Lung Damage In Patients Research Articles

Розвиток ХОЗЛ при неспецифічному виразковому коліті: клініко-інструментальне підтвердження

Objective — to study the degree and frequency of lung damage in patients with UC. Materials and methods: A total of 24 patients with a verified diagnosis of UC were examined, 63.6% of them with left-sided intestinal lesions of moderate severity and 36.4% with total lesions of moderate severity. The age according to WHO was 45.2 + _2.2 years. The control group consisted of 42 people. The study of lung function in 24 patients with UC was carried out using spirography (Spirolab3): the volume of forced expiration was measured in 1 sec. (FEV1), forced vital capacity (FVC), forced expiratory flow in the middle of 25—75% (FEF25-75), residual volume and ratio (FEV1 \ FVC) and used the CAT-test questionnaire (COPD Assessment Test). To assess the severity of COPD, the GOLD classification (2019) was used. The data were statistically processed using the Statistica 8.0 software. Results. UC with lesions of the left intestine was detected in 63.6% of patients and corresponded to the obstructive type of pulmonary lesion. With total intestinal lesion, UC was found in 36.4%, which corresponded to the restrictive type of lung lesion. In 17 patients with left-sided lesions, the volume of forced expiration in 1 sec. (FEV1- 2.95 l/s ± 0.62), forced vital capacity (FVC-2.68 l/s + _0.8), residual volume (70.1%), forced expiratory volume ratio in 1 sec. and forced vital capacity of the lungs (FEV1 \ FVC — 62.1%) indicates an obstructive type of lung injury. In 7 patients with UC with total lesion, a restrictive type of lung lesion was noted, which is statistically significant (p<0.002). Pathology of the bronchopulmonary system in patients with NUC according to GOLD criteria in 2.8% of patients corresponded to GOLD1, GOLD2 in 70.8% and GOLD3 in 26.4% of patients. Conclusions. In 63.6% of patients with UC, the obstructive type of COPD was established, and 36.4 was the restrictive type. Violation of bronchopulmonary pathology in patients with UC is associated with the level of intestinal damage, the severity and activity of the disease. With left-sided intestinal lesions, a significant decrease in indicators was observed FEV1, FVC, FEV1 / FVC, MEF (p<0.002), which can be explained by a higher likelihood of lung inflammation. Spirometry is a non-invasive, simple, and informative method for early detection of latent lung lesions in patients with UC.

Adaptive Phage Therapy in the Treatment of Patients with Recurrent Pneumonia (Pilot Study)

Aim. To evaluate the safety and efficacy of the adaptive phage therapy technique in patients with recurrent pneumonia in neurological critical care.Material and methods. The clinical study included 83 chronically critically ill patients with severe brain damage. The bacteriophage cocktail selected against specific hospital strains was administered by inhalation to 43 patients. The control group included 40 patients who received conventional antimicrobial therapy. The changes in clinical, laboratory and instrumental parameters, levels of biomarkers, microbiological and PCR tests of bronchoalveolar lavage fluid were assessed, including those in the «phage therapy with antibiotics» (n=29) and «phage therapy without antibiotics» (n=14) subgroups.Results. The groups were comparable in terms of basic parameters (age, sex, diagnosis, organ dysfunction according to APACHE II, use of vasoactive drugs) and the level of airway colonization with antibioticresistant bacterial strains. Good tolerability and absence of clinically significant side effects were observed during inhaled administration of the bacteriophage cocktail. Computed tomography on day 21 showed a significant reduction in lung damage in patients who received bacteriophages. Patients treated with bacteriophages without antibiotics had significantly lower need for mechanical ventilation. The mortality rate on day 28 did not differ significantly and was 4.7% (2/43) in the bacteriophage-treated group vs 5% (2/40) in the control group.Conclusion. The first experience of using the adaptive phage therapy technique in chronically critically ill patients in neurological intensive care demonstrated the safety of inhalational administration of the bacteriophage cocktail. The efficacy of the technique was confirmed by the treatment results obtained in the phage therapy group, which were not inferior to those in the group with conventional antibiotic therapy, while several clinical and laboratory parameters tended to improve even in patients who received bacteriophages and did not receive antibiotics.

