Exudative Stage Research Articles

Deep Learning in Neovascular Age-Related Macular Degeneration.

Background and objectives: Age-related macular degeneration (AMD) is a complex and multifactorial condition that can lead to permanent vision loss once it progresses to the neovascular exudative stage. This review aims to summarize the use of deep learning in neovascular AMD. Materials and Methods: Pubmed search. Results: Deep learning has demonstrated effectiveness in analyzing structural OCT images in patients with neovascular AMD. This review outlines the role of deep learning in identifying and measuring biomarkers linked to an elevated risk of transitioning to the neovascular form of AMD. Additionally, deep learning techniques can quantify critical OCT features associated with neovascular AMD, which have prognostic implications for these patients. Incorporating deep learning into the assessment of neovascular AMD eyes holds promise for enhancing clinical management strategies for affected individuals. Conclusion: Several studies have demonstrated effectiveness of deep learning in assessing neovascular AMD patients and this has a promising role in the assessment of these patients.

FROM OUTER RETINAL NEOVACULARIZATION TO EXUDATIVE SUBRETINAL NEOVASCULARIZATION IN MACULAR TELANGIECTASIA TYPE 2.

To describe the progression from outer retinal neovascularization (ORNV) to exudative subretinal new vessels (SRNVs) in idiopathic macular telangiectasia type 2. A total of 135 patients (270 eyes) imaged with optical coherence tomography angiography were included. Ellipsoid zone loss, outer retinal hyperreflectivity, ORNV, and SRNVs. Outer retinal neovascularization was defined as a flow signal passing through the outer plexiform layer, with or without vertical linear outer retinal hyperreflectivity on the optical coherence tomography B-scan. Subretinal new vessels were defined as an abnormal capillary network with a peripheral anastomotic arcade seen on en face optical coherence tomography angiography and a convex hyperreflectivity at the retinal pigment epithelium. Subretinal new vessels were observed in 38/270 eyes (14%). Subretinal new vessels were at a fibrotic stage in 24/38 eyes and at an exudative stage in 6/38 eyes, and a progression from ORNV to SRNVs was documented in 8/38 eyes. All cases showed an ellipsoid zone loss. In seven eyes (2.5%), SRNVs were also associated with subepithelial neovascularization. No retinochoroidal anastomosis was detected. The visual acuity dropped when SRNVs were present. In this case series, SRNVs were found in 14% of eyes. In all cases, they were associated with an ellipsoid zone loss and with outer retinal hyperreflectivity. A progression from ORNV to SRNVs was observed.

Spatiotemporal relationship between hydrocarbon fluid and sandstone‐hosted uranium deposits in the Qianjiadian area, Songliao Basin

The spatiotemporal coupling relationship between deep hydrocarbon fluid and sandstone uranium mineralization within the shallow buried red‐variegated clastic rocks in the Qianjiadian area of the Songliao Basin remains a topic of controversy. This paper aims to provide a comprehensive understanding of the source, nature and exudative age of deep exotic hydrocarbon, as well as the interaction mechanism and alteration process between hydrocarbon fluid and clastic rock. To achieve this, various methods were employed, including acidolysis hydrocarbon test (AHT), clay x‐ray diffraction (XRF), scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), carbon isotope analysis (CIA) and LA‐ICP‐MS U–Pb isotopic dating. The results indicate that some tight sandstones from the Qingshankou Formation in Dalin uranium deposit exhibit high acidolysis hydrocarbon content (AHC), reaching n × 104 μL/kg, and predominantly consisting of low mature oil‐type gas. Local microscopic observations reveal pore fluorescence and hydrocarbon‐bearing inclusions with nattier blue tone. Furthermore, the kaolinites present in the ore area's sand‐bodies show a significantly higher content anomaly, commonly exceeding >50%, compared to the same layer in peripheral regions. Extensive dissolutions of lithic grains and feldspars are observed, along with the widespread occurrence of ferro‐dolomites and colloidal pyrites. Additionally, exotic asphaltenes are sporadically developed in localized areas. These findings provide evidence that the sand‐bodies experienced a significant exfiltration event of external gaseous fluids. The light carbon isotopes (δ13CV‐PDB ranging from −33.26‰ to −30.06‰) of group components and n‐Alkane suggest that the hydrocarbon originates from the source rock of the Lower Cretaceous Jiufotang Formation. A detailed two‐stage alteration sequence caused by acidic and reducing hydrocarbon is clarified, encompassing acidic corrosion, kaolinization, pyritization, silification and asphaltization during the exudation stage, followed by ferro‐dolomitization in the later cessation stage. Notably, vermicular secondary kaolinites, formed through the interaction between acidic hydrocarbon fluid and low‐temperature meteoric groundwater, serve as significant markers for the exfiltration of deep hydrocarbon fluid. In‐situ U–Pb dating of hydrocarbon‐bearing ferro‐dolomite yielded absolute exfiltration ages of 63.54 ± 4.13 and 65.93 ± 3.35 Ma. By integrating the tectonic–sedimentary–fluid evolution history and uranium mineralization characteristics in the study area, a three‐stage superimposed metallogenic model is proposed for the Upper Cretaceous red‐variegated layers: (1) the sedimentary and diagenetic stage of the target layer during the Late Cretaceous, (2) the predominant hydrocarbon exudation stage at the end of the Late Cretaceous, and (3) the main uranium mineralization stage since the Paleogene. This study enhances our understanding of coupled‐genetic sandstone‐type uranium deposit in a sedimentary basin and provides valuable guidance for prospecting similar red‐variegated beds in the Songliao Basin and other sedimentary basins worldwide.

