Peribronchial Tissue Research Articles

Aspects of histogenesis of the coniotic process in workers of the main professions of the coal industry

Introduction.In pulmonology dust bronchitis is regarded as a primary process that is not associated with coniotic pneumonia. Modern studies point to the pathogenetic and pathomorphological unity of friendly coniotic manifestations in the lungs and bronchi, leading to the understanding of pneumosclerosis from the position of epithelial-mesenchymal transformation.T e purpose of this studywas to histogenetic aspects coniotic process of coal industry employees having dif erent work experience in the conditions of dusty working environment.Materials and methods.Histological and morphometric study of lung and bronchial compartments obtained during forensic examinations of 80 miners of dif erent experience groups and 20 persons of the control group was carried out. In addition, an immunohistochemical study of biopsy and autopsy materials of the bronchi of 60 miners with work experience from 5 to 30 years was carried out to determine non-core proteins vimentin, desmin and actin in the epithelial component.Results.It is revealed that the interalveolar partitions of miners with experience from 1 year to 5 years are thickened. The development of peribronchial f brosis is noted, the muscle layer of the air-conducting structures is hypertrophied, the basalmembrane is thickened. In the bronchi epithelium f at ened. Pulmonary vessels with hypertrophy of media, endothelial cells increased. In perivascular spaces there is a proliferation of f brous tissue. T e pleura is slightly thickened. Coal dust deposition is observed in all structures. In miners with work experience from 5 to 10 years, the changes progress, the epithelium of the bronchi with subatrophy phenomena. With an increase in internship up to 10–20 years in the respiratory part of the lungs, small areas of sclerosis are formed. In the wall of the bronchi there is a proliferation of connective tissue f bers. Miners with experience more than 20 years in the lung tissue develops a pronounced f brosis. T e air-conducting structures are characterized by hypertrophy of the muscular plate, thickening of the basal membrane, f brosis of the peribronchial tissue and the bronchial wall, the mucous membrane is sharply f at ened. T e pulmonary vessels have thickened walls due to hypertrophic and f brotic changes of the deformation. T e pleura is f brous, thickened. The immunohistochemical study of the bronchi of miners showed that, depending on the length of work in the mucous membrane, the area of expression of vimentin, desmin and actin increases.Conclusion.T e simultaneous development of the same type of pathological changes in the bronchi, vessels of the small circle of blood circulation and respiratory tissue indicates a pathogenetic community of changes in pneumoconiosis. As a result of the immunohistochemical reactions for the detection of non-specif c epithelial cells of the bronchi proteins obtained clear of selective coloring Chromogen. Based on the calculated percentage of their expression area, we can talk about the degree of f brous transformation.

THE FEATURES OF THE RADIOLOGICAL IMAGE OF COMMUNITY-ACQUIRED PNEUMONIA AT INTERSTITIAL LUNG DISEASES

Community-acquired pneumonia (CAP) in patients with interstitial lung diseases is a terrible complication and has an atypical course. Diagnosis of CAP is difficult, since the clinical symptoms of inflammation are similar to those of ILD. The results of radiation studies are not pathognomonic, they are not always correctly interpreted, which leads to errors in diagnosis, delay in the examination and treatment of the patient.Aims: to evaluate the possibilities of CT in the detection and differential diagnosis of pneumonia in patients with ILD.Material and methods. The results of a complex clinical and radiological studies of 336 patients with IZL, 48 patients showed infiltrative changes in the lungs that were not characteristic of the main process.Results. Nonspecific inflammatory changes in the lung tissue were manifested by the following CT symptoms: alveolar type with local infiltration of the lung tissue corresponding to the segmental structure of the lungs (segment, lobe), the appearance of peribronchial alveolar type lung tissue that is not characteristic of radiation semiotics of the underlying disease.Conclusions: рerforming CT and VRKT reveals the appearance of infiltrative and focal changes that are atypical for IL, characteristic of specific and non-specific inflammatory processes, which affects the treatment tactics of patients.

