Large Bronchi Research Articles

Photodynamic Theranostics of Central Lung Cancer: Capabilities of Early Diagnosis and Minimally Invasive Therapy (Review).

The aim of the study was to assess the prospects for central lung cancer (CLC) screening using fluorescent diagnostics and its treatment by endobronchial photodynamic therapy (PDT).Bronchoscopic fluorescent diagnostics using chlorin e6 photosensitizers and a developed instrumental system enable to reveal tumor changes in large bronchi mucosa at early stages, and a developed PDT technique performed under fluorescent control helps achieve personalized treatment. Such an approach is considered as a theranostic technique — photodynamic theranostics.central lung cancer screening requires a fluorescent dye characterized by availability and can be used directly within the examination. Indocyanine green can be used as a dye, its peculiarity is the necessity to excite and record fluorescence in the near-infrared (NIR) wavelength band. First experiments using NIR bands to diagnose a bronchoscopic system showed the detectability of tumor areas using on-site bronchoscopic photodynamic theranostics, which consists in NIR imaging of tumor foci when a standard dose of indocyanine green is administered during the examination.ConclusionFurther progress of early diagnostics and minimally invasive CLC therapy will be determined by the development of new photosensitizers, which should be characterized by a high absorption band in NIR area, quick accumulation in a tumor, high yield of single oxygen in NIR illumination, bright fluorescence, high potential in terms of the induction of an anti-tumor immune response.

Healthy lungs maintain a young and energetic body

In general, life is only possible in the presence of oxygen in a form that can be easily absorbed by the body. In the case of humans, the lungs have as their main task the provision of the oxygen necessary for the body to carry out daily activities. The lung is a paired organ located in the chest cavity, a fibro-elastic organ capable of altering your volume during breathing (inspire and expire). The weight of a lung varies between 800 and 1,000 grams, of which more than 50% is blood. The air reaches the lungs through a pipeline system consisting of Nazo-pharynx, larynx, trachea, bronchi, and bronchiole. The role of the piping system is to heat and dampen the air or to capture and remove foreign inhaled particles. The channel system decreases in diameter after each branch - from the trachea and the large bronchi to the bronchiole with a diameter of less than one millimeter. The lung consists of over 30 different cell types. Trachea and large bronchi are taped by a mucous layer containing multiple cell types: ciliary cells - provides mucus movement, caliciform cells - secretes mucus, basal cells - plays a role in regeneration and neuro-ectodermic cells - ensures the secretory function of the lungs. In the chorion (the deep layer beneath the mucosa) there are cells involved in the defense processes - lymphocytes, mast cells, eosinophils or neutrophils.

Benign tumors of the large bronchi and trachea

The OBJECTIVE was to assess the incidence, diagnostic abilities and surgical tactics in case of benign tumors of the large bronchi and trachea.METHODS AND MATERIALS. Benign tumors of the large bronchi and trachea were diagnosed in 29 (6.3 %) of patients among 445 patients with benign bronco-pulmonary tumors. The diagnosis was made due to X-ray and endoscopic studies. Lung resections were performed in 5 (17.2 %) patients. RESULTS. Clinical symptoms were non-specific. In 10 (35.7 %) cases, the disease was diagnosed during X-ray examination. Computed tomography revealed pulmonary changes caused by bronchial narrowing in 5 patients (17.2 %).The biopsy taken during bronchoscopy detected the histological form of the tumor in 16 (55 %) patients. The exact morphological type of the tumor was identified after its removal. More often, they were polyps (48.3 %), papillomatosis (20.7 %), chondromas (10.3 %), in single cases – teratomas, sclerosing hemangioma, adenoma, mucoepidermoid tumor, histiocytoma, inflammatory pseudotumors. In 24 (82.8 %) patients, tumors were removed during bronchoscopy by electrosurgical or argonoplasmic destruction methods. The repeated surgery for a recurrence was required in 5 (17.2 %) patients in terms of (8.3±4.7) months, three times for two patients. In three cases, we performed lobectomy; in one case, we performed lobectomy with wedge resection of the intermediate bronchus. Pneumonectomy was made in two patients: one patient suspected of cancer after tumor biopsy, the other – complicated with lung gangrene. The latter patient died of pneumonia of the single lung. The mortality rate was 3.4 %.CONCLUSION. In presence of non-specific pulmonary symptoms resistant to therapy, it is necessary to rule out benign bronchial tumors using X-ray and endoscopy. Most formations can be removed during bronchoscopy. In case of irreversible lung changes or impossible endoscopic removal, we should use surgery.