Lung pathology of natural Babesia rossi infection in dogs.

A proportion of Babesia rossi infections in dogs are classified as complicated and one of the most lethal complications is acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Most dogs that die succumb within 24 hours of presentation. The pulmonary pathology caused by B. rossi in dogs has not been described. The aim of this study was to provide a thorough macroscopic, histological and immunohistochemical description of the lung changes seen in dogs naturally infected with B. rossi that succumbed to the infection. Death was invariably accompanied by alveolar oedema. Histopathology showed acute interstitial pneumonia characterised by alveolar oedema and haemorrhages, with increased numbers of mononuclear leucocytes in alveolar walls and lumens. Intra-alveolar polymerised fibrin aggregates were observed in just over half the infected cases. Immunohistochemistry showed increased numbers of MAC387- and CD204-reactive monocyte-macrophages in alveolar walls and lumens, and increased CD3-reactive T-lymphocytes in alveolar walls, compared with controls. These histological features overlap to some extent (but far from perfectly) with the histological pattern of lung injury referred to as the exudative stage of diffuse alveolar damage (DAD) as is quite commonly reported in ALI/ARDS.

The Contrasting Seasonality Patterns of Some Cancer-Types and Herpes Zoster Can Be Explained by a Binary Classification of Immunological Reactions.

A binary classification of the pathogenic immune reactions as anti-inflammatory high-Treg reactions or pro-inflammatory low-Treg reactions explains both the relatively low incidence rate of several types of cancer, and the relatively high incidence rate of herpes zoster cases diagnosed in the summer compared to cases diagnosed in the winter (in regions with temperate climate). This binary model also elucidates the longer survival of cancer patients diagnosed during the summer compared to these diagnosed in the winter. The three key elements of this explanation are: (a) the effect of sunlight on Treg production; (b) the evolvement of cancer from a low-Treg condition at early stage, to a high-Treg condition at advanced stage, and (c) the evolvement of herpes zoster from a high-Treg condition at pre-exudative stage to a low-Treg condition at acute exudative stage. A significant proportion of indolent tumors at the time of diagnosis (>20%) is a prerequisite for a beneficial effect of sunlight on cancer incidence rate and prognosis. This prerequisite restricts the beneficial effect of diagnosis during summer to certain types of cancer. Clinical implication: the prognosis of early stage tumors may be improved by a course of corticosteroid (or other immunosuppressant) treatment.

DIAGNOSIS DAN TATALAKSANA EFUSI PARAPNEUMONIA

Parapneumonic effusion is a pleural effusion associated with bacterial pneumonia, lung abscess or bronchiectasis. The effusion of parapneumonic arising from inflammation in the lung and pleura is due to a direct invasion of bacteria, cascade of inflammatory reactions, and bacterial virulence. The development of the effusion of parapneumonic is grouped into 3 stages: 1) exudative stage, 2) fibrinopurulent stage, 3) organizing stage with pleural peel form. This stage helps categorize effusions into groups to evaluate the risk of cases requiring intervention. Proper management and antibiotic therapy will result in improvements to the effusions of parapneumonic

Growth of nonexudative macular neovascularization in age-related macular degeneration: an indicator of biological lesion activity