Application value of color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns complicated with upper respiratory tract obstruction

Objective: To explore the application value of color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns complicated with upper respiratory tract obstruction. Methods: From July 2013 to June 2018, 17 patients with head and neck burns complicated with upper respiratory tract obstruction, including 15 males and 2 females, aged 19-63 years, were hospitalized in our unit and treated with color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps. Before operation, the trachea was examined by color Doppler ultrasonography to specify condition of trachea and peribronchial tissues and organs for comprehensive assessment, so as to confirm optimal incision site of puncture and pathways as well as specify distance from anterior cervical skin to intima of anterior tracheal wall. Then, under real-time guidance of color Doppler ultrasound, percutaneous dilational tracheostomy with dilatation forceps was performed. The position, shape, inner diameter, and intraluminal abnormalities of trachea of patients before operation, abnormal location of peribronchial vessels and thyroid, distance from anterior cervical skin to intima of anterior tracheal wall, success rate of puncture, surgical time (from skin disinfection to successful catheterization), success rate of catheterization, intraoperative blood loss, heart rate, blood pressure, respiration, percutaneous oxygen saturation, and presence or absence of complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative hemorrhea, wound infection after operation were observed and detected. Results: (1)Preoperative color Doppler ultrasonography showed that the trachea of one patient deviated from the anterior median line of neck 13 mm to the right; 17 patients had edema of different degrees in the cervical soft tissue and more secretions in the trachea; 3 patients had the trachea changed from round to oval with reduced anteroposterior diameter; 1 patient had a small artery obstruction at the conventional puncture point; 2 patients had the trachea covered by the congestive and swollen isthmus of the thyroid between the first and the third tracheal cartilage rings; 16 patients had a distance from anterior cervical skin to anterior tracheal wall intima of 17-33 mm, and 1 patient had a distance from anterior cervical skin to anterior tracheal wall intima of 47 mm. (2) Puncture for 17 patients was successful at one time, and success rate of puncture was 100%. The operation time was 5-11 min, with an average of 7 min, and the success rate of catheterization was 100%. (3) Intraoperative blood loss of patients was less, all not exceeding 8 mL. Intraoperative percutaneous oxygen saturation was maintained between 0.90 and 0.99. The heart rate, blood pressure, and respiration were stable. (4) No complications such as vascular/thyroid injury, emphysema, pneumothorax, suffocation, postoperative massive hemorrhage, or wound infection occurred in any patient. Conclusions: Applying color Doppler ultrasound-guided percutaneous dilational tracheostomy with dilatation forceps in patients with head and neck burns combined with upper respiratory tract obstruction can not only open up the airway quickly and effectively, but also reduce the complications related to the operation. It is expected to improve the success rate of rescue and improve the prognosis, making it of good application value.

Photodynamic therapy for R1 lung cancer resections

Theobjectivewas to evaluate the effectiveness of endobronchial photodynamic therapy (PDT) for preventing a non-small cell lung cancer (NSCLC) relapse after R1 resection with positive bronchial resection margins.Material and methods.This study included 17 patients. The planned morphological diagnostics revealed the presence of tumor cell complexes at the bronchial resection margins in 5 (29 %) patients (cancer in situ – 2, invasive cancer – 3), in peribronchial tissues – in 5 (29 %) patients, in lymphatic vessels at the resection margins – in 7 (41 %) patients.Results.All patients underwent one session of endobronchial PDT as an adjuvant treatment. No complications of PDT were noted. The five-year observation revealed a relapse at the bronchial stump area in 1 patient only (6 %). 16 (94 %) patients lived for 1 year, 12 (71 %) patients – for 5 years. Long-term results were significantly worse in patients with tumor complexes in lymphatic vessels at the bronchial resection margins (5-year survival rate – 29 %, p=0.04), with pN2 (0 %, p=0.01), lung adenocarcinoma (20 %, p=0.03).Conclusion.The use of endobronchial PDT as an adjuvant treatment for patients with NSCLC after R1 resection with positive bronchial resection margins is simple, safe and characterized by good immediate and long-term results.