Features of the course of new coronaviral infection (COVID-19) in patients with acute kidney injury and end stage renal failure

BACKGROUND. In the modern era, COVID-19 is the biggest problem facing doctors and scientists around the world. SARSCоV-2 is a multisystem infection that is not limited to lung damage and has the immuno-mediated effect of negative effects on organs and systems, including the kidneys. To date, there is no precise understanding of the pathogenesis of nephrological disorders in patients with COVID-19. Patients with chronic kidney disease (CKD) are a group of particularly high risk of CO-VID-19 infection and high mortality in the development of the disease.THE AIM: to evaluate the features of the course of a new coronavirus infection (COVID 19) in patients with acute kidney injury and terminal renal insufficiency.PATIENTS AND METHODS. The study of clinical, laboratory and instrumental parameters was carried out in 119 patients (67 men and 52 women) diagnosed with COVID-19. The average age of the patients was 63.1±1.7 years. All patients were divided into two groups: group 1 - patients with CKD and HD, group 2 - patients with newly diagnosed kidney damage against the background of coronavirus infection (COVID-19). Statistical data analysis was carried out using the software package "IBM SPSS Statistics 21.0" (USA) (Russified version).RESULTS. As a result of the study, it was found that in the clinical picture of COVID-19 patients suffering from CKD and undergoing hemodialysis, such a symptom as myalgia was noted 2 times more often, the percentage of saturation of arterial blood hemoglobin with oxygen (SaO2,%) was significantly lower compared to patients with newly diagnosed kidney damage on the background of infection. The duration of the temperature reaction during the disease was 5 times longer than in patients without CKD. Although the incidence of lung damage in patients of both groups was identical, mortality was significantly higher in the group of patients with CKD.CONCLUSION. In the patients examined by us, proteinuria, an increase in the level of nitrogenous metabolites, as well as D-dimers in both groups, are associated with increased mortality. Mortality in patients with CKD and HD was several times higher than in those without pathology of the urinary system. The severity of the patients' condition was primarily due to the symptoms of damage to the respiratory system, but the degree of renal dysfunction is undoubtedly an important prognostic value. Thus, monitoring the state of individual nephron structures in patients with CO-VID-19 is of great importance, and emergency nephroprotective measures may be crucial in the fight against cytokine storm.

The Roles of Tissue-Resident Memory T Cells in Lung Diseases.

The unique environment of the lungs is protected by complex immune interactions. Human lung tissue-resident memory T cells (TRM) have been shown to position at the pathogen entry points and play an essential role in fighting against viral and bacterial pathogens at the frontline through direct mechanisms and also by orchestrating the adaptive immune system through crosstalk. Recent evidence suggests that TRM cells also play a vital part in slowing down carcinogenesis and preventing the spread of solid tumors. Less beneficially, lung TRM cells can promote pathologic inflammation, causing chronic airway inflammatory changes such as asthma and fibrosis. TRM cells from infiltrating recipient T cells may also mediate allograft immunopathology, hence lung damage in patients after lung transplantations. Several therapeutic strategies targeting TRM cells have been developed. This review will summarize recent advances in understanding the establishment and maintenance of TRM cells in the lung, describe their roles in different lung diseases, and discuss how the TRM cells may guide future immunotherapies targeting infectious diseases, cancers and pathologic immune responses.

Organizing pneumonia-like pattern in COVID-19.

Organizing pneumonia (OP) is a radio-histologic pattern that forms in response to lung damage in patients with focal or diffuse lung injury. OP is frequently observed subsequent to viral-induced lung damage and is associated with a diverse range of clinical outcomes. We included 210 patients (mean age: 55.8 ± 16.5 years old; 61% male) with mild Coronavirus disease 2019 (COVID-19) who underwent chest computed tomography (CT) from 25 February to 22 April, 2020. The patients were divided into two groups based on the presence (n = 103) or absence of typical OP-like pattern (n =107) on initial chest CT. The extent of lung involvement and final outcome was compared across the two groups. Serial changes in imaging were also evaluated in 36 patients in the OP-group with a second CT scan. Duration from symptom onset to presentation was significantly higher in the OP group (7.07 ± 3.71 versus 6.13 ± 4.96 days, p = 0.008). A higher COVID-19-related mortality rate was observed among patients with OP-like pattern (17.5% vs 3.7%, p = 0.001).There was no significant difference in the overall involvement of the lungs (p = 0.358), but lower lobes were significantly more affected in the OP group (p < 0.001). Of the 36 patients with follow-up imaging (mean duration of follow-up = 8.3 ± 2.1 days), progression of infiltration was seen in more than 61% of patients while lesions had resolved in only 22.2% of cases. Our observation indicates that physicians should carefully monitor for the presence of OP-like pattern on initial CT as it is associated with a poor outcome. Furthermore, we recommend interval CT to evaluate the progression of infiltrations in these patients.