PurposeTo investigate the growth of nonexudative macular neovascularization (MNV) in age-related macular degeneration (AMD) using swept-source optical coherence tomography angiography (SS-OCTA).MethodsPatients with treatment-naïve nonexudative AMD in one eye and exudative AMD in the fellow eye who underwent SS-OCTA imaging for at least 12 months were retrospectively reviewed. The MNV area measurement was quantified in eyes with treatment-naïve nonexudative MNV using ImageJ for analysing the correlation between MNV growth and the onset of exudation, as well as evaluating the consistency of the MNV growth rate during the subclinical and exudative stages. Kaplan-Meier survival analysis and logistic regression analyses were used.ResultsIn total, 45 eyes with treatment-naïve nonexudative AMD from 45 patients were enrolled. Treatment-naïve nonexudative MNV was identified in 21 eyes (46.67%) at baseline. The development of exudative findings was noted in eight eyes (17.78%), including six eyes with previously noted nonexudative MNV. Eyes with growing MNV (increase in area ≥50% within 12 months) had an increased risk of exudation and developed exudation earlier than eyes with stable MNV (13.60 [6.43–20.77] months versus 31.11 [26.61–35.62] months, P < 0.0001, Log-rank test). Consistent growth pattern of MNV lesions was further identified in eyes with growing MNV during anti-VEGF treatment.ConclusionSS-OCTA allows to qualitatively and quantitatively evaluate nonexudative MNV in AMD patients. Growing MNV involved higher probabilities and a faster onset of exudation compared to stable MNV. Identifying the growth of MNV on OCTA might be helpful for establishing treatment strategies and follow-up planning.

Pachychoroid Disease

Pachychoroid spectrum disorders include uncomplicated pachychoroid, pachychoroid pigment epitheliopathy, central serous chorioretinopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy/aneurysmal type 1 neovascularisation, focal choroidal excavation and peripapillary pachychoroid syndrome. They are characterized by a thickened and hyperpermeable choroid and thinning of the choriocapillaris. The disorders are being diagnosed with increasing frequency and differentiation due to the advancement of multimodality imaging. Current understanding of the development, course, possible complications and treatment of these diseases is growing rapidly, but not all mechanisms have yet been elucidated. A correct diagnosis is important, especially the differentiation between the presence of active neovascularisation or a purely exudative stage, in order to initiate a therapy. It is also not yet clear why patients have a thickened choroid and why some of these patients develop pathological changes such as subretinal fluid, RPE changes or neovascularisation.

Characteristics of droplet exudation on slippery liquid-infused porous surfaces considering thermal effect

The self-healing property of slippery liquid-infused porous surfaces ensures the continuity and stability of the liquid film on the surfaces. Therefore, how to promote the exudation and spreading of the lubricant is the key to realize the self-healing. In this study, a numerical model of lubricant exudation and spreading in micropores was established under the stimulation of the external temperature field. The morphological evolution of the meniscus and the distribution characteristics of the internal pressure during the exudation process were investigated. The influence mechanism of the thermal effect on the exudation and film formation on the porous surface was revealed. Results show that the formation process of lubricating film includes the lubricant exudation in the pores, the growth and spreading of microdroplets on the porous surface. In the lubricant exudation stage, the internal pressure of the fluid is negative. When the lubricant exudes to the edge of the pore, the internal pressure of the liquid changes from negative to positive. The three-phase contact wire is pinned at the edge of the pore and droplets are formed on the porous surface. When the droplet begins to spread, the internal pressure of the droplet decreases for the increasing of the meniscus curvature radius. The spreading velocity decreases gradually in the form of fluctuation under the combined action of the time-varying resistance and driving force. At higher wall temperature, the droplet surface tension and viscous resistance decrease, whereas the thermal-capillary force and driving force increase. Therefore, the higher the wall temperature, the greater the average velocity of the droplet spreading front, and the better the droplet spreading performance. Therefore, higher wall temperature can promote the droplet exudation and spreading on the surface, which is conducive to the self-healing of the lubricating film.