Pulmonary adenocarcinoma causing oesophageal and bronchial compression in a cat with concurrent peritoneopericardial diaphragmatic hernia

AbstractA 13‐year‐old female neutered domestic longhair cat was presented for intermittent, self‐limiting episodes of laboured breathing and wheezing and also vocalising, coughing, retching, vomiting and inappetence. Abdominal ultrasound and thoracic radiographs revealed a peritoneopericardial diaphragmatic hernia (PPDH), and the cat was referred for further investigations and surgical treatment. Computed tomography (CT) of the thorax confirmed the presence of a large PPDH and individuated the existence of a heterogeneous mass lesion in the caudal mediastinum. Additionally, there were disseminated lesions affecting multiple organs, numerous skeletal muscles, and several lymph nodes. On the basis of these findings and a likely neoplastic cause, the owner elected to have the cat euthanised. Postmortem examination and histopathological analysis revealed the presence of a pulmonary adenocarcinoma, invading and compressing the distal part of the oesophagus and a large bronchus, and likely representing the cause of the patient's main clinical signs.

Lattice Radiotherapy (LRT)-Spatially Fractionated Radiotherapy (SFRT): Advanced Non-Small Cell Lung Cancer (NSCLC): Early Experience

Lattice Radiotherapy (LRT)-Spatially Fractionated Radiotherapy (SFRT): Advanced Non-Small Cell Lung Cancer (NSCLC): Early Experience

Bioinformatic Analysis of ABCA1 Gene Expression in Smoking and Chronic Obstructive Pulmonary Disease.

Smoking is a key modifiable risk factor for developing the chronic obstructive pulmonary disease (COPD). When smoking, many processes, including the reverse transport of cholesterol mediated by the ATP binding cassette transporter A1 (ABCA1) protein are disrupted in the lungs. Changes in the cholesterol content in the lipid rafts of plasma membranes can modulate the function of transmembrane proteins localized in them. It is believed that this mechanism participates in increasing the inflammation in COPD. Methods: Bioinformatic analysis of datasets from Gene Expression Omnibus (GEO) was carried out. Gene expression data from datasets of alveolar macrophages and the epithelium of the respiratory tract in smokers and COPD patients compared with non-smokers were used for the analysis. To evaluate differentially expressed genes, bioinformatic analysis was performed in comparison groups using the limma package in R (v. 4.0.2), and the GEO2R and Phantasus tools (v. 1.11.0). Results: The conducted bioinformatic analysis showed changes in the expression of the ABCA1 gene associated with smoking. In the alveolar macrophages of smokers, the expression levels of ABCA1 were lower than in non-smokers. At the same time, in most of the airway epithelial datasets, gene expression did not show any difference between the groups of smokers and non-smokers. In addition, it was shown that the expression of ABCA1 in the epithelial cells of the trachea and large bronchi is higher than in small bronchi. Conclusions: The conducted bioinformatic analysis showed that smoking can influence the expression of the ABCA1 gene, thereby modulating lipid transport processes in macrophages, which are part of the mechanisms of inflammation development.

Lungworm infection with Otostrongylus circumlitus in a free-ranging harbor seal (Phoca vitulina)

A young wild harbor seal (Phoca vitulina) was found stranded on the North Sea coast at Kok- sijde (Belgium)and was admitted to a rehabilitation center where it died one day later. Full ne- cropsy with histopathology was performed. Gross examination revealed severe diffuse hemorr- hagic and emphysematous pneumonia with the presence of 6-10 cm-large nematodes. The nema- todes were found in the trachea, large bronchi, right heart and pulmonary arteries, and subsequently identified as Otostrongylus circumlitus. Histologic examination demonstrated severe eosinophilic to granulomatous bronchointerstitial pneumonia with intralesional nematodes. It was concluded that the seal died of severe verminous pneumonia. In this case report, the importance of lungworm infection, which is a common and critical disease in young seals, is highlighted.

