.1) and 46.2% (95% CI 19.3-74.8), respectively. The PCR- and microarray-based rapid molecular diagnostic assay offers an alternative to conventional cultures for detection of potentially pathogenic bacteria in bronchoalveolar lavage of patients with pneumonia. However, the clinical relevance is unclear as it may also detect colonisers in patients without a corresponding infection.

Endothelin-1 induces VCAM-1 expression-mediated inflammation via receptor tyrosine kinases and Elk/p300 in human tracheal smooth muscle cells.

The elevated level of endothelin-1 (ET-1) has been detected in the bronchoalveolar lavage of patients with severe asthma, acute lung injury, acute respiratory distress syndrome, and sepsis. ET-1 may affect vessel tone together with lung physiology and pathology. Vascular cell adhesion molecule-1 (VCAM-1) is one kind of adhesion molecules participating in the process of polymorphonuclear leukocyte transmigration and regulating the occurrence and amplification of tissue inflammation. However, the molecular mechanisms underlying ET-1-mediated expression of VCAM-1 on human tracheal smooth muscle cells (HTSMCs) were largely unknown. Here we reported that ET-1 stimulated expression of VCAM-1 gene on HTSMCs, which was blocked by pretreatment with the inhibitors of ET receptors, Src, matrix metalloproteinases (MMPs), epidermal growth factor receptor (EGFR), platelet-derived growth factor receptor (PDGFR), phosphatidylinositol 3-kinase (PI3K), AKT, MEK1/2, and p300, suggesting the participation of these signaling components in ET-1-regulated HTSMC responses. Furthermore, transfection with small-interfering RNA (siRNA) of Src, AKT, p42 mitogen-activated protein kinase (MAPK), or p300 downregulated the respective proteins and significantly attenuated ET-1-induced VCAM-1 expression. ET-1 also stimulated phosphorylation of Src, EGFR, PDGFR, AKT, p42/p44 MAPK, and Elk-1 and acetylation of histone H4 on HTSMCs. Immunoprecipitation assay showed the association between Elk-1 and p300 in the nucleus. Adhesion assay revealed that the adhesion of THP-1 to HTSMCs challenged with ET-1 was increased, which was attenuated by the inhibitors of ET receptors, Src, MMPs, EGFR, PDGFR, PI3K, AKT, p42/p44 MAPK, and p300. Taken together, these data suggested that ET-1 promotes occurrence and amplification of pathology-related airway inflammation via enhancing VCAM-1 expression in an ET receptor/Src/MMP/EGFR, PDGFR/PI3K/AKT/p42/p44 MAPK/Elk-1/p300 pathway in HTSMCs.

Clinical study of the value in bronchoalveolar lavage in patients with severe lung infection by bed side painless fiberoptic bronchoscopy under chest CT guidance and mechanical ventilation