Histo-Pathological Findings of Critical COVID-19 Pneumonia: A Case Series

Objective: To study the histo-pathological findings in lung biopsies of critical COVID-19 cases.&#x0D; Study Design: Case series.&#x0D; Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from Jul to Dec 2020.&#x0D; Methodology: Deceased patients who remained on ventilatory support with a confirmatory diagnosis of SARS-CoV-2 both by PCR and radiological evidence on HRCT and clinically established severity of disease as per CALL scoring were included in the study. Written informed consent for lung biopsy was taken from the deceased's next of kin&#x0D; Result: Mean age of the study group was 67.20 ± 6.01 years. The patients had a mean high resolution computed tomography score of 36.73 ± 1.59, and the mean CALL score was 12.73 ± 0.691 on admission. The average time after intensive care unit admission to intubation was 1.23 ± 0.50 days. Histopathological examination of the lung biopsy showed 27 (87.1%) patients had the exudative stage of adult respiratory distress syndrome while three (9.7%) patients had a proliferative stage of adult respiratory distress syndrome.&#x0D; Conclusion: Histopathological findings of an exudative stage of adult respiratory distress syndrome in the lung biopsies of critical COVID-19 showed no significant difference with typical adult respiratory distress syndrome and are correlated with very high mortality rates in critical COVID-19.

Клинические случаи формирования наружных ретинальных тубуляций на фоне введения афлиберцепта при экссудативной и рубцовой формах возрастной макулярной дегенерации

Outer retinal tubulation (ORT) is a common finding in optical coherence tomography, which is usually associated with age-related macular degeneration. It is not clear are ORT appear as a sign of a degenerative process in the outer retinal layers or a way of photoreceptors survival. There are no data on the dynamics of ORT associated with angiogenesis inhibitors injections. This paper presents two clinical cases of dynamic observation of tubulation formation in age-related macular degeneration in the disciform scar stage and in the exudation stage after Aflibercept injections based on optical coherence tomography – angiography and scanning laser ophthalmoscopy. Key words: оuter retinal tabs, age-related macular degeneration, angiogenesis inhibitors.

NECROTIZING PNEUMONIA AND MASSIVE AIR LEAK IN A PATIENT WITH COVID-19

TOPIC: Cardiothoracic Surgery TYPE: Global Case Reports INTRODUCTION: To observe the pathological characteristics and the clinical significance of COVID 19 infected pneumonia causing degeneration and necrosis of parenchymal cells, thrombus in small and medium vessels. Pulmonary pathological changes of fatal COVID-19 are diffuse alveolar damage that is presents in the acute exudative stage and the organic proliferative stage. There is alveolar cavity formation, fibrinous exudate, fibroblastic proliferation in alveolar septum, and alveolar epithelial cell injuries. A large number of neutrophils and monocytes infiltration is present in most cases and bacteria and fungi are detected in some cases, suggesting a serious combination to generate lung necrosis and huge air leak. CASE PRESENTATION: The case of a 50 years old female with severe COVID 19 pneumonia, requiring admission to the ICU during her hospitalization present bilateral pneumothorax that was solved with bilateral chest tube, one week later present persistent right pneumothorax and a continuous air leak that prevented ventilation, surgical intervention was decided as a result of the ventilatory, hemodynamic deterioration and state of sepsis finding in the right lower lung focal hemorrhage, organization of exudates in various cavities in the lung, and pulmonary fibrosis generating degeneration and necrosis of parenchymal cells, formation of thrombus in small vessels, and pathological changes of chronic diseases were observed with fibrous tissue, firm adhesions DISCUSSION: Infectious disease by COVID 19 pneumonia can generate cavitary lung process, necrotizing pneumonia, lung abscess and septic pulmonary embolism. Being able to aggregate infections that include cavitating fungal and superinfection of preexisting spaces. Accompanied by infarction from thromboembolic disease. In these cases, we found an extensive lung necrosis with a grade 4 air leak, accompanied by intraparenchymal purulent fibrin, infected cavities with fluid and bronchial necrosis as well as blood vessel thrombosis CONCLUSIONS: The management of this pathology include treatment as any lung necrosis with major resection and reinforcement of the bronchial stump with the considerations of the aerosol that are generated by bronchial necrosis and parenchyma, the initial approach includes immediate obturation of the bronchus and subsequently continue with vascular dissection. Which indicates that COVID pneumonia can present in a short time all the changes of acute and chronic disease. Generally, an acute or subacute process suggests bacterial and fungal causes of pulmonary abscesses, necrotizing pneumonias, and septic emboli. And a chronic process suggests mycobacterial, fungal, viral, or parasitic infections;malignancy or autoimmune disorders REFERENCE #1: Anaesthesia. 2020 Nov;75(11):1509-1516. doi: 10.1111/anae.15112. Epub 2020 Jun 2. Management of the airway and lung isolation for thoracic surgery during the COVID-19 pandemic: Recommendations for clinical practice endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and IrelandM Thornton 1, D Reid 1, B Shelley 2 3, M Steven 1 REFERENCE #2: Anaesthesia. 2020 Nov;75(11):1509-1516. doi: 10.1111/anae.15112. Epub 2020 Jun 2.Management of the airway and lung isolation for thoracic surgery during the COVID-19 pandemic: Recommendations for clinical practice endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and IrelandM Thornton 1, D Reid 1, B Shelley 2 3, M Steven 1 REFERENCE #3: Am Fam Physician. 1991 Nov;44(5):1719-21.Necrotizing aspiration pneumoniaD Disler 1, S A Deluca DISCLOSURES: No relevant relationships by Gabriela Alejandra Buerba Romero Valdes, source=Web Response No relevant relationships by Gabriela Del Angel Millan, source=Web Response No relevant relationships by EMMANUEL PENA GOMEZ PORTUGAL, source=Web Response No relevant relationships by ALMA SOLANO NIETO, source= eb Response