FEASIBILITY STUDY OF MAGNETIC RESONANCE IMAGINING APPLICATION IN EXPERIMENTAL RADIOLOGY FOR INTRAVITAL VERIFICATION OF LUNGS METASTASES IN MICE

Background. For preclinical studies of radiopharmaceuticals there is a high need for development new methods of in vivo metastasis diagnosis in mice after tumor cells transplantation. The study was carried out to assess feasibility of lung metastasis diagnosis with magnetic resonance imaging (MRI) visualization in mice C57Bl6.The aim of this study was to assess feasibility of MRI for verification of distant metastases of the solid B16-F10 melanoma with validation by anatomic dissection.Methods. Metastatic lesions were caused by injection of B16-F10 murine melanoma cells into cavum medullare of the tibia. Imaging studies were performed on the 21th day after transplantation using 7T magnetic resonance tomograph, coronal and axial images were acquired. Validation of metastasis was made by anatomic dissection and histological examination.Results. MRI method enables visualization of lung nodules with diameter at least 0.8 mm, because smaller nodules cannot be distinguished from heartbeat artifacts. Histological examination revealed that macroscopic anatomic dissection can precisely detect subpleural lung nodules.Conclusion. This study demonstrated feasibility of in vivo lung metastasis verification with MRI method in mice: metastases comparable in diameter to the size of large bronchi can be detected by MRI as well as by ex vivo dissection. For centrally located lung metastasis MRI method is preferable because macroscopic dissection enables to visualize only nodules which are located subpleurally.

Comparative efficacy of leukotriene modifier and inhaled corticosteroids in the complex treatment of steroid-naive patients with bronchial asthma combined with chronic obstructive pulmonary disease with neutrophilic type of inflammation

The aim: to compare the efficacy and tolerability of the leukotriene modifier and inhaled corticosteroids in combination with long-acting β2-agonist formoterol in steroid-naive patients with asthma combined with COPD with neutrophilic inflammation. Materials and methods. After obtaining the written consent, 30 patients with asthma combined with COPD and a number of blood neutrophils >4000/μl were randomized (1:1): group I – received a fixed combination of budesonide/formoterol 160/4.5 μg/1 inhalation twice daily as a basic therapy; group II – montelukast 1 tab. (10 mg) once daily and inhalation of formoterol 12 mcg/dose twice daily. The duration of therapy was 12 weeks. General clinical methods, asthma control questionnaires, COPD questionnaire, physical tolerance evaluation (6-minute walk test), pulmonary function tests, quality of life assessment were performed to all the patients before and after the treatment course studied. Results. The combination of budesonide/formoterol improved clinical symptoms – significantly (P < 0.05) increased the total ACT score, decreased the average ACQ score, shortness of breath (mMRC scale), COPD symptoms. PFT indices were improved significantly (P < 0.05), bronchoobstruction at the level of large, medium and small bronchi was significantly reduced. Physical tolerance was significantly improved. There were no statistically significant dynamics of the studied indices in patient group II. The patients of both groups showed a tendency to improve their quality of life. In patients of I group, there was a significant decrease in activity limitations and the total SGRQ score. Conclusions. The combination of inhaled corticosteroid/formoterol has proven to be more effective than the leukotriene modifier or formoterol in steroid-naive patients with asthma combined with COPD and neutrophilic inflammation.

The place of impulse oscillometry system in the diagnosis of early obstructive disorders associated with asthma

Asthma is one of the most common and socially significant human diseases. To date, spirometry is included in most recommendations as the gold standard for the diagnosis of obstructive disorders. However, in real clinical practice, this procedure does not always reveal signs of bronchial obstruction, not only in the early stages of the disease but also in more severe controlled bronchial asthma. Tests of oscillatory mechanics are increasingly being used to detect early violations of the pulmonary ventilation function. These tests are based on the forced oscillation technique, and the latest modification is impulse oscillometry system. Theaimof this study was to investigate the capabilities of impulse oscillometry in diagnosing early changes in the function of the respiratory system in patients with asthma and identifying the most informative parameters of the method.Methods. A total of 146 patients with an established diagnosis of mild and moderate asthma were examined during remission. The patients were divided into 2 groups by the severity of asthma. The comparison group included 40 people with no signs of lung abnormalities.Results. Disorders of the pulmonary ventilation function were found in 23% of patients with asthma by spirometry, in 42% by bodypletismography in 42%, and in 72% of patients by impulse oscillometry. Impulse oscillometry system revealed obstructive changes localized in the central respiratory tract in 11% of patients, and obstruction of mixed localization was found in 6% of respondents. Peripheral respiratory tract disorders were diagnosed in 56 % of patients. Most respiratory tract lesions were located in the small bronchi in both groups. The obstructive disorders in large bronchi and generalized obstruction were observed more often in the 2ndgroup. Among impulse oscillometry parameters, the increase in Delta (Rrs5– Rrs20) was most often recorded in both examined groups of patients with asthma.Conclusion. Compared to standard methods, impulse oscillometry system is more sensitive. Therefore, it has advantages in diagnosing respiratory system dysfunctions both in the early stages of asthma and in more severe cases during remission.