Srolo Bzhtang, a traditional Tibetan medicine formula, inhibits cigarette smoke induced airway inflammation and muc5ac hypersecretion via suppressing IL-13/STAT6 signaling pathway in rats

Ethnopharmacological relevanceSrolo Bzhtang (SBT), a traditional Tibetan medicine formula, was composed of three herbs, Solms-Laubachia eurycarpa, Bergenia purpurascens, Glycyrrhiza uralensis, and one lac, and was first documented in the ancient Tibetan medical work Four Medical Tantras (rGyud-bzhi) in the eighth century AD. It has been widely used to treat lung “phlegm-heat” syndromes such as chronic bronchitis and chronic obstructive pulmonary disease (COPD). ObjectiveThe aim of this study was to evaluate the potential influences of aqueous extract of SBT on airway inflammation and mucus secretion and to reveal the underlying mechanism in a rat model of cigarette smoke (CS)-induced chronic bronchitis (CB). Materials and methodsSixty male Sprague-Dawley rats were randomly divided to six groups: control (room air exposure), model (CS exposure), DEX (CS exposure and 0.2 mg/kg/day dexamethasone), and three SBT (CS exposure and 1.67, 2.50, and 3.34 g/kg/day SBT) groups. DEX and the three doses of SBT were administered by oral gavage every day for eight weeks. Pathological changes and mucus expression in the lung tissue were determined by hematoxylin and eosin (H&E), Alcian blue-periodic acid-Schiff (AB-PAS) and immunohistochemical staining. The levels of cytokines in bronchoalveolar lavage fluid (BALF) were assessed by ELISA. Western blot analysis and qRT-PCR were performed to explore the effects of SBT on the expression of IL-13, STAT6 and MUC5AC. ResultsPretreatment with SBT attenuated the TNF-α, IL-8, IL-13 expression levels in BALF and the inflammatory cell infiltration in bronchial walls and peribronchial lung tissue. SBT exhibited a dose-dependent downregulation of MUC5AC expression as assessed by AB-PAS and immunohistochemical staining. The protein and mRNA levels of IL-13, STAT6/p-STAT6 and MUC5AC were also downregulated by SBT preconditioning. ConclusionThese results for the first time demonstrated that SBT exhibited protective effects on CS-induced airway inflammation and MUC5AC hypersecretion, which might be related to the downregulation of the IL-13/STAT6 signaling pathway.

AN INTRAPULMONARY MASS: A RARE PRESENTATION OF CASTLEMAN DISEASE

SESSION TITLE: Lung Pathology 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Castleman disease (CD) is a lymphoproliferative disease clinically classified as unicentric or multicentric. Histologically, CD has two variants: hyaline vascular and plasma cell type. Unicentric CD (UCD) is commonly found in the mediastinum and is usually of the hyaline vascular subtype. CD presenting as an intrapulmonary mass is very rare with only a few reported cases. We present a patient with intrapulmonary Castleman disease (IPCD). CASE PRESENTATION: 31 year old male, non-smoker, with no past medical history who presented with pleuritic chest pain. Chest radiograph revealed a 7.7 cm right infrahilar mass. CT of the chest revealed a 5.6x4.2x3.3 right infrahilar partially calcified mass complicated by a right lower lung collapse and nodular opacities (see image 1 and 2). Infectious workup and tumor makers HCG/AFP/LD were negative. Subsequent PET/CT showed low to moderate FDG avidity. He underwent two separate bronchoscopies with transbronchial biopsies of the right middle lobe bronchus that were both non diagnostic. He then underwent CT guided biopsy that displayed lymphoid infiltrate, but was non diagnostic for lymphoid malignancy. Lastly, he underwent right thoracotomy with right middle and lower lobe resection. Pathology of the lung parenchyma was consistent with the hyaline vascular variant of CD. DISCUSSION: UCD is a rare disease that most commonly occurs in the thorax with nodal proliferation into any lymphatic tissue including: the hila, axillae, pleural space, chest wall and extrapleural soft tissues. IPCD is even rarer, with only a few reported cases in the literature. Histologically both IPCD and UCD are of the hyaline vascular variant. Further characterization of our patient's pathology also reveals large caliber airways, blood vessels, glandular tissue and cartilage, which suggests that the process originated in the peribronchial or peribronchiolar lymphoid tissue. While the pathogenesis of the disease has yet to be fully elucidated, the hyaline variant is generally less aggressive. The treatment of choice is surgical resection, which is usually curative. CONCLUSIONS: CD remains a diagnostic challenge as clinical presentation is variable, radiographic findings are nonspecific and an adequate sample for biopsy may be difficult to obtain. Surgical resection is typically both diagnostic and therapeutic. Given this complexity, it is essential to include CD in the differential for intrapulmonary masses. Reference #1: Kligerman S, Auerbach A et al. Castleman Disease of the Thorax: Clinical, Radiologic, and Pathologic Correlation: RadioGraphics. 2016;36(5):1309-1332. Reference #2: Liu Y, Chen G, Qiu X, et al. Intrapulmonary unicentric Castleman disease mimicking peripheral pulmonary malignancy. Thoracic Cancer. 2014;5(6):576-580. DISCLOSURES: No relevant relationships by Nader Kamangar, source=Web Response No relevant relationships by Maralee Kanin, source=Web Response