Pathological findings and morphologic correlation of the lungs of autopsied patients with SARS-CoV-2 infection in the Brazilian Amazon using transmission electron microscopy.

INTRODUCTION: Electron microscopy (EM) is a rapid and effective tool that can be used to create images of a whole spectrum of virus-host interactions and, as such, has long been used in the discovery and description of viral mechanisms. METHODS: Electron microscopy was used to evaluate the pulmonary pathologies of postmortem lung sections from three patients who died from infection with SARS-associated coronavirus 2 (SARS-CoV-2), a new member of the Coronaviridae family. RESULTS: Diffuse alveolar damage (DAD) was predominant in all three patients. The early exudative stage was characterized principally by edema and extravasation of red blood cells into the alveolar space with injury to the alveolar epithelial cells; this was followed by detachment, apoptosis, and necrosis of type I and II pneumocytes. The capillaries exhibited congestion, exposure of the basement membrane from denuded endothelial cells, platelet adhesion, fibrin thrombi, and rupture of the capillary walls. The proliferative stage was characterized by pronounced proliferation of type II alveolar pneumocytes and multinucleated giant cells. The cytopathic effect of SARS-CoV-2 was observed both in degenerated type II pneumocytes and freely circulating in the alveoli, with components from virions, macrophages, lymphocytes, and cellular debris.CONCLUSIONS: Viral particles consistent with the characteristics of SARS-CoV-2 were observed mainly in degenerated pneumocytes, in the endothelium, or freely circulating in the alveoli. In the final stage of illness, the alveolar spaces were replaced by fibrosis.

Хронический гиперсенситивный пневмонит, осложненный острой респираторной вирусной инфекцией

The article presents a clinical case of hypersensitivity pneumonitis complicated by a viral infection in a 72-year-old woman. The introductory part provides a concise literature review on the etiology, classification, frequency, and possible complications of hypersensitivity pneumonitis. The patient’s computed tomography (CT) lung scan showed bilateral interstitial lesions. The patient was diagnosed with idiopathic pulmonary fibrosis based on the clinical manifestations and radiological findings. The autopsy revealed morphological signs of hypersensitivity pneumonitis (obliterative bronchiolitis, moderate interstitial fibrosis with honey-combing, nonspecific interstitial pneumonia, giant multinucleated cells) and viral lung damage (exudative stage of acute respiratory distress syndrome with interalveolar edema, hyaline membranes lining the alveoli, pneumocyte desquamation, and ugly giant cells). Keywords: hypersensitivity pneumonitis, exogenous allergic alveolitis, viral infection, lungs

Pediatric Empyema Thoracis: Jabalpur Image-Based Staging and Stage-Directed Decision-Making Algorithm

