Pathological Processes In Lung Research Articles

IL-6 and TGF-β as markers of air-blood barrier damage in children with acute lymphoblastic leukemia: сlinical and prognostic aspects

Background. Damage markers of blood-air barrier are important for studding pathological process in lungs in children with acute lymphoblastic leukemia (ALL).
 Purpose is to analyses pulmonary complications and to assess IL-6 and TGF-β levels in the exhaled breath condensate (EBC) in children with ALL and its prognostic value.
 Materials and Methods. 40 children with ALL aged 6–17 years were examined. 1st group included newly diagnosed ALL (n = 18). 2nd group involved ALL survivors who had completed course of ALL IC BFM 2009 protocols (n = 22). The control group consisted of 15 healthy children. The levels of IL-6 and TGF- β in the EBC were analyzed by ELISA.
 Results and discussion. Pulmonary complications presented in 82.5% of children with ALL during chemotherapy and in 15.8% of ALL survivors. IL-6 and TGF-β levels in EBC were significantly higher in both ALL groups than control: IL-6 p1-C = 0,000001; p2-C = 0,000000; TGF-β p1-C = 0.000014; p2-C = 0.009364. 1st group had higher levels of IL-6 and TGF-β in the EBC than 2nd group: IL-6 p1-2 = 0,000000; TGF-β p1-2 = 0.000141. There was a positive correlation between IL-6 and TGF-β levels (r = 0.681176, p = 0.000001). According to ROC analysis, IL-6 level in EBC collected during Protocol 1 > 47.64 pg/ml can be prognostic for pulmonary complications during chemotherapy (AUC 0.875; Sensitivity 75.0%; Specificity 100,0%). Level of IL-6 > 49.96 pg/ml can predict pneumonia during chemotherapy (AUC 0,883; Sensitivity 100.00%; Specificity 81.82%). IL-6 level after the total course of chemotherapy > 23.64 pg/ml can predict pulmonary complications in ALL survivors (AUC 0.819; Sensitivity 75.00%; Specificity 81.82%). TGF-β level in EBC after the completion of chemotherapy > 19.93 pg/ml can be prognostic for pulmonary complications in ALL survivors (AUC 0.896; Sensitivity 100.00%; Specificity 77.78%).
 Conclusions. IL-6 and TGF-β levels in EBC can be prognostic for pulmonary complications in children with ALL.

THE DYNAMICS OF HISTOMORPHOLOGICAL CHANGES IN ACUTE BACLOFEN POISONING

Aim: to assess the dynamics of histolological changes in the lung under acute baclofen poisoning. Materials and methods: The study was performed on 20 male Wistar rats weighing 200-215 g and aged 20 weeks. The animals were divided into four groups (5 animals in each) – controls, group 1 (baclofen, 3h.), group 2 (baclofen, 4,5 h.) and group 3 (baclofen, 24 h.). Results: The thickness of intraalveolar septi in group 1 (baclofen, 3 h.) was considerably lower than in the group of controls. 4,5 hours after baclofen administration the thickness of intraalveolar septa was significantly higher than in group 1 (baclofen, 3 h.) and in the group of controls. 24 hours after baclofen administration the thickness of intraalveolar septa was significantly higher than in group 1 (baclofen, 3 h.) and in the group of controls. The diameter of the alveoli was considerably higher in all study groups than in the group of controls. The diameter of the alveoli 3 hours after baclofen administration was higher than 4,5 and 24 hours after baclofen administration, but the difference was not significant. Conclusion: In baclofen poisoning, a certain complex of general pathological processes in lungs develops. It includes circulatory disorders, increased vascular permeability, infiltration of intraaveolar septa. The quantitive assessment of the changes can be used to assess the severity of general pathological process in acute baclofen poisonings and to determine the exact time of the poisoning.

THE QUANTITATIVE CHARACTERISTICS OF HISTOPATHOLOGICAL CHANGES IN LUNGS IN ACUTE BACLOFEN POISONING

The aim of the study was to quantify the changes in the lungs in acute baclofen poisoning in an animal experiment. Materials and Methods: The study was performed on 20 male Wistar rats weighing 290–350 g and aged 20 weeks. The animals were divided into 4 groups. The reference group of controls included 5 intact rats. The animals of three experimental groups included 5 rats each were treated with baclofen at a dose of 85 mg/kg. The tested rats were euthanized by displacement of cervical vertebrae at 3, 4,5 and 24 hours, respectively. Lung tissue samples were examined by light microscopy using a video system at ×400 magnification. Results: The area of the intraalveolar septi 4,5 hours after baclofen administration was significantly higher than in the reference group of controls. 3 and 4,5 hours after baclofen administration an increase in the area of alveloli was observed, but the increase was insignificant and the area of alveoli returned to the initial size by the 24th hour. 3 and 4,5 hours after baclofen administration a slight decrease in the area of pulmonary parenchima was observed, which also returned to its initial size in 24 hours. The total area of pulmonary microvessels 4,5 hours after baclofen administration was significantly higher than in the control group and 3 hours after baclofen administration. The area of pulmonary microvessels 24 hours after baclofen administration was significantly higher than in the group of controls, 3 or 4,5 hours after baclofen administration. The area of edema increased and was significantly higher 24 hours after baclofen administration. In baclofen poisoning, a certain complex of general pathological processes in lungs develops. There is a circulatory disorder, increased vascular permeability, infiltration of intraaveolar septis. Conclusion: The quantitative assessment of the changes can be used to evaluate severity of general pathological process in acute baclofen poisonings and to determine the exact time of the poisonings.