Clinical and morphological comparison of respiratory failure in patients with COVID-19 who died under different options of respiratory support

The aim. Based on the study of the effect of invasive mechanical ventilation and NIV in the CPAP mode on the pathomorphosis of lung damage in patients with HRF caused by SARS-nCoV-2 and deaths in intensive care unit (ICU), determine the safest method of respiratory support.&#x0D; Materials and methods. The study included morphological material from 20 patients with HRF caused by SARS-nCoV-2 (COVID-19) who died in ICU. Group 1 included patients who received non-invasive lung ventilation in CPAP mode through a face mask (n=10), group 2 - patients who underwent invasive ventilation (n=10). The prepared sections, 5 μm thick, were stained according to the Van Gizon method. Photomicrographs were taken using Zeiss ZENliteimaging. Data are presented as M [25-75] and P±Sp. Statistical analysis of the results was performed using the program “Statistica 10”. Significance of differences in indicators was assessed using the nonparametric Wilcoxon test, the parametric Student's test. The results were considered reliable at values of p&lt;0.05.&#x0D; Results The morphological structure of the lungs of patients of group 1 corresponded to the exudative phase of DAD with severe edematous-hemorrhagic syndrome, signs of interstitial pneumonia with desquamation of alveolocytes and the formation of hyaline membranes. In patients of group 2 in the lung tissue there was a picture of the proliferative phase of DAD with signs of interstitial pneumonia, and the development of focal fibrosing alveolitis. Thus, invasive mechanical ventilation, can accelerate the development of irreversible processes in the lungs in the form of fibrosing alveolitis and promote the formation of ventilator-associated pneumonia&#x0D; Conclusions. CPAP NIV is a promising method of respiratory support in patients with ARDS caused by SARS-nCoV-2 virus (COVID-19), which needs further study

A strong correlation exists between platelet consumption and platelet hyperactivation in COVID-19 patients. Pilot study of the patient cohort from CCH RAS Hospital (Troitsk).

It is known that in COVID-19, hypercoagulation and sometimes thrombocytopenia are related to disease severity. There is also controversial data on platelet participation in COVID-19 pathology. We aimed to determine the degree of platelet hyperactivation in COVID-19 patients. Whole blood flow cytometry with Annexin-V and lactadherin staining ("PS+ platelets") was utilized. Additionally, a stochastic mathematical model of platelet production and consumption was developed. Here we demonstrated that the percentage of PS+ platelets in COVID-19 patients was twofold that of healthy donors. There was a significant correlation between the amount of PS+ platelets and the percentage of lung damage in patients. No connection was found between platelet senescence and hospital therapy or patients' chronic diseases, except for chronic lung disease. Although no thrombocytopenia was observed in patients, the observed increase in platelet size (FSC-A parameter in flow cytometry) could indicate that platelet age is decreased in patients. The developed computational model of platelet turnover confirms the possibility of intense platelet consumption without noticeable changes in platelet count. We conclude that the observed platelet hyperactivation in COVID-19 could be caused by platelet activation in circulation, leading to platelet consumption without significant thrombocytopenia.