Structure and Distribution of an Unrecognized Interstitium in Human Tissues

Confocal laser endomicroscopy (pCLE) provides real-time histologic imaging of human tissues at a depth of 60–70 μm during endoscopy. pCLE of the extrahepatic bile duct after fluorescein injection demonstrated a reticular pattern within fluorescein-filled sinuses that had no known anatomical correlate. Freezing biopsy tissue before fixation preserved the anatomy of this structure, demonstrating that it is part of the submucosa and a previously unappreciated fluid-filled interstitial space, draining to lymph nodes and supported by a complex network of thick collagen bundles. These bundles are intermittently lined on one side by fibroblast-like cells that stain with endothelial markers and vimentin, although there is a highly unusual and extensive unlined interface between the matrix proteins of the bundles and the surrounding fluid. We observed similar structures in numerous tissues that are subject to intermittent or rhythmic compression, including the submucosae of the entire gastrointestinal tract and urinary bladder, the dermis, the peri-bronchial and peri-arterial soft tissues, and fascia. These anatomic structures may be important in cancer metastasis, edema, fibrosis, and mechanical functioning of many or all tissues and organs. In sum, we describe the anatomy and histology of a previously unrecognized, though widespread, macroscopic, fluid-filled space within and between tissues, a novel expansion and specification of the concept of the human interstitium.

Outcome of long-term complications after permanent metallic left bronchial stenting in children.

We describe the way we treated 7 children with critical long-term complications after metallic balloon-expandable stenting in the left mainstem bronchus. Endoscopic follow-up included a first bronchoscopy 3 weeks after stenting, then monthly for 3 months, every 4-6 months up to 1 year and at scheduled times to calibrate stent diameter up to final calibration. When major complications occurred, patients underwent chest computed tomographic angiography. In 1 of the 7 children (median age 2.8 years), metallic left bronchial stenting served as a bridge to surgery. After a median 4-year follow-up, all 7 children experienced recurrent stent ovalizations with stent breakage in 3 and erosion in 1. In 4 children, computed tomographic angiography showed abundant peribronchial fibrous tissue, in 2 left mediastinal rotation and in 1 displacement along the left bronchus after pulmonary re-expansion as the cause of stent-related complication. Of the 7 children, 6 underwent surgery (5 posterior aortopexy and 1 section of the ligamentum arteriosus) and 3 required nitinol stents placement within the metallic ones. One patient completed the follow-up, and 1 patient was lost to follow-up. All 5 remaining children still have permanent bronchial stents in place, patent and re-epithelialized after a median 10.5-year follow-up. There were no deaths. Satisfactory anatomical relationships when children have stents placed in the left mainstem bronchus alone do not guarantee the final success. Several mechanisms intervene to cause critical stent-related complications in children during growth. Permanent metallic stents should be used carefully, and only in selected patients.