Pneumonia in the pediatric age group is common and it can commonly progress to pediatric empyema thoracis (PET). The American Thoracic Society has described three stages of PET which have been the following: exudative, fibrinopurulent, and organized. We describe a new Jabalpur image-based staging system for empyema thoracis in children which has allowed focused intervention and improved outcomes. Pre-empted focused observation, gaps in the treatment and outcomes, and the triangulation of these resulted in the evolution of a new, image-based staging system for pediatric empyema thoracis. From 2009 to 2014, our team was a participant-observer of the usual practices to treat children up to 18 years of age with pneumonia who developed empyema. The prevalent classification into exudative, fibrinopurulent, and organized empyema was treated as per practice. Patients with chronic empyema, empyema necessitans, and tubercular and those with incomplete data were excluded. A staging system purely based on ultrasound (US) and computed tomography (CT) findings was evolved, and we call it Jabalpur image-based staging (JIBS) system for pediatric empyema thoracis. A decision-making algorithm was further evolved using the JIBS system to provide stage-directed treatment. This staging system and algorithm after a pilot run was prospectively applied to a set of patients accrued from January 2015 to December 2019 with PET which was strictly allocated as per new evolved staging and treated with discrete choices by all the methods inclusive of general supportive care, nutritional support, tube drainage, and open and video-assisted thoracoscopic surgery (VATS). The successful early outcome was defined statistically significant reduction of mean ICTD days, the number of CXRs, and the mean hospital days, which reflects earlier recovery. The long-term successful outcome was defined as the absence of fever, breathlessness, and adequate weight gain (according to age) at a minimum follow-up of 3 months. On the prospective evaluation of JIBS and the stage-directed decision-making algorithm on a set of 187 children accrued from January 2015 to December 2019, there was a significant improvement in the success of drainage and the number of VATS procedures, and their success significantly improved. There was a significant reduction in mean preoperative stay, mean intercostal tube drainage (ICTD) days, the number of chest x-rays (CXRs), mean hospital stay, and the number of open procedures in the prospective group. Accuracy of a new staging system to identify exudative, fibrinopurulent, and organized stages of PET was found to be 94.65%, 94.65%, and 97.86% respectively. The long-term successful outcome was observed in 179 (95.72%) children while 8 patients had chest deformity and a minimum secondary scoliosis which was addressed with physiotherapy. This study proposes a simple image-based staging system and stage-directed decision-making algorithm for empyema thoracis in children, which sharply defines the stages and allows the selection of appropriate surgical modality in cases of PET.

Pathological changes of fatal coronavirus disease 2019 (COVID-19) in the lungs: report of 10 cases by postmortem needle autopsy

Objectives: To observe the pulmonary changes with coronavirus disease 2019 (COVID-19) in postmortem needle specimens, to detect the presence of 2019 novel coronavirus(2019-nCoV) in the lung tissues, and to analyze the clinicopathological characteristics. Methods: For 10 decedents with 2019-nCoV infection in Wuhan, bilateral lungs underwent ultrasound-guided percutaneous multi-point puncture autopsy, and pulmonary pathological changes were described in routine hematoxylin-eosin staining (HE) slides. Electron microscopy was also performed. The reverse transcription polymerase chain reaction (RT-PCR) was employed to detect 2019-nCoV nucleic acid in lung tissue, and the pathological characteristics were demonstrated in combination with clinical data analysis. Results: Of the 10 deaths associated with COVID-19, 7 were male and 3 were female. The average age was 70 (39-87) years. Medical record showed that 7 patients had underlying diseases. The average course of disease was 30 (16-36) days. Nine cases showed fibrinous and suppurative exudation in the alveolar cavity accompanied by the formation of hyaline membrane, and fibroblastic proliferation of alveolar septum. Type Ⅱ alveolar epithelial cells showed reactive hyperplasia and desquamation. Many macrophages accumulated in the alveolar cavity. Capillary hyaline thrombus and intravascular mixed thrombus were noted. In some cases, acute bronchiolitis with mucous membrane exfoliation, accumulation of bronchiolar secretions, and bronchiolar epithelial metaplasia occurred. In the cohort, a large number of bacteria (cocci) were detected in 1 case and a large number of fungi (yeast type) were detected in 1 case. Nine cases were positive for the nucleic acids of 2019-nCoV while one case remained negative by RT-PCR. Coronavirus particles were detected in the cytoplasm of type Ⅱ alveolar epithelium. Conclusions: The pulmonary pathological changes of fatal COVID-19 are diffuse alveolar damage (DAD), mainly in the acute exudative stage and the organic proliferative stage. There are fibrinous exudate aggregation in alveolar cavity with hyaline membrane formation, fibroblastic proliferation in alveolar septum, and alveolar epithelial cell injuries with reactive hyperplasia and desquamation of type Ⅱ alveolar epithelial cells. A large amount of neutrophils and monocytes infiltration is present in most cases and bacteria and fungi are detected in some cases, suggesting a serious bacterial or fungal infection secondary to the DAD.