КОМПЬЮТЕРНАЯ ТОМОГРАФИЯ ОРГАНОВ ГРУДНОЙ КЛЕТКИ ПРИ ПНЕВМОНИИ, ОБУСЛОВЛЕННОЙ COVID-19, У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

The study aims to evaluate the signs and extent of lung damage in patients with pneumonia affected by COVID-19, associated with end-stage renal disease (ERSD) and without kidney disease, according to the data of computed tomography (CT) of the chest organs. Material and methods. The group of patients with pneumonia and ERSD had 53 people and the group without kidney disease consisted of 59 people. Despite the appropriate treatment, all patients died. The autopsy confirmed the presence of pneumonia caused by COVID-19. The average age of the patients was 68.40 ± 14.63 years. All 112 patients had chest CT 2.12 ± 0.94 days before death. Results. The lethal outcome in patients with pneumonia caused by COVID-19 and long-term ESRD occurred when the extent of the lung damage equaled 40.64 ± 18.50% with fluctuations from 3 to 69%. Among the patients without kidney disease, the extent of lung damage was 56.63 ± 19.17%, (p < 0.05) with fluctuations from 18 to 94%. According to CT data the ground-glass opacification, crazy-paving, and consolidation signs were observed in 100.0% of patients in both groups. These signs were referred to as the main ones for the purposes of the study. The frequency of other signs such as air bronchogram, pleural thickening, pleurisy, lymphadenopathy, atelectasis, local emphysema, nodules, reticulation, calcifications, fibrosis, bronchiectasis, and pulmonary edema ranged from 2 to 73%. There was no statistically significant difference in the frequency of the signs in both groups. The most frequent locations of pneumonia were the lower (94.4%) and posterior (98.2%) parts of the lungs, regardless of the group observed. The percentage of the severity of the main signs in the lungs was significantly lower among the patients with long-term ERSD.

A simple x-ray scoring system for the diagnosis of chronic pulmonary aspergillosis.

Chronic pulmonary aspergillosis (CPA) is a severe form of post-tuberculosis lung disease (PTBLD). Considering the high burden of TB in India, it can be concluded that the prevalence of CPA is also high. Chest x-ray though most feasible, interpretation is subjective. Therefore, decision on evaluation for CPA cannot be based on x-ray alone. Present study evaluated an x-ray score as a marker for extent of lung damage in patients with PTBLD presenting with haemoptysis and its utility to predict Aspergillus serum IgG levels. We used a modified scoring system developed by Anna Ralph et al X-ray score cut-offs of >71 and 40, with or without history of massive haemoptysis, were compared with serum IgG levels. With a chest x-ray score cut-off of 71, specificity was 88%. With an x-ray score of >71 combined with history of massive haemoptysis, 86% cases were found to be IgG positive. The specificity of this combination was 96%. This study concluded that a simple chest x-ray scoring system in addition to the symptom of massive haemoptysis helped in the decision on further evaluation of the subject for CPA, especially in resource constrained settings.

Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario.

The mechanisms of acute respiratory failure other than inflammation and complicating the SARS-CoV-2 infection are still far from being fully understood, thus challenging the management of COVID-19 patients in the critical care setting. In this unforeseen scenario, the role of an individual’s excessive spontaneous breathing may acquire critical importance, being one potential and important driver of lung injury and disease progression. The consequences of this acute lung damage may impair lung structure, forecasting the model of a fragile respiratory system. This perspective article aims to analyze the progression of injured lung phenotypes across the SARS-CoV-2 induced respiratory failure, pointing out the role of spontaneous breathing and also tackling the specific respiratory/ventilatory strategy required by the fragile lung type.

Radiation-induced lung damage in patients treated with stereotactic body radiotherapy after EGFR-TKIs: is there any difference from stereotactic body radiotherapy alone?