Objective To explore the effects of bed side painless fiberoptic bronchoscopy for bronchoalveolar lavage (BAL) under chest computed tomography (CT) guidance and mechanical ventilation in the patients with severe pulmonary infection (SPI) . Methods A total of 131 cases of SPI under mechanical ventilation support were randomly (random number) divided into CT group (C group) , chest X-ray examination group (X group) and without radiological examination group (N group) . The bronchoalveolar lavage (BAL) by using painless fiberoptic bronchoscopy with invasive mechanical ventilation was carried out in patients of these three groups. Vital signs and variables of respiratory mechanics of patients were monitored before and 1 h, 2 h, and 4 h after BAL and the time consumed for BAL was simultaneous recorded. Meanwhile, infection related biomarkers on the 3rdd and 5th d after BAL, positive detection rate of pathogenic bacteria, the time of invasive mechanical ventilation used during BAL and total duration of mechanical ventilation support were measured. Results During BAL and at 10 min after BAL, heart rate and respiratory rate of C group and X group were lower than those of N group (P 0.05) . One and two hours after BAL, peak inspiratory pressure (PIP) , work of breathing ventilation (WOBvent) and airway resistance (RAW) in C group and X group were lower than those in N group, therefore, dynamic compliance (Cdyn) in C and X groups was better than that in N group (P 0.05) . BAL time (BAL-t) in C group (16.81±2.62) min was shorter than that in X group (20.12±3.81) min and N group (23.69± 2.76) min, (P <0.05) . Three and five days after BAL, core body temperature, WBC and procalcitonin (PCT) in C and X group were lower than those in N group (P <0.05) , and those in C group was lower than those in X group (P <0.05) . Pathogenic micro-organism detection rate in C group (80.55%, 29/36) was higher than that in X group (72.09%, 31/43) and N group (59.65%, 34/57) (P <0.05) . Total mechanical ventilation time (MV-t) in C group (114.36±38.39) h was shorter than that in X group (132.07±42.51) h and N group (165.28±67.28) h (P<0.05) . Conclusions BAL by using painless fiberoptic bronchoscopy under chest CT guidance can effectively reduce the stress on patients with severe pulmonary infection supported with mechanical ventilation, decrease airway hyper-reactivity, shorten the BAL time, ICU stay and duration of mechanical ventilation, facilitate drainage of lung infection exudates and pathogen detection rate and improve efficacy of comprehensive treatment. Key words: CT chest; X-ray; Fiberoptic bronchoscopy; Bronchial lavage; Painless; Mechanical ventilation; Pulmonary infection; Intensive care unit

A Comparative Study of Bronchoscopic Microsample Probe versus Bronchoalveolar Lavage in Patients with Burns-Related Inhalational Injury, Acute Lung Injury and Chronic Stable Lung Disease

Background and Objectives: The bronchoscopic microsample (BMS) probe allows direct epithelial lining fluid (ELF) level measurement without saline lavage. We investigated whether cytokine levels in ELF from a BMS differed from those obtained by bronchoalveolar lavage (BAL) in stable and acute lung disease. Methods: In a single-centre, prospective observational cohort study of 45 patients, a sequential BMS probe procedure and BAL were performed on patients with stable chronic obstructive lung disease, interstitial lung disease, acute lung injury (ALI), burns-related inhalational injury or controls. ELF samples were assayed for IL-1β, IL-6, IL-8, TNF-α and G-CSF. Results: Both bronchoscopic microsampling and BAL showed significantly higher cytokine levels in the ELF from patients with ALI and burns-related inhalational injury than from those with chronic stable lung disease. The BMS method detected cytokine levels approximately 20- to 80-fold higher than the corresponding BAL (uncorrected for dilution). The ratio of BMS and BAL cytokine levels was as follows: the ratio for IL-1β [mean 55, 95% confidence interval (CI) 34-88] was higher than that for IL-6 (mean 16, 95% CI 10-23, p = 0.015) and IL-8 (mean 13, 95% CI -5 to 36, p = 0.03). The ratio for G-CSF (mean 43, 95% CI 24-75) was higher than that for IL-6 (mean 16, 95% CI 10-23, p = 0.008). Conclusions: The BMS probe safely collects ELF with higher equivalent inflammatory cytokine concentrations than via BAL from patients with both acute and chronic lung disease and can be an alternative to saline BAL. Variations in cytokine concentrations between BMS and BAL and sampling-site differences warrant further study.

Detection of helicobacter pylori in bronchoalveolar lavage of patients with chronic obstructive pulmonary disease by real time polymerase chain reaction.