Frequency and Significance of Pathologic Pulmonary Findings in Postmortem Examinations-A Single Center Experience before COVID-19.

Coronavirus disease 2019 (COVID-19) has shown the importance of postmortem investigation of deceased patients. For a correct interpretation of the pulmonary findings in this new era, it is, however, crucial to be familiar with pathologic pulmonary conditions observed in postmortem investigations in general. Adequate postmortem histopathological evaluation of the lungs may be affected by suboptimal gross work up, autolysis or poor fixation. Using a standardized preparation approach which consisted in instillation of 4% buffered formaldehyde through the large bronchi for proper fixation and preparing large frontal tissue sections of 1–2 cm thickness after at least 24 h fixation, we comprehensively analyzed postmortem pulmonary findings from consecutive adult autopsies of a two-year period before the occurrence of COVID-19 (2016–2017). In total, significant pathological findings were observed in 97/189 patients (51%), with 28 patients showing more than one pathologic condition. Acute pneumonia was diagnosed 33/128 times (26%), embolism 24 times (19%), primary pulmonary neoplasms 18 times (14%), organizing pneumonia and other fibrosing conditions 14 times (11%), pulmonary metastases 13 times (10%), diffuse alveolar damage 12 times (9%), severe emphysema 9 times (7%) and other pathologies, e.g., amyloidosis 5/128 times (4%). Pulmonary/cardiopulmonary disease was the cause of death in 60 patients (32%). Clinical and pathological diagnoses regarding lung findings correlated completely in 75 patients (40%). Autopsy led to confirmation of a clinically suspected pulmonary diagnosis in 57 patients (39%) and clarification of an unclear clinical lung finding in 16 patients (8%). Major discrepant findings regarding the lungs (N = 31; 16%) comprised cases with clinical suspicions that could not be confirmed or new findings not diagnosed intra vitam. A significant proportion of acute pneumonias (N = 8; 24% of all cases with this diagnosis; p = 0.011) was not diagnosed clinically. We confirmed the frequent occurrence of pulmonary pathologies in autopsies, including inflammatory and neoplastic lesions as the most frequent pathological findings. Acute pneumonia was an important cause for discrepancy between clinical and postmortem diagnostics

Risk factors for local tumor progression after RFA of pulmonary metastases: a matched case-control study.

Curative treatment of oligometastatic pulmonary disease aims at eradication of all metastases. Radiofrequency ablation (RFA) has been shown to be an efficient method and the frequency of local tumor progression (LTP) should be minimized. The objective of this study was to determine the morphological and treatment-related risk factors for LTP after RFA of pulmonary metastases. All patients treated with RFA for pulmonary metastases from 2002 to 2014 were reviewed. All LTPs from 2011 to 2014 were individually matched on the basis of tumor size, number, and histology. In total, 48 LTPs and 112 controls were blindly analyzed for morphological factors including vicinity of bronchus and vessels as well as treatment-related factors such as the size of the ablation zone and ablation margins. In the simple regression analysis, the significant predictive variables were ≤ 5-mm distance to a large bronchus (OR = 4.94; p = 0.0095) or large vessel (OR = 7.09; p < 0.001), minimal ablation margin (≤ 5 mm (OR = 42.67; p < 0.001), and a central-peripheral ablation offset/ablation zone size > 0.36 (OR = 13.83; p = 0.013). In the multiple regression model, only a minimal ablation margin ≤ 5 mm remained a significant risk factor for LTP. Only the minimal ablation margin remains significant in the multiple regression analysis; the other factors are presumably surrogates of an insufficient ablation margin. Improvement of lung RFA outcomes can probably be obtained by immediate post RFA evaluation of ablation margins to ensure a minimal ablation margin of at least 5 mm. • A distance < 5 mm to a bronchus or vessel of over 3 mm diameter is associated with insufficient ablation margin and thus risk factors for local tumor progression after pulmonary radiofrequency ablation. • A minimal ablation margin of > 5 mm after pulmonary RFA is associated with significantly less local tumor progression and should be looked for at the end of treatment session before needle removal in order to decrease local tumor progression. • Tumor location, pleural contact, occurrence of intra-alveolar hemorrhage, pulmonary atelectasis, and pneumothorax are not associated with an increased risk of local tumor progression.