Effects of icariin on asthma mouse model are associated with regulation of prostaglandin D2 level

BackgroundWe aimed to observe the effect of icariin on an asthma mouse model and explore the potential underlying mechanisms. MethodsThe asthma mouse model was established by ovalbumin (OVA) sensitisation and respiratory syncytial virus (RSV) infection and then treated with icariin. Airway resistance was assessed by whole body plethysmograph. In addition, pathological slides were stained with haematoxylin–eosin, and the peribronchial inflammation was observed microscopically. The concentration of prostaglandin D2 (PGD2) in serum and bronchoalveolar lavage fluid (BALF) was detected by enzyme-linked immuno sorbent assay (ELISA). The relative level of prostaglandin D2 receptor 2 (CRTH2) mRNA was assessed by real-time quantitative PCR. ResultsCompared with the icariin-untreated group, there was a significant reduction of Penh in the treated group. Total leucocyte amount and all sorts of leukocytes were lower in the treated group than in the untreated group. HE staining results revealed that a large number of inflammatory cells infiltrated into the peribronchial tissues of untreated group, and the degree of airway inflammation decreased significantly in the treated group. PGD2 in serum and BALF, as well as CRTH2 mRNA level in lung tissues were lower in the treated group than in the untreated group. ConclusionIcariin is a promising therapeutic strategy for asthma, and PGD2 might be a new target for asthma therapy in OVA-induced and RSV-infected asthma model.

Effect of high laser output on the central bronchi and pulmonary artery.

A diode-pump Nd:YAG high-power laser (wavelength 1320nm, power 100W) is routinely used to surgically remove lung metastases. Even pulmonary lesions in central locations are resectable via this method, yet it also carries a potential risk of damaging the larger bronchi and vessels in the vicinity. Studies investigating the safety of using high-power lasers are lacking. We therefore aimed to examine the direct effects of a 100-watt laser on the bronchi and pulmonary artery at a standard working velocity. From freshly slaughtered pigs, we isolated cylindrical specimens of the trachea, the main and lobar bronchi, and the central pulmonary artery from the both lungs. These specimens were fixed consecutively in rows behind each other on a Styrofoam surface in the laboratory. The laser's handle was clamped into a hydraulic feed unit so that the laser was focused at constant distance perpendicular to the tissue and would move at 10mm/s over the specimens. The Nd:YAG Laser LIMAX® 120 functioned at a consistent power of 100W during all the experiments. The lasered specimens were examined macroscopically and histologically for tissue damage. None of the trachea or bronchial walls were perforated. Compared to the pulmonary parenchyma, we observed no vaporization effects-only minor superficial coagulation (with a mean depth of 2.1 ± 0.8mm). This finding was histologically confirmed in each specimen, which revealed mild superficial coagulation and no damage to the cartilage. In the presence of a residual peribronchial fatty tissue, the laser effect was even attenuated. The pulmonary arteries presented no lumen openings whatsoever, merely a discrete trace of coagulation. The vessel wall revealed increased vacuolization without alteration of the remaining vessel wall. In conclusion, laser resection at 100W of the central lung areas is safe with respect to airways and blood vessels and the laser output does not need to be reduced when treating these areas.

МОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ В ТКАНИ ЛЕГКИХ КРЫС ПРИ ДЕЙСТВИИ РАДИОТОКСИЧЕСКИХ ФАКТОРОВ В ЭКСПЕРИМЕНТЕ