To quantitatively evaluate lung damage after treatment of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and stereotactic body radiotherapy (SBRT) in patients with nonsmall cell lung cancer (NSCLC), and compare that of SBRT only treatment. Eligible patients from an IRB-approved prospective clinical trial had one month of EGFRTKIs treatment followed by SBRT (TKI + SBRT) and with 3-month follow-up high resolution CT. NSCLC patients treated with SBRT alone during the same time period without EGFR-TKIs or other systemic therapies were identified as controls. The lung damage was assessed clinically by pneumonitis and quantitatively using by CT intensity (Hounsfield unit, HU) changes. The mean HU values were extracted for regions of the lungs receiving the same dose range at 10 Gy intervals to generate dose-response curves (DRC). The relationship of HU changes and radiation dose was modeled using a Probit model. Four out of 20 (25%) TKI + SBRT patients and none of 19 (0%) SBRT alone patients had developed grade 2 and above pneumonitis (P=0.053), respectively. Sixty percent of TKI + SBRT patients and 30% SBRT alone patients had HU changes of the normal lung density >200 HU, respectively. There were significant differences in the DRC and in lung HU changes between the two groups (all P<0.05). The physical dose for a 50% complication risk (TD50) of CT lung damage was 52 Gy (CI: 46-59) in TKI + SBRT group versus 72 Gy (CI: 58-107) in SBRT alone group (P<0.01). Compared to patients treated with SBRT alone, patients treated with EGFR-TKIs followed by SBRT were more incline to develop radiation pneumonitis, and resulted in greater lung CT intensity changes and steeper dose-CT lung damage response relationship at 3 months post treatment. Future study with larger number of patients and longer follow-up period is warranted to validate this finding.

Морфологическая характеристика коронавирусной инфекции первой и второй волн пандемии

Introduction. A peculiarity of the first two waves of the epidemic of a novel coronavirus infection was that during their development only diagnostic methods, treatment regimens and anti-epidemic measures were only being developed, there were no vaccines and no mass vaccination was carried out. In this regard, the pandemic of the novel coronavirus infection of the first two waves is characterized by spontaneous progression of the disease. Aim of the research. Comparative study of morphological and clinical features of the novel coronavirus infection in the 1st and 2nd waves of the pandemic in 2020. Materials and methods. The autopsy protocols of deceased patients at the City Clinical Hospital No. 1 (Novosibirsk) during the 1st (May — June 2020) (1st group) and 2nd (October — December 2020) (2nd group) waves of the epidemic were analyzed. The 1st group included 30 cases, that is 14 women (46.7%) and 16 men (53.3%), in the 2nd — 110 cases, of which 43 were women (39.1%) and 67 – men (60.9%). In all cases, the presence of SARS-CoV-2 RNA in nasopharyngeal swabs from the patients was confirmed by polymerase chain reaction. Results. The novel coronavirus infection (coronavirus disease 2019 (COVID-19), ICD-10 code: U07.1) as the principal diagnosis in both the 1st and 2nd waves was recorded in more than 66% of observations. Among the comorbidities, the circulatory and endocrine disorders (primarily diabetes mellitus and obesity), kidneys and urinary tract diseases, mainly chronic pyelonephritis, prevailed. The COVID-19 pneumonia was predominantly bilateral polysegmental serоhemorrhagic in nature, however, in the 1st wave of the pandemic, the frequency of subtotal and seropurulent pneumonias was higher than in patients hospitalized during the 2nd wave. Diffuse alveolar damage in the 1st wave of the epidemic was characterized by the predominance of the early (exudative) phase of inflammation, in contrast to the 2nd wave, which was characterized by the predominance of the late (productive) phase in patients. Histologically, in patients of the 1st wave, the signs of exudative inflammation and hemorrhagic phenomena (with neutrophils and hyaline membranes in the alveoli, infarctions caused by thrombosis and pulmonary thromboembolism) prevailed. In the 2nd wave, signs of productive inflammation were more common in the lungs (predominance of macrophages in the alveoli, organizing pneumonia (pneumofibrosis), squamous cell metaplasia). Conclusion. The differences in the course of the novel coronavirus infection in the 1st and 2nd waves of the 2020 epidemic concerned primarily the frequency and structure of comorbidities and the level of polymorbidity, which were higher in patients during the 2nd wave. The severity of lung damage in patients of the 2nd wave was less pronounced: subtotal bilateral pneumonias were less common, lower lobe seropurulent pneumonias were more common. Diffuse alveolar damage in the 1st wave of the epidemic was characterized by the predominance of the early (exudative) phase, in contrast to the 2nd wave, which was characterized by the predominance of the late, productive phase of inflammation.