PECULIARITIES OF THE COURSE OF ASPIRATION SYNDROME IN NEWBORNS

Respiratory distress syndrome is a non-infectious pathological process in lungs developing in children in the first hours or days of life with acute respiratory failure caused by primary surfactant system failure, insufficiency of lung tissue, pathological processes taking place in lungs against the background of considerable suppression of vital functions of the body. Respiratory distress syndrome is one of the main causes of morbidity and death of premature and premature babies.

LUNG ULTRASOUND DURING COVID-19 PANDEMICS: WHY, HOW AND WHEN?

The aim: To optimize diagnostic of pathological processes in lungs affected by COVID-19, dynamic monitoring and clinical decision making using lung ultrasound in limited resources settings. Materials and methods: Between the onset of pandemics and January 2021, approximately 9000 patients have been treated for confirmed COVID-19 in the Olexandrivska Clinical Hospital. Assessment of all hospitalized patients included hematology, chemistries and proinflammatory cytokines – IL-6, CRP, procalcitonin, ferritin. Diagnosis was confirmed by PCR for SARS-CoV-2 RNA. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. Lung ultrasound was proactively utilized to assess the type and extent of lung damage and to monitor the progress of disease in patients hospitalized into the ICU and Infection Unit (n=135). Ultrasound findings were recorded numerically based on scales. Results: In the setting of СOVID-19, bedside lung ultrasound has been promptly recognized as a tool to diagnose and monitor the nature and extent of lung injury. Lung ultrasound is a real time assessment, which helps determine the nature of a pathologic process affecting lungs. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. Described in article data is collected in one of the biggest facility that deals with COVID-19. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. The cases presented in the paper indicate potential advantages to the use of ultrasound in limited resource healthcare settings, especially when the risk of transportation to CT outweighs the value of information obtained. Conclusions: Grading of ultrasonographic findings in the lungs was sufficient for both initial assessment with identification of high risk patients, and routine daily monitoring. Hence, lung ultrsound may be used to predict deterioration, stratify risks and make clinical decisions.

Mast cells and pathological process in lungs of rats and mice

The aim of this study was to evaluate the number of mast cells in healthy and affected lungs of mice and rats and determine histopathological differences of the inflammatory process in the lungs of rats and mice. The lungs of healthy and affected laboratory mice (n = 80) and rats (n = 80) were used for the studies. The histpathological examination of HE slides was performed. The number of mast cells in healthy and affected lungs of mice and rats was calcaluted in Giemsa stained slides. The number of connective tissue mast cells in healthy animals and in areas of lymphoid hyperplasia and bronchiectasis was significantly higher in rats than in mice. Interstitial pneumonia with bronchiolitis and bronchiectasis and atelectasis was more expressed in rats (P = 0.006-0.025) than in mice. Lymphoid tissue hyperplasia in the lungs of mice was found much more intense than in rats (P = 0.011). In affected laboratory mice and rats Mycoplasma pulmonis was identified. Interstitial pneumonia with bronchiolitis and bronchiectasis and atelectasis were more pronounced in rats. In our opinion, because healthy rats have more mast cells in the connective lung tissue and developed more severe pneumonia, they had a higher response of mast cells to the inflammatory process compared to mice. There was a more intense lymphocytic response in the lungs of mice.

Is COVID-19 a Systemic or Local Pathological Process?