Background:Chronic obstructive pulmonary disease (COPD) is one of the most important causes of disability and mortality in the world. Although cigarette smoking and environmental pollutants have been recognized as the major causes of COPD, the role of infection in the pathogenesis and progression of COPD has also been reported.Objectives:The aim of the present study was to find the relationship between Helicobacter Pylori infection and COPD through anti H. pylori IgG serology, real time PCR of bronchoalveolar lavage and trans bronchial biopsy urease tests.Patients and Methods:This descriptive cross-sectional study was carried out on 60 adults with COPD. After obtaining the patient’s history, physical examination, spirometry and confirmation of COPD diagnosis by pulmonologist, subjects were selected through convenience sampling. In order to determine the severity and prognosis of disease, the global initiative for chronic obstructive lung disease (GOLD) criteria and BODE index were used. Subjects underwent bronchoscopy for obtaining bronchoalveolar lavage (BAL) samples and biopsy was performed. Biopsy and BAL samples were investigated respectively by urease test and real time PCR. Moreover, patients’ serum samples were serologically studied for detection of anti H. pylori IgG.Results:Mean age of the participants was 60.65 ± 9.15 years, and 25% were female and 75% were male. The prevalence rate of H. pylori in COPD patients was 10% according to real time PCR, 88.3% according to the serology test and 0% based on the urease test. According to the results of PCR and considering the severity of disease based on the GOLD criteria, from those with a positive PCR, one patient (16.6%) had very severe obstruction, three (50%) had severe obstruction and two patients (33.3%) had moderate obstruction. The relationship between H. pylori presence (based on PCR) and disease severity and prognosis was not statistically significant.Conclusions:These findings can justify the hypothesis of direct injury and chronic inflammation via inhalation and aspiration resulting in H. pylori colonization. In fact, it is thought that H. Pylori infection, beside the host genetic vulnerability and other environmental risk factors might make the patient susceptible to COPD or lead to COPD worsening. Although we found H. pylori infection in some patients with COPD, the results of this study, could not explain the pathogenic mechanisms of COPD.

Pretransplant serum human chitinase-like glycoprotein YKL-40 concentrations independently predict bronchiolitis obliterans development in lung transplant recipients

Bronchiolitis obliterans syndrome (BOS) is the main long-term complication limiting survival after lung transplantation. There exists no cure for BOS and its mechanisms are not well understood. Early identification of BOS could therefore contribute to improvement of therapeutic and preventive measures. The human chitinase-like glycoprotein YKL-40 is involved in regulation of inflammatory tissue response and remodeling and is associated with pulmonary fibrosis. However, its role in BOS is unknown. A total of 57 recipients with irreversible fibrotic BOS and matched 85 recipients without BOS were retrospectively analyzed. Pretransplant serum samples were available at the time of the study. Serum and bronchoalveolar lavage samples were obtained at BOS diagnosis or at a comparable time point in patients without BOS. Additionally, serum samples were obtained 3 months later after BOS diagnosis or after the first sample in patients without BOS. YKL-40 concentrations were analyzed by enzyme-linked immunosorbent assay. Pretransplant serum YKL-40 concentrations were higher in recipients who developed BOS and were useful in identifying patients at high risk for BOS development (odds ratio, 1.3; 95% confidence interval, 1.01-1.9; P=.02). At BOS diagnosis, posttransplant YKL-40 concentrations were significantly elevated in the serum and bronchoalveolar lavage of patients with BOS compared with those without BOS at a comparable posttransplant time point. Of note, there was no significant association between serum YKL-40 concentrations and the frequency of acute rejection episodes. Elevated pretransplant serum YKL-40 concentration is associated with BOS development and could be an independent biomarker in early prediction and monitoring of BOS.

Prognostic value of bronchoalveolar lavage in patients with non-HIV pneumocystis pneumonia.