Correction of mitochondrial dysfunction in the complex rehabilitation of COVID-19

To study the effectiveness of a course of intravenous administration of cytoflavin in combination with a standard rehabilitation program for post-COVID fatigue syndrome caused by mitochondrial dysfunction. The dynamic examination of 45 patients with post-COVID syndrome at the second stage of rehabilitation was carried out. The patients were subdivided into 2 groups comparable in gender and age. The volume of lung damage in patients of both groups was also comparable at range of 25-80%. Twenty-four patients of the control group were treated with the standard post-COVID rehabilitation protocol: pulse magnetic therapy, inhalation therapy, aeroion therapy, infrared laser therapy, course aerobic training, psychotherapy, and standard drug therapy. Twenty-one patients of the main group additionally received intravenous administration of cytoflavin daily for 10 days. The dynamics of the scores on the Rehabilitation Routing Scale, HDRS, the Asthenic Status Scale, and the 6-minute walk test was analyzed. The additional intravenous administration of cytoflavin at the complex rehabilitation of post-COVID syndrome can significantly improve the therapeutic results: it significantly improves the overall functional state, reduces depression and fatigue level and increases tolerance to physical exertion.

MiR-20a attenuates acute lung injury in septic rats via targeting TLR4

Background: Sepsis is most likely to cause lung damage in patients, and the detection rate and mortality rate are high. Here, we investigated the expression of miR-20a in sepsis-induced acute lung injury (ALI) rats and its effect on inflammatory response, and reveal its possible molecular mechanism. Method: The model of acute lung injury caused by sepsis in rats was established by cecal ligation and puncture. The expression of miR-20a in lung tissue was determined by RT-qPCR. Acute lung injury rats were injected with 5 nmol miR-20a agomir or agomir NC every day for 3 days. Rats were sacrificed by arterial bleeding and lung tissues were removed. Serum interleukin (IL) -1β, IL-6, and tumor necrosis factor alpha (TNF-α) were detected by ELISA. HE staining was used to observe the pathology of lung tissue and calculate the pathological score of lung injury. Western blot to determine the level of TLR4 and nuclear transcription factor κB p65 (NF-κB p65) protein in lung tissue. The luciferase reporter assay was used to verify the binding effect of miR-20a on the 3 non-coding TLR4. Results: We found that compared with that in Normal group, the expression of miR-20a in lung tissues of rats with ALI was decreased (p &lt; 0.05). In miR-20a agomir group, the plasma level of IL-1β, IL-6, and TNF-α was significantly lower than that in agomir NC group and ALI group (p &lt; 0.05), while higher than those in Normal group (p &lt; 0.05). The HE staining results showed that the pathological score of lung injury in rats in miR-20a agomir group was lower than that of agomir NC group and ALI group (p &lt; 0.05). Compared with agomir NC group and ALI group, the expression of TLR4 and NF-κB p65 in miR-20a agomir group was decreased (p &lt; 0.01). The luciferase reporting experiment confirmed that TLR4 was a target gene of miR-20a. Conclusion: To sum up, miR-20a exerts a protective effect on sepsis-induced ALI rats through its anti-inflammatory effect. The targeting of TLR4 by miR-20a may be an effective method to reduce the inflammatory response in sepsis-induced ALI.

Lung ultrasound in COVID-19 pneumonia: comparison with computed tomography. An observation prospective clinical trial

Introduction. Pneumonia is the most severe form of the new coronavirus infection (COVID-19). The large area of damage and the high mortality rate in COVID-19 pose the challenge of rapid bedside diagnosis and dynamic monitoring of the volume and nature of lung tissue damage.&#x0D; Objectives. The goal of the study was to compare the data obtained with computed tomography and ultrasound of the lungs, as well as the accuracy of ultrasound segment-by-segment verification of damage zones in patients with pneumonia caused by SARS-CoV-2.&#x0D; Material and methods. The observational prospective clinical study included 388 patients aged 18–75 years; with a confirmed diagnosis of pneumonia caused by COVID-19 or suspected COVID-19. Lung ultrasound was performed within 24 hours after computed tomography (CT) of the chest. During the CT scan, pathological signs, infiltration, and consolidation of the lungs were determined, which were recorded by lung segments. Ultrasound of the lungs was performed according to the “Russian Protocol”, ultrasound signs in the lines and consolidation were also recorded based on the projection of the lung segments on the chest wall. An analysis was performed to describe and generalize the distributions of variables. The sensitivity and specificity of ultrasound methods were evaluated with ROC analysis against CT as a “gold standard”.&#x0D; Results. Bilateral involvement was found in 100 % of cases. Typical signs of pneumonia caused by coronavirus infection on CT were a “ground glass” pattern, thickened pleura, consolidation, reticular pattern, and a “crazy paving” pattern. During ultrasound examination of the lungs and pleura, the detected signs corresponded to the signs of CT. B-lines (multifocal, discrete, or confluent) and consolidation of various volumes of lung tissue were most frequently encountered during ultrasound. The sensitivity of ultrasound of the lungs in the accuracy of the segment-by-segment diagnosis of damage by the sign of infiltration is 87.9 %, and the specificity is 91.5 % (the area under the ROC curve is 0.939; p &lt; 0.001). The sensitivity of the ultrasonic sign of consolidation was 84.6 %, and the specificity was 79.2 % (the area under the ROC curve is 0.846; p &lt; 0.001).&#x0D; Conclusions. The use of ultrasound of the lungs during the COVID-19 allows us to identify and assess the volume and nature of lung damage. Thus, lung ultrasonography has demonstrated accuracy comparable to chest CT in detecting lung damage in patients with COVID-19.