Severe acute respiratory syndrome COVID-19 targets clinicians primarily to the processes in lung tissue. In other cases, however, clinical evidence reflects the conclusion of endotheliitis development in different parts of vascular bed of SARS-CoV-2 patients. ACE2 dysfunction leads to abnormal activation of renin-angiotensin system and systemic endotheliitis, which is accompanied by abnormal coagulation and sepsis. Sepsis and thrombi formation in various parts of blood vessel bed are of fundamental importance for reasonable choice of preventive and therapeutic tactics in COVID-19. Systemic nature of pathological processes in COVID-19, medical procedures from the first minutes of hospitalization of a patient will be focused on timely diagnosis and therapy of both local and systemic manifestations of COVID-19. There is a difference in the manifestation of risk factors associated with COVID-19 between sexes and age. Many clinicians focus on the fact that severe acute respiratory syndrome COVID-19, called coronavirus SARS-CoV-2, is a systemic disease, which is accompanied by development of pathological processes in lungs and in fact all the organs of human body. The dominant local symptoms of COVID-19 in pulmonary ventilation system in patients at the beginning of pandemic development fix the attention of clinicians on prevention of primarily fatal processes in lung tissue. However, in many cases, it is advisable to immediately after diagnosis establishment begin intensive therapeutic measures aimed at correcting the functions of cardiovascular system, central nervous or digestive systems. Clinical observations accumulating during development of COVID-19 pandemic indicate a variety of systemic pathological events in the body of SARS-CoV-2 patients. Asymptomatic COVID-19 is present also in a currently unknown fraction of the affected patients. Somewhat paradoxically, asymptomatic people had a weaker immune response to SARS-CoV-2 infection. These data formed the basis for development of preventive and therapeutic measures aimed at correction of functions of cardiovascular, immune, endocrine, nervous, digestive, excretory and other functional systems of the body. The older patient (especially smoking) is the more chronic pathological processes are present in his organism (hypertension, ischemic heart disease, asthma and other pathologies). A peculiar pattern of disease is formed in SARS-CoV-2 patients, which reflects both systematicity of the pathology and pronounced individuality of symptoms appearance. Therefore, prophylaxis, therapy and rehabilitation in COVID-19 should be focused on management of systemic pathology including Severe Acute Respiratory Syndrome with respect to local pathological processes and individual features of SARS-CoV-2 patients.

Predictors of extracorporeal membrane oxygenation efficacy in patients with acute respiratory failure

The purpose of this article is to describe the problem of predicting the lung function recovery in patients with extracorporeal membrane oxygenation for acute respiratory distress syndrome. Data from CESAR and EOLIA clinical trials on the efficacy of extracorporeal membrane oxygenation in patients with acute respiratory distress syndrome have been reviewed and some controversial results discussed. The prognostic PRESERVE and RESP scores developed as prognostic tools on the basis of the results of these studies, are presented, the limitations of their applicability in various forms of acute respiratory distress syndrome are discussed. We propose to subdivide the predictors of the extracorporeal membrane oxygenation outcome in patients with acute respiratory distress syndrome into 4 following groups: 1. Lung injury severity criteria, including parameters of their lung mechanical and functional properties. 2. Time from acute respiratory failure onset to extracorporeal membrane oxygenation initiation, which reflects the rate of pathological processes in lungs and timing of decision to initiate extracorporeal membrane oxygenation. 3. The etiology of pulmonary disorders, directly affecting the reversibility of pathological processes in the lungs. 4. The severity of the patient's general condition, including the severity of manifestations of multiple organ failure, the degree of decompensation of concomitant chronic diseases, including oncological and associated with immunosuppression. Several diseases are associated with a higher risk of specific complications, particularly hemorrhagic, during extracorporeal membrane oxygenation.

Remote preconditioning phenomenon. prospects for use in pathology of lung and gastrointestinal tract

The literature data on the effectiveness of remote ischemic preconditioning (RIP) in the prevention of lung injury are contradictory. Authors of some works argue that RIP prevents lung damage during surgical interventions, the authors of other publications claim that the RIP does not protect lung against pathological processes. It is obvious that there is an urgent need for multicenter, randomized trials aimed at studying RIP protective effects against pathological processes in lung. Also required is clinical evaluation of the effectiveness of RIP in the thromboembolism of pulmonary arteries, the transplantation of the lungs and intestinal infarction. Remote preconditioning prevents the intestine injury associated with abdominal aortic aneurysm repair. Experimental data indicate that RIP has the hepatoprotective effect during ischemia and reperfusion injury of liver, septic or haemorrhagic shock. The question of whether the DIP has a protective effect during ischemia-reperfusion of the pancreas remains open.

Densitometrical volume diagnostics of spherical formations in lungs with the use of artificial neuron

Cancer, specific, nonspecific inflammatory and other pathological processes in lungs have similar lines in their visualization by multislice computed tomography methods. In order to improve the accuracy of the differential diagnosis of spherical formations in lungs by quantifying their internal structure with multislice computed tomography a newly developed method comprising sighting volume densitometry was used. 328 patients with primary cancer of a lung, pneumonia and infiltrative tuberculosis are surveyed. The set of densitometry parameters for differential diagnostics of diseases is defined. For paired division of diseases the nonlinear neuron was used. Sensitivity at division of the «primary cancer - infiltrative tuberculosis» made 91,1%, specificity - 88,6%, accuracy - 90,2%. Sensitivity at division of the «primary cancer - pneumonia» made 90,4%, specificity - 74,5%, accuracy - 84,2%. Sensitivity at division of the «infiltrative tuberculosis - pneumonia» made 79,5%, specificity - 80,8%, accuracy - 80,2%.