Changes in the ventilation function of the lungs during the formation of chronic obstructive pulmonary disease and its combination with lung cancer

Aim. To study the ventilation function of the lungs in patients with varying degrees of severity of chronic obstructive pulmonary disease (COPD) and in patients with COPD combined with lung cancer (LC), as well as to establish the features of its disorders using spirography and body plethysmography. Materials and methods . A clinical and functional study of 57 individuals was carried out with 10 healthy patients (control group), 30 patients with COPD and 17 patients in whom LC was combined with COPD using the Masterlab Pro diagnostic complex (Erich Jaeger, Germany). Results . In patients with early COPD, a decrease in MEF 75 (a ventilation parameter characterizing small airway patency) is the most informative. With the progression of bronchial obstruction, both restrictive and obstructive disorders, characterized by a decrease in FEV 1 , VC, a change in the structure of the total lung capacity in the form of an increase in the RV/TLC ratio such as an increase in the RV/TLC ratio and an increase in bronchial resistance were recorded. In patients with LC and mild COPD, pulmonary volumes, capacities, flow-volume loop and bronchial resistance parameters did not differ from patients with COPD with a similar bronchial obstruction. In patients with LC and more severe COPD, in contrast to patients suffering from a similar severity of COPD, a decrease in the patency of large, medium and small diameter bronchi (PEF, MEF 25 , MEF 50 , MEF 75 ) was detected, which indicated development of generalized bronchial obstruction. Conclusion . Modern diagnostics of pulmonary ventilation disorders in patients with LC and COPD should be aimed at identifying the disease, and drug therapy should target maximum leveling of reversible components of bronchial obstruction in order to increase the functional reserve of the respiratory system and reduce the risk of postoperative complications caused by COPD.

Construction of a computational mechanical model of bronchi for practical simulation of the optimal positive intrathoracic pressure conditions during general thoracic surgery.

Thoracic CO2 insufflation with positive intrathoracic pressure is usually effective during thoracoscopic surgery, however, lung collapse is sometimes insufficient. We hypothesized that inappropriate bronchial collapse might cause this unsuccessful lung collapse. The objective of this study was to construct a computational mechanical model of bronchi for practical simulation to discover the optimal conditions of positive intrathoracic pressure during thoracoscopic surgery. Micro-focus high-resolution X-ray computed tomography measurements of lungs from just-slaughtered swine were extracted, and the three-dimensional geometries of the bronchi under pressurized and depressurized conditions were measured accurately. The mechanical properties of the bronchus were also measured. Computational fluid dynamics (CFD) and computational structural mechanics (CSM) analyses were conducted. The CSM results indicated that the present structural model could simulate bronchial occlusion. The CFD results showed that airflows from pressed lung alveoli might cause low-internal-pressure regions when suddenly or heterogeneously pushed airflow was injected from a small branching bronchus to a large bronchus. A preliminary computational mechanical model of bronchi was constructed. We demonstrated the performance of the mechanical model of bronchi in rough simulations of bronchial occlusions. However, this model should be verified further using human data to facilitate its introduction to clinical use.

Usefulness of autofluorescence bronchoscopy in early diagnosis of airway complications after lung transplantation