Non-HIV patients with pneumocystis pneumonia (PCP) have a poor prognosis. We aimed to evaluate the prognostic factors for in-hospital mortality in terms of the clinical findings, including the results of bronchoalveolar lavage fluid (BALF)-analyses, in non-HIV PCP patients. We retrospectively reviewed non-HIV PCP patients diagnosed using bronchoalveolar lavage between April 2006 and July 2012. For patients with a poor respiratory status, noninvasive positive pressure ventilation (NPPV) was used during the bronchoalveolar lavage (BAL) procedure. Data regarding demographics, laboratory findings and the prognosis were evaluated. A total of 29 non-HIV PCP patients were analyzed. NPPV was carried out safely and successfully in 12 patients during the BAL procedure. Twelve patients (41%) died. The multivariate logistic regression analysis identified only BALF neutrophilia to be a significant prognostic factor determining in-hospital mortality. The log-rank test showed that the patients with BALF neutrophilia (≥ 31%) had a significantly lower survival rate than the other patients (p=0.001). Only BALF neutrophilia was found to be a significant predictor of survival in patients with non-HIV PCP. Our data also emphasize the significance of performing BAL in such patients, as it provides both diagnostic and prognostic information.

Systemic involvement of acute generalized exanthematous pustulosis: a retrospective study on 58 patients

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterized by rash with sterile pustules, high fever and elevated circulating neutrophil counts. To investigate the frequency and clinical features of AGEP systemic involvement. This retrospective study included all patients hospitalized in our department between 2000 and 2010 with a discharge diagnosis of AGEP. Patients had to fulfil the following criteria: (i) a specific EuroSCAR score > 4 and (ii) biological and radiological work-up available. Among the 58 patients enrolled, 10 had at least one systemic involvement: hepatic function test results were abnormal for seven; six had renal insufficiency; two developed acute respiratory distress, with one patient's bronchoalveolar lavage fluid containing many neutrophils but no microorganisms; one was agranulocytotic. Mean peripheral neutrophil counts and mean C-reactive protein levels were elevated significantly in patients with systemic involvement. Amoxicillin rechallenge and hospitalization duration were associated with systemic involvement. AGEP systemic involvement was observed in 17% of cases studied, including liver, kidney, bone-marrow and lung involvement. Outcomes were favourable after drug withdrawal, and symptomatic and topical steroid treatments. The neutrophil count-systemic involvement association may suggest a role for neutrophils in AGEP systemic involvement. Physicians should be aware of the possibility of systemic involvement in AGEP and should actively look for signs of extracutaneous reactions.

Lipoxin A4-mediated KATP potassium channel activation results in cystic fibrosis airway epithelial repair

The main cause of morbidity and mortality in cystic fibrosis (CF) is progressive lung destruction as a result of persistent bacterial infection and inflammation, coupled with reduced capacity for epithelial repair. Levels of the anti-inflammatory mediator lipoxin A₄ (LXA₄) have been reported to be reduced in bronchoalveolar lavages of patients with CF. We investigated the ability of LXA₄ to trigger epithelial repair through the initiation of proliferation and migration in non-CF (NuLi-1) and CF (CuFi-1) airway epithelia. Spontaneous repair and cell migration were significantly slower in CF epithelial cultures (CuFi-1) compared with controls (NuLi-1). LXA₄ triggered an increase in migration, proliferation, and wound repair of non-CF and CF airway epithelia. These responses to LXA₄ were completely abolished by the ALX/FPR2 receptor antagonist, Boc2 and ALX/FPR2 siRNA. The KATP channel opener pinacidil mimicked the LXA₄ effect on migration, proliferation, and epithelial repair, whereas the KATP channel inhibitor, glibenclamide, blocked the responses to LXA₄. LXA₄ did not affect potassium channel expression but significantly upregulated glibenclamide-sensitive (KATP) currents through the basolateral membrane of NuLi-1 and CuFi-1 cells. MAP kinase (ERK1/2) inhibitor, PD98059, also inhibited the LXA₄-induced proliferation of NuLi-1 and CuFi-1 cells. Finally, both LXA₄ and pinacidil stimulated ERK-MAP kinase phosphorylation, whereas the effect of LXA₄ on ERK phosphorylation was inhibited by glibenclamide. Taken together, our results provided evidence for a role of LXA₄ in triggering epithelial repair through stimulation of the ALX/FPR2 receptor, KATP potassium channel activation, and ERK phosphorylation. This work suggests exogenous delivery of LXA₄, restoring levels in patients with CF, perhaps as a potential therapeutic strategy.