Lung injury in patients age 75 years and older with the use of polymethylmethacrylate fenestrated pedicle screws

Pulmonary complications in patients age 75 years and older who undergo spinal fusion may have catastrophic consequences. The use of augmentation techniques with polymethylmethacrylate (PMMA) have been associated with pulmonary damage. The use of fenestrated pedicle screws augmented with PMMA may increase the risk of lung injury in this population. To investigate whether the use of PMMA-augmented screws is correlated with increased lung injury in patients undergoing instrumented lumbar spinal fusion. A nonrandomized, prospective, case-controlled clinical study was carried out. We included 50 consecutive patients: 25 classifieds as patients who required PMMA-augmented screws in lumbar spinal fusion, and 25 classifieds as control participants because they underwent uncemented instrumented spinal fusion. We compare the incidence of the event, lung damage, in both groups by measuring a series of parameters: arterial blood gas, transesophageal echocardiography, urinary desmosine, and chest radiograph. The epidemiological parameters analyzed were age, sex, body mass index, status as a smoker, and number of cement leaks. Changes in pulmonary damage markers were described in both groups of patients, comparing postsurgery values with baseline values. In control participants, each change was evaluated for the total number of patients. All changes are indicated in this report by mean differences for quantitative variables and by differing proportions for qualitative variables, with 95% confidence intervals provided for all values. There was an increase in postinstrumentation PaO2 (arterial partial pressure of oxygen) in both groups, probably related to the use of mechanical ventilation and recruitment maneuvers. Even though the group that required augmentation had lower baseline levels, the difference between groups was not statistically significant. On transesophageal echocardiographs, we observed scattered small, snowflake-like emboli, and bright echo signals appeared in the right atrium during PMMA injection. Signal density was constant but gradually faded away when PMMA injection ended. No participants in the group without augmentation had radiological complications. Overall, desmosine levels increased in both groups, and the rise was similar in both. There was a slight average increase in urine desmosine levels after instrumentation and progressively continues to rise until 24 hours after instrumentation, with a subsequent decrease at 72 hours. Comparing the two groups, we found no statistically significant differences at any time. We were not able to identify a significant difference in urine desmosine levels associated with the augmentation of with fenestrated pedicle screws with PMMA. Despite comparing patients age 75 years or older with a younger group, we found no clinical, analytical, or gasometric data indicating lung damage in patients who had augmentation.

Lung Ultrasound in COVID-19 A Role Beyond the Acute Phase?