Morphological characteristics of lung tissue in two cases with critical corona virus disease 2019

Objective To observe the morphological features of lungs in patients with critical 2019 corona virus disease (COVID-19), and to analyze the clinical-pathological relationship. Methods Two critical patients with COVID-19 who died in Beijing You'an Hospital affiliated to Capital Medical University on February 13 and 14, 2020, respectively were examined by bilateral lungs biopsy. The obtained samples were dehydrated, paraffin embedded, sectioned, stained with hematoxylin-eosin as routine methods, and then observed under light microscope. Results The pulmonary morphology changes of patients with COVID-19 showed diffuse alveolar damage. Case one was an elderly patient with underlying diseases and his lesions were mainly exudation and hyaline membrane formation, which showed an acute exudation stage of diffuse alveolar damage. Case two was a patient without underlying diseases and his pathological changes were diffuse inflammatory cell infiltration, extensive fibrosis of alveolar wall, filling of necrotizing inflammatory cellulosic exudate in alveolar airspace, extensive destruction of alveoli and pulmonary consolidation, which was characterized by organized stage of diffuse alveolar damage complicated with bacterial pneumonia. The injury of paracronchial submucosal gland was not observed in the two patients. Conclusions Diffused alveolar damage is the main pathological feature of critical COVID-19. Diffused alveolar damage can induce or aggravate the underlying diseases of elderly patients in the early stage. Extensive destruction of alveoli, pulmonary consolidation and secondary infection are the main causes of respiratory failure in the late stage. Key words: Coronavirus infections; Pneumonia; Pathology; 2019-nCoV; COVID-19; Lung tissue

TREATMENT OF PHLEGMONS OF THE MAXILLOFACIAL AREA BY AUXILIARY DRAINAGE WITH CONSTANT REDUCED NEGATIVE PRESSURE

Relevance. In the treatment of purulent wounds of the maxillofacial area, aspiration of the exudate is often ineffective due to the aspirational-obstructive effect. Therefore, the search for ways to improve wound drainage is relevant in the treatment of patients with phlegmons of all deep spaces of the maxillofacial area, including the fiber of the cervical neurovascular bundle.&#x0D; Objective: To increase the efficiency of drainage of the phlegmons of the maxillofacial area and neck with the help of drainage with constant negative pressure.&#x0D; Materials and methods. In the maxillofacial department of the City hospital of emergency and urgent medical care in Zaporizhzhia, 100 people aged 20-80 years were treated with phlegmons of the maxillofacial area. In one group (45 people), treatment was performed according to the traditional method. In group 2 (55 people), traditional treatment was supplemented by drainage of purulent wound with sustained reduced pressure at the exudation stage. To do this, in group 2 we used a device which shape was similar to the shape of a purulent cavity. It was made individually according to the imprint of the patient's purulent wound cavity, which reduced the likelihood of pressure sores in the wound. At installation of drainage the immersion limiter was covered with a sealing oily substance on a fat basis. The device was made of medical plastic with a through sponginess, the size of the frame was smaller than the capacity of the purulent wound cavity by 10-30%. The sizes of the openings of the frame wall were 0.1-0.5 mm. Mathematical calculations of the efficiency of exudate aspiration were conducted. The number of openings of the drainage body with the walls of the wound was 200 in one square centimeter, at an effective speed of 0.2 m/sec and an evacuation volume of 150 ml/min. This allowed to eliminate the aspirational-obstructive effect.&#x0D; Results. The duration of hospitalization of the 2 group patients was shortened in comparison with patients of the 1 group. Improvement of the clinical picture and stabilization of the general condition in 53 (96.4%) patients of the 2 group were observed at 3 day after surgery, and the same indicators in 43 (95.6%) patients of the 1 group were observed at 4-5 day. In addition, it was decrese of the pain intensity at 4-5 day. In 48 (87.3%) patients of the 2 group, purulent exudation was stopped at 2-3 day, granulations appeared at 3-4 day, and the complete clearance and marginal closure of the wound were observed at 6-8 day. In 4 patients of the 1 and 2groups, the healing time of the postoperative wound was longer: termination of purulent discharge was observed up to 6-7 days, appearance of granulations - up to 7-8 days, complete clearance and marginal closure of the wound - up to 10-12 days. Also, in the 2 group, there were fewer complications, pressure sores in the wound from tubular drainage and less spread of the inflammatory process in adjacent tissues of space.&#x0D; Conclusions. Drainage of purulent wounds with constant reduced negative pressure increases the efficiency of exudate evacuation; reducing the number of complications; acceleration of the onset of the second phase of the inflammatory process.