Anti-Fibrotic Effect of Combined mTORc1 and mTORc2 Inhibition in Bronchiolitos Obliterans

Purpose The mammalian target of rapamycin (mTOR) pathway plays an important role in regulating protein translation. The aim of this study was to evaluate the contribution of mTORc1 and mTORc2 signaling in fibrotic functions of mesenchymal cell and the potential use of mTOR inhibitors as anti-fibrotic agents in bronchiolitis obliterans syndrome (BOS). Methods and Materials Lung-resident mesenchymal stromal cells (LR-MSCs) were isolated from bronchoalveolar lavage of patients±BOS. PI3K/PTEN/Akt/mTOR pathway was studied by western analysis of whole-cell lysates for total PTEN, phospho-Akt, and phospho-p70S6K1. Effect of mTOR inhibitors on collagen I and α-smooth muscle actin (α-SMA) expression was assessed. Results A significantly higher expression of p70S6Kinase (Thr389) and 4E-BP1 (Thr37/46) was noted in BOS LR-MSCs compared to non-BOS LR-MSCs. BOS LR-MSCs also exhibited increased expression of phosphorylated AKT (S473). A decrease in collagen I protein expression was seen in the presence of rapamycin, while α-SMA expression was not changed. Rapamycin inhibited p70S6Kinase but failed to decrease 4E-BP1 expression. An increased in pAKT(S473) in response to rapamycin was noted. A high baseline expression of pAKT(S473) in BOS LR-MSCs and its further upregulation by mTORc1 inhibition, led us to study AZD8055, an ATP-competitive mTOR inhibitor which inhibits downstream signaling from both mTORc1 and mTORc2. Treatment with AZD8055 led to a 96% collagen suppression compared to 62% decrease by rapamycin (p Conclusions mTOR signaling pathway is activated in BOS LR-MSCs. While treatment with rapamycin modestly inhibits fibrotic phenotype of LR-MSCs, its also results in augmented mTORc2 signaling. AZD8055, an ATP-competitive mTOR inhibitor, inhibits collagen, α-SMA, and mTOR substrate phosphorylation more significantly than rapamycin, suggesting AZD8055 as a promising therapeutic in the context of lung transplantation.

Estudo bacteriológico do lavado broncoalveolar na gestão de antibióticos na pneumonia associada à ventilação mecânica de pacientes em unidades de terapia intensiva cirúrgica

To determine the correlation of Gram staining with the culture of bronchoalveolar lavage in patients with clinical features of ventilator-associated pneumonia from two adult trauma and surgical intensive care units. We conducted a retrospective study of 252 samples of bronchoalveolar lavage from patients with clinical ventilator-associated pneumonia in trauma or surgical postoperative care. Gram staining samples were classified as Gram-positive cocci and Gram-negative bacilli, all other results being excluded. Cultures from bronchoalveolar lavage were compared with Gram staining results. The correlation between Gram staining and culture from the bronchoalveolar lavage showed a kappa index of 0.27. The sensitivity of Gram staining was 53.9% and the specificity, 80.6%. Considering the identification of Gram-positive cocci against other results (negative and Gram-negative bacilli), the negative predictive value was 94.8%. The evaluation of Gram-negative bacilli against other results (negative and Gram-positive cocci) rendered a sensitivity of 27.1% and a specificity of 95.4%. It appears that the negative predictive value for Gram-positive cocci is acceptable, but the sensitivity of Gram staining in the etiology of ventilator-associated pneumonia was not able to identify the microorganism before culture.