Coronavirus disease 2019 (COVID-19) is a viral illness caused by severe acute respiratory syndrome coronavirus 2. With the increasing number of improved and discharged patients with COVID-19, the definition of an adequate follow-up strategy is needed. The purpose of this study was to assess whether lung ultrasound (LUS) is an effective indicator of subclinical residual lung damage in patients with COVID-19 who meet discharge criteria. We prospectively enrolled 70 consecutive patients with COVID-19 who had a prolonged hospitalization with inpatient rehabilitation between April 6 and May 22, 2020. All of the patients underwent an LUS evaluation at discharge. Data of patients with more severe disease during the acute phase (ie, required ventilatory support) were compared to those of patients with milder disease. Among the 70 patients with COVID-19 (22 women and 48 men; mean age ± SD, 68 ± 13 years), the LUS score before discharge was still frankly pathologic and higher in patients who had more severe disease during the acute phase compared to patients with milder disease (median [interquartile range], 8.0 [5.5-13.5] versus 2.0 [1.0-7.0]; P < .001), even when both categories met internationally defined discharge criteria. Lung ultrasound can identify the persistence of subclinical residual lung damage in patients with severe COVID-19 even if they meet discharge criteria. Considering the low cost, easy application, and lack of radiation exposure, LUS seems the ideal tool to be adopted in outpatient and primary care settings for the follow-up of patients with COVID-19.

The Pathology of Severe COVID-19-Related Lung Damage.

The histomorphological changes of lung damage in severe coronavirus disease 2019 (COVID-19) have not yet been adequately characterized. In this article, we describe the sequence of pathological changes in COVID-19 and discuss the implications for approaches to treatment. Standardized autopsies were performed on thirteen patients who had died of COVID-19. The findings were analyzed together with clinical data from the patients' medical records. Most (77%) of the deceased patients were men. Their median age at death was 78 years (range, 41-90). Most of them had major pre-existing chronic diseases, most commonly arterial hypertension. The autopsies revealed characteristic COVID-19-induced pathological changes in the lungs, which were regarded as the cause of death in most patients. The main histological finding was sequential alveolar damage, apparently due in large measure to focal capillary microthrombus formation. Alveolar damage leads to the death of the patient either directly or by the induction of pulmonary parenchymal fibrosis. Diffuse lung damage was seen exclusively in invasively ventilated patients. Autopsies are crucial for the systematic assessment of new diseases such as COVID-19: they provide a basis for further investigations of disease mechanisms and for the devising of potentially effective modes of treatment. The autopsy findings suggest that focal damage of the microvascular pulmonary circulation is a main mechanism of lethal lung disease due to the SARS-CoV-2 virus. It may also be a cause of persistent lung damage in patients who recover from severe COVID-19.

Neutrophil extracellular traps impair fungal clearance in a mouse model of invasive pulmonary aspergillosis.

Neutrophil extracellular traps (NETs) are formed by polymorphonuclear neutrophils (PMN) and contribute to the innate host defense by binding and killing bacterial and fungal pathogens. Because NET formation depends on histone hypercitrullination by peptidylarginine deiminase 4 (PAD4), we used PAD4 gene deficient (Pad4-/-) mice in a mouse model of invasive pulmonary aspergillosis (IPA) to address the contribution of NETs to the innate host defense in vivo. After the induction (24 h) of IPA by i.t. infection with Aspergillus fumigatus conidia, Pad4-/- mice revealed lower fungal burden in the lungs, accompanied by less acute lung injury, TNFα and citH3 compared to wildtype controls. These findings suggest that release of NETs contributes to tissue damage and limits control of fungal outgrowth. Thus inhibition of NETosis might be a useful strategy to maintain neutrophil function and avoid lung damage in patients suffering from IPA, especially in those suffering from preexisting pulmonary disease.

Fibrotic lung toxicity induced by cytotoxic drugs, radiation and immunotherapy in patients treated for lung cancer.

Patients treated for lung cancer may develop lung toxicity induced by chemotherapy (DILD), radiation or combined radiation recall pneumonitis. In the literature, some cases of immune-mediated pneumonitis have been reported associated with immunotherapy. The clinical and radiologic features of interstitial lung toxicity are unspecific, dyspnoea and dry cough are the most common symptoms while the most frequent radiological pattern is the cryptogenic organizing pneumonia (COP). Why only some individuals treated with these drugs develop interstitial lung toxicity is unclear.In the last few years some studies have reported the utility of KL 6 for the evaluation of DILD. The treatment is based on high doses of systemic steroids or immune suppressor. In this study we report severe interstitial lung damage in patients treated with different anti-blastic, immune and radiation therapies. Treated with surgery, chemotherapy, immuno and radiotherapy for lung cancer, they unfortunately died of severe DILD.