Early diagnosis and treatment for burn complicated with severe paroxysmal sympathetic hyper-activity

Objective: To investigate the early diagnosis and treatment for burn complicated with severe paroxysmal sympathetic hyperactivity (PSH). Methods: Medical records of patients with burn complicated with severe PSH, admitted to our department from April 2016 to March 2019 and meeting the inclusion criteria were analyzed retrospectively. There were 4 males and 1 female, aged 17 months to 39 years, with an average of (21±16) years. During occurrence of PSH, the vital signs of patients were routinely monitored and oxygen were given. Other treatment included central venous catheterization and infusion of electrolyte solution, infusion of plasma according to patients' condition, use of opioid analgesics and benzodiazepine sedatives, physical cooling and drug cooling, and establishment or maintenance of artificial airway and use of ventilator. Heart rate was controlled below 120 beats per minute in adults and 140 beats per minute in children with comprehensive treatment dominated by analgesia and sedation. Besides, single or multiple vasoactive agents, even in large doses were used to maintain normal blood pressure of patients. The occurrence characteristics, time, and treatment outcome of PSH were analyzed. Results: PSH happened rapidly, with a sharp increase in several minutes to dozens of minutes. Five patients were with symptoms such as high body temperature, shortness of breath, very fast heart rate, normal or elevated systolic blood pressure, hyperhidrosis, and dystonia at the onset. The symptoms occurred simultaneously or successively. According to the Clinical Feature Scale, the above-mentioned 6 indexes achieved the highest score of 3 points except of systolic blood pressure. Four patients showed dilated pupils and impaired consciousness. Among the patients, PSH occurred in the acute exudation stage in 3 patients, in the fluid reabsorption stage in 1 patient, and in the late repair stage in 1 patient. PSH of patients lasted for 3 hours to 12 days. The symptoms of 4 patients were effectively controlled, and 1 patient died of deterioration. No PSH occurred in the cured patients during follow-up of 3 to 14 months. Conclusions: Burn complicated with PSH can occur at any time before wound repair and in patients with different injury conditions. The causes of PSH include sudden burn, persistent pain, fright and fear, strange environment, low blood volume, and other adverse stimuli, and PSH is more likely to occur in children with underdeveloped brain function. Intravenous infusion of analgesics sedatives, physical therapy and medication to lower body temperature, stabilizing blood pressure and respiration are effective measures to treat PSH. PSH should be distinguished from the common complications of burns, such as sepsis, cerebral edema, hyperpyretic convulsion, transfusion response, stress disorder, etc.

Endothelial stromelysin1 regulation by the forkhead box-O transcription factors is crucial in the exudative phase of acute lung injury

Enhanced vascular permeability is associated with inflammation and edema in alveoli during the exudative phase of acute respiratory distress syndrome (ARDS). Mechanisms leading to the endothelial contribution on the early exudative stage of ARDS are not precise. We hypothesized that modulation of endothelial stromelysin1 expression and activity by Akt1-forkhead box-O transcription factors 1/3a (FoxO1/3a) pathway could play a significant role in regulating pulmonary edema during the initial stages of acute lung injury (ALI). We utilized lipopolysaccharide (LPS)-induced mouse ALI model in vivo and endothelial barrier resistance measurements in vitro to determine the specific role of the endothelial Akt1-FoxO1/3a-stromelysin1 pathway in ALI. LPS treatment of human pulmonary endothelial cells resulted in increased stromelysin1 and reduced tight junction claudin5 involving FoxO1/3a, associated with decreased trans-endothelial barrier resistance as determined by electric cell-substrate impedance sensing technology. In vivo, LPS-induced lung edema was significantly higher in endothelial Akt1 knockdown (EC-Akt1–/–) compared to wild-type mice, which was reversed upon treatment with FoxO inhibitor (AS1842856), stromelysin1 inhibitor (UK356618) or with shRNA-mediated FoxO1/3a depletion in the mouse lungs. Overall, our study provides the hope that targeting FoxO and styromelysin1 could be beneficial in the treatment of ALI.