Adherent Human Alveolar Macrophages Exhibit a Transient Pro-Inflammatory Profile That Confounds Responses to Innate Immune Stimulation

Alveolar macrophages (AM) are thought to have a key role in the immunopathogenesis of respiratory diseases. We sought to test the hypothesis that human AM exhibit an anti-inflammatory bias by making genome-wide comparisons with monocyte derived macrophages (MDM). Adherent AM obtained by bronchoalveolar lavage of patients under investigation for haemoptysis, but found to have no respiratory pathology, were compared to MDM from healthy volunteers by whole genome transcriptional profiling before and after innate immune stimulation. We found that freshly isolated AM exhibited a marked pro-inflammatory transcriptional signature. High levels of basal pro-inflammatory gene expression gave the impression of attenuated responses to lipopolysaccharide (LPS) and the RNA analogue, poly IC, but in rested cells pro-inflammatory gene expression declined and transcriptional responsiveness to these stimuli was restored. In comparison to MDM, both freshly isolated and rested AM showed upregulation of MHC class II molecules. In most experimental paradigms ex vivo adherent AM are used immediately after isolation. Therefore, the confounding effects of their pro-inflammatory profile at baseline need careful consideration. Moreover, despite the prevailing view that AM have an anti-inflammatory bias, our data clearly show that they can adopt a striking pro-inflammatory phenotype, and may have greater capacity for presentation of exogenous antigens than MDM.

Application of fiberoptic bronchoscopy with bronchoalveolar lavage in patients with mechanical ventilation

Objective To explore the clinical application of fiberoptic bronchoscopy with bronchoalveolar lavage(BAL) in patients with mechanical ventilation.Methods Sixty patients with mechanical ventilation were randomly divided into control group ( n =30) and treatment group ( n =30).All patients accepted anti-infection,nutritional support treatments.The patients in the control group accepted routine treatment;others in the treatment group were treated with BAL.The therapeutic effects in the two groups were evaluated and compared.Results The treatment effects in treatment group was better than that in control group( P ＜0.05).The improvement of blood gas analysis in treatment group was better than in control group (P ＜ 0.05 ),the time of mechanical ventilation,length of stay in treatment group were shorter than those in the control group ( P ＜ 0.05 ).The number of success to remove ventilator,organs failure and hospital mortality in treatment group were less than those in the control group ( P ＜ 0.05 ).Conclusion Fiberoptic bronchoscopy with BAL treatment could be safe and effective for patients with mechanical ventilation.It deserves to be popularized. Key words: Bronchoscopes; Ventilators,mechanical; Respiratory insufficiency

Outcomes of non-HIV-infected patients with Pneumocystis pneumonia and concomitant pulmonary cytomegalovirus infection

The pathogenic effect of concomitant pulmonary cytomegalovirus (CMV) infection on morbidity and mortality of Pneumocystis jirovecii pneumonia (PCP) has been questioned in the case of non-HIV-infected patients. We conducted a retrospective cross-sectional study of patients who were diagnosed with PCP by bronchoalveolar lavage. We compared demographics, clinical characteristics, morbidity, and mortality in non-HIV-infected PCP patients with (n = 31) and without (n = 75) pulmonary CMV infection. Morbidity was assessed by length of hospital stay, admission to the intensive care unit, and use of mechanical ventilation. Mortality was defined as 30-day and 90-day all-cause mortality. Morbidity and mortality did not differ between PCP patients with and without pulmonary CMV infection. In multivariate analysis using the Cox proportional hazard model, haematological malignancy (relative risk (RR) 0.20, 95% confidence interval (95% CI) 0.06-0.71), PCP treatment duration (RR 0.81, 95% CI 0.75-0.88), changing to a second-line regimen due to treatment failure (RR 4.51, 95% CI 1.61-12.64), and mechanical ventilation (RR 17.99, 95% CI 4.83-67.04) were independently associated with 30-day all-cause mortality. Being a solid organ transplant recipient (RR 0.17, 95% CI 0.05-0.56) and the use of mechanical ventilation (RR 6.49, 95% CI 2.84-14.83) were independently associated with 90-day all-cause mortality. However, concomitant pulmonary CMV infection was not associated with either 30-day or 90-day mortality. Our results suggest that concomitant pulmonary CMV infection does not significantly affect the prognosis of PCP, as indicated by morbidity and mortality in non-HIV-infected patients with PCP. Based on this result, we propose that it is not essential to administer an anti-CMV regimen when CMV is co-isolated from the bronchoalveolar lavage in patients with PCP.