Despite the promising results achieved so far in long-term survival after lung transplantation (LuTx), airway complications (ACs) still arise in the post-operative period. Early diagnosis and prompt treatment of ACs play a critical role in preventing their onset. Specifically, large bronchi ischemia has been recognized as a triggering factor for ACs. Autofluorescence bronchoscopy, which was first introduced for early cancer diagnosis, displays ischemic mucosae as red spots, while normal vascularized mucosae appear in green. The aim of this study is to investigate whether a significant correlation exists between ACs and the red/green (RG) ratio detected on scheduled autofluorescence bronchoscopy up to 1 year after LuTx. This prospective, observational, single-center cohort study initially considered patients who underwent LuTx between July 2014 and February 2016. All patients underwent concomitant white-light and autofluorescence bronchoscopy at baseline (immediately after LuTx), on POD7, POD14, POD21, POD28, POD45, 3 months, 6 months, and 1 year after LuTx. An autofluorescence image of the first bronchial carina distal to the anastomosis was captured and analyzed using histograms for red and green pixels; the R/G ratio was then recorded. Potential ACs were classified according according to the presence of a white-light following the MDS (macroscopic aspect, diameter and suture) criteria. The authors assessed the association between the R/G ratio and the ACs occurrence using a generalized estimating equations model. Thirty-one patients met the inclusion criteria and were therefore selected. Out of a total of 53 bronchial anastomoses, 8 developed complications (late bronchial stenosis), with an average onset time of 201 days after LuTx. ACs showed a similar baseline covariate value when compared to anastomoses that involved no complication. Generalized estimating equations regression indicated a clear association over time between the R/G ratio and the rise of complications (p = 0.023). The authors observed a significant correlation between post-anastomotic stenosis and the delayed decrease of the R/G ratio. Preliminary outcomes suggest that autofluorescence bronchoscopy may be an effective and manageable diagnostic tool, proving complementary to other instruments for early diagnosis of ACs after LuTx. Further research is needed to confirm and detail preliminary findings.

Bronchoscopy in HIV-infected patients (based on data from patients with pulmonary symptoms)

Aim objective. The study aimed at determining the facility for bronchoscopic examination and management of HIV-infected patients.Materials and methods. Results of a total of 1393 bronchoscopic procedures carried out in HIV-infected patients (100%) hospitalized in the pulmonology departments with different pulmonologic disorders. The HIV-infection was a comorbidity at that.Results. In terms of study process organization two patient flows have been discerned. The first flow included patients with asymptomatic infection/carrier state (138 bronchoscopic procedures [9,91%] for 104 patients), for whom bronchoscopy was performed due to general indications. The second flow comprised patients with a full-scale clinical picture of the disease (1255 bronchoscopic procedures [90,09%] for 1099 patients). The second flow was divided into two groups, namely, patients with earlier diagnosed HIV-infection (group IIА amounting to 523 bronchoscopic procedures [37,54%] for 473 patients) and patients newly diagnosed with HIV infection (group IIВ; 732 bronchoscopic procedures [52,55%] for 626 patients). Common to both groups was the absence of urgent indications for bronchoscopy, although the elective indications were different between the groups. In all instances the endobronchial symptoms were either non-specific or reflected mucosal lesions in the large bronchi related to lung tumor or tuberculosis.

Endocrine Structures Of The Lungs In Ontogenesis And In Children With Pneumonia

During embryonic histogenesis of human lungs, early morpho- functional differentiation of apudocytes is observed. In the lungs of young children with an inflammatory pathology of this organ, endocrine structures are detected with great constancy, and their number is large. The longer the disease lasts, the more apudocytes and NETs are found in the bronchi and respiratory tract. In large bronchi there are more endocrine structures than in small ones. Inflammatory lung diseases in early postnatal ontogenesis are a predisposing factor for apudocyte hyperplasia.

Difficulties in the Differential Diagnosis of Tracheobronchomegaly in Children

Tracheobronchomegaly is a rare developmental defect in children, which is characterized by the expansion of the trachea and large bronchi, the diagnosis and treatment of which are made more often in adult practice, when the clinical diagnostic picture acquires the obvious features of Mounier-Kuhn syndrome. In this connection, the need arises for the early detection of this pathology in children and its differentiation from other diseases and malformations of the tracheobronchial tree, which mask a recurrent inflammatory process in the lung and upper respiratory tract, and primarily with those, such as cystic fibrosis and primary ciliary dyskinesia.The paper describes a case of secondary tracheobronchomegaly in a child with obvious clinical manifestations of Mounier-Kuhn syndrome in the presence of bronchiectasis, pulmonary fibrosis, and signs of systemic connective tissue disease. It discusses the possibilities of chest computed tomography in the diagnosis of this defect in children, as well as its causes. The sizes of the trachea and main bronchi in this patient are compared with those in the groups of children of the same age and sex who have cystic fibrosis or diffuse pulmonary fibrosis to identify a more significant role of hereditary connective tissue diseases in the development of secondary tracheobronchomegaly. The authors propose to separate the concepts of tracheobronchomegaly and Mounier-Kuhn syndrome in children and to recognize the threshold for tracheal expansion in these patients having +3SD or more.