Bacterial Pathogens of Ventilator Associated Pneumonia in a Tertiary Referral Hospital

BackgroundThis study evaluates the bacterial pathogens of Ventilator-associated pneumonia (VAP) in a tertiary referral hospital.MethodsA total of 109 bacterial pathogens from 91 adult patients with VAP, who were admitted to the medical intensive care unit from January 2008 to December 2009, were examined. Clinical characteristics, bacterial pathogens, and resistance profiles were analyzed.ResultsStaphylococcus aureus (44%) was the most frequently isolated. Acinetobacter baumanii (30%), Pseudomonas aeruginosa (12%), Stenotrophomonas maltophilia (7%), Klebsiella pneumoniae (6%), and Serratia marcescens (2%) were isolated from the transtracheal aspirates or bronchoalveolar lavage in patients with VAP. There was no significant difference of bacterial pathogens between early and late onset VAP. All isolated S. aureus were methicillin resistant S. aureus; the imipenem resistance rate of A. baumanii was 69%.ConclusionThe two most frequent pathogens of VAP were S. aureus and A. baumanii. There were no pathogenic differences between early and late onset VAP.

Maladie des moules bronchiques chez l’enfant

A 17-months-old boy presented with left pulmonary atelectasis associated with plastic bronchitis which was diagnosed and removed by fibroscopy. No other specific pathogenetic factor was found, except for a nonexistent serum IgA level. A bocavirus was found in the patient's broncho-alveolar lavage fluid. In order to better characterize the profile of plastic bronchitis disease, we have reviewed the data in the pediatric literature, consisting of some small series and isolated case reports, published in the last 30 years. The level of detail was sufficient in 51 observations – including the case presented here – to allow us to make an analytical evaluation of the symptoms, the evolution, the predisposing factors and the histological type of this disease. Plastic bronchitis is a rare disease whose mechanisms remain hypothetical.

Treatment with imatinib results in reduced IL-4-producing T cells, but increased CD4+ T cells in the broncho-alveolar lavage of patients with systemic sclerosis

T cells, particularly those producing IL-4, are implicated in inflammation-mediated fibrosis. In our phase I/IIa open-label pilot study in 15 patients with scleroderma-interstitial lung disease (SSc-ILD), high-dose imatinib treatment showed modest improvement in lung function and skin score, but with several adverse events. Here, we investigated T cell phenotype and cytokine production in bronchoalveolar lavage (BAL) from patients enrolled in this trial. We found that IL-4(+) T cells showed a stronger correlation with ground glass opacity (GGO) than fibrosis scores on lung high-resolution computer tomography scans. Frequencies of IL-4(+) T cells also discriminated patients with high (≥20) versus low (<20) GGO scores. Functional annotation clustering of proteins that correlated with T cells identified two major clusters that belonged to immune/inflammatory and wounding response. Repeat analyses after 1 year of treatment in 10 BAL samples, one each from the right middle and lower lobes of lung from 5 patients, showed that post-imatinib, IL-4(+) T cells were profoundly reduced but CD4(+) T cells increased, except in one patient who showed worsening of SSc-ILD. Post-imatinib increase in CD4(+) T cells correlated with soluble ICAM-3 and PECAM-1 levels in BAL, which associated with the lack of worsening in SSc-ILD. Thus, imatinib might confer its therapeutic effect in fibrosis via re-directing T cell responses from type 2 to other, non-type 2 cytokine producing CD4(+) T cells.