New aspect of studying the mechanisms of development of the lungs ventilation capacity disorders in children with bronchial asthma

Purpose. Study of the pathogenetic role of the polymorphism of the ACTN3 gene (actinin, alpha 3) rs1815739 in the development of lungs ventilation capacity disorders in children with bronchial asthma.Materials and methods. To study the polymorphism of ACTN3 gene (actinin, alpha 3) rs1815739, the molecular and genetic study of 90 children aged from 6 to 18 years with bronchial asthma, who were passing in-patient treatment at the Allergy Department of the Municipal Non-Profit Enterprise "Children's Hospital no.5" of Zaporizhia City Council, and 25 healthy children (control group) was conducted. The external respiration function was studied using a computer spirograph "PULMOREM" TU U 33.1-02066769-005-2002 (Kharkiv). The study of the polymorphism of the ACTN3 gene (actinin, alpha 3) rs1815739 was performed in the Division of Molecular Genetic Researches of the Training Medical Laboratory Center at the Department of Microbiology of Zaporizhia State Medical University in Zaporizhia on the CFX96TM Real-Time PCR Detection Systems amplifier (Bio-Rad laboratories Inc., USA) with extraction of DNA from venous blood by means of polymerase-chain reaction. The results of the study were processed using statistical analysis of the license software package Statistica for Windows 6.1.RU, serial number AXXR712D833214SAN5.Results. The study of the distribution of allelic genes and genotypes of ACTN3 (actinin, alpha 3) polymorphism for rs1815739 showed that among children with bronchial asthma, the homozygous C/C genotype was recorded in 37.7% of cases, heterozygous C/T genotype in 40% of cases, homozygous T/T genotype in 22.3% of cases, while in healthy children, the frequencies of the homozygous C/C (68%) and T/T (4%) genotypes were significantly more frequent. The indicators of external respiration function (forced vital capacity (FVC), forced expiratory volume at the 1-second (FEV1)) in patients with a homozygous C/C genotype were significantly lower than in patients with homozygous T/T genotype and were 2.69 (1.9; 3.49) vs. 3.11 (2.47; 4, 14) and 2.06 (1.6; 2.76) vs. 2.82 (2.02; 3.51). The patency of large and small bronchi, characterized by spirographic MEF25 and MEF75 indicators, was significantly better in children with bronchial asthma with homozygous T/T genotype than in children with C/T and C/C genotypes (5.46 (4.87; 6, 31) and 2.36 (1.89; 3.32) against 4.54 (3.69; 5.43) and 4. 17 (3.24; 5.44), and 1.88 (1.10; 2.56) and 1.69 (1.16; 2.02), respectively. In children with bronchial asthma and the C/C and C/T genotypes of ACTN3 gene (actinin, alpha 3) rs1815739 with probable sufficient synthesis of alpha-actinin-3 protein in muscles, a stronger contraction of the respiratory muscles on inhalation is possible, and in patients with the T/T genotype, which encodes insufficient synthesis of alpha-actinin-3 protein in the muscles, the muscle contraction is probably less pronounced in asthma attacks, which can lead to less pronounced disorders of lungs ventilation capacity.Conclusions. The study of ACTN3 (actinin, alpha 3) rs1815739 gene polymorphism showed that the C / C and C / T genotypes were associated with impaired lung ventilation in children with bronchial asthma.

Normal murine respiratory tract has its mucus concentrated in clouds based on the Muc5b mucin.

The organization of the normal airway mucus system differs in small experimental animals from that in humans and large mammals. To address normal murine airway mucociliary clearance, Alcian blue-stained mucus transport was measured ex vivo on tracheal tissues of naïve C57BL/6, Muc5b-/-, Muc5ac-/-, and EGFP-tagged Muc5b reporter mice. Close to the larynx with a few submucosal glands, the mucus appeared as thick bundles. More distally in the trachea and in large bronchi, Alcian blue-stained mucus was organized in cloud-like formations based on the Muc5b mucin. On tilted tissue, the mucus clouds moved upward toward the larynx with an average velocity of 12 µm/s compared with 20 µm/s for beads not associated with clouds. In Muc5ac-/- mice, Muc5b formed mucus strands attached to the tissue surface, while in Muc5b-/- mice, Muc5ac had a more variable appearance. The normal mouse lung mucus thus appears as discontinuous clouds, clearly different from the stagnant mucus layer in diseased lungs.