The study shows morphological features in the lung tissue of rats found after inhalation of dust ofuranium ore. Destructive changes have been detected, both at the cellular and subcellular levels.Theeffect of radio-toxic factors at a dose of 50 MPC was accompanied by the development of acute focalserous inflammation in the wall of small bronchi and in the lung parenchyma in the early stages of theexperiment, fibrosis of pneumonic foci and development of pronounced sclerotic changes in peribronchial tissue for 30 days. The increase in sclerotic changes in the bronchial wall was accompanied by thesuppression of the reaction from the interstitial macrophages and bronchial associated lymphoid tissue,indicating that on the intense flow of compensatory processes.The electron microscopic studies confirmed the results obtained with light microscopy. Under theinfluence on animals with PUR at a dose of 50 MPC, destructive changes in the alveolar epithelium predominated from the early stages of the experiment. From 30 days up to 60 days marked development ofsevere fibrosis with a decrease in the respiratory surface. Compensatory reactions characterized by highdegree of voltage in the form of regeneration A1, endothelial hypertrophy, high phagocytic activity ofalveolar macrophages.Key words: dust of uranium ore, radio nuclides, lung disease.

FDG uptake at the bronchial stump after curative lobectomy for non-small cell lung cancer.

Focal areas of FDG uptake may occur at the bronchial stump following curative lobectomy for non-small-cell lung carcinoma (NSCLC), even in the absence of suspicious CT changes. The purpose of our study was to investigate the significance of such PET/CT findings. FDG-PET/CT scans performed in 54 patients after lobectomy for NSCLC were reviewed. The presence of focal areas of FDG uptake at the bronchial stump, associated CT abnormalities, SUVmax, and normalized SUV (SUVnorm = SUVmax/mean liver SUV) were recorded. Final diagnosis was based on biopsy or imaging follow-up. Focal areas of FDG uptake at the bronchial stump were detected in 30 patients (56 %). Mean SUVmax was 4.0 ± 1.9 (range; 2.2-12.1) and mean SUVnorm was 1.8 ± 0.8 (range; 0.9-4.5). Biopsy showed recurrence in two patients. In these patients, SUVnorm was respectively 4.4 and 4.5 (with SUVmax of 8.8 and 12.1), whereas SUVnorm was lower than 4.0 in those without recurrence, with mean SUVnorm of 1.6 ± 0.5 (range; 0.9-3.4) and mean SUVmax of 3.6 ± 0.9 (range; 2.2-5.8). The CT component of the PET/CT revealed ill-defined peribronchial soft tissue opacity only in both patients with recurrence. FDG uptake at the bronchial stump is a frequent finding after pulmonary lobectomy. Moderate levels of FDG uptake (i.e., SUVnorm < 4.0) without corresponding abnormal CT findings might be a dual criterion for diagnosing benign post-surgical changes.

An Inorganic Habit

SESSION TITLE: Pulmonary Vascular Disease Case Report Posters SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM INTRODUCTION: Intravenous drug abuse (IVDA) of crushed oral tablets can lead to microvascular thromboembolism of microcrystalline cellulose1, an undegradable excipient of pharmaceutical tablets2, with angiogranulomatous reaction2, centrilobular nodules2, and pulmonary hypertension3. CASE PRESENTATION: A 53 year old female inorganic chemistry professor with aerosolized aluminum oxide and silicone oxide exposures, right total knee replacement complicated by pulmonary embolism (PE), and multiple prosthetic joint infections requiring incision and drainage with prolonged intravenous antibiotics via tunneled line was admitted with respiratory failure. B Type Natriuretic Peptide was elevated. Computed tomography pulmonary angiography demonstrated diffuse centrilobular micronodules and no acute embolus. Lung biopsy showed peribronchial tissue with multiple foci of foreign body giant cell reaction and various forms of polarizable crystalline material predominantly intravenously. Bronchoalveolar lavage contained small white particles. Echocardiogram showed pulmonary artery systolic pressure 77mmHg. Hypoxia resolved with supportive measures. A later right heart catheterization and repeat echo was normal. Few weeks later, she suffered a cardiac arrest. Autopsy demonstrated polarizable foreign material that stained positive with grocott's methenamine silver and congo red, and weakly positive with PAS, consistent with microcrystalline cellulose, in small and large pulmonary vasculature diffusely with associated giant cell reaction and thrombus formation. These findings were consistent with hematogenous route of dispersion. The foreign material didn't match the knee replacement material. DISCUSSION: Without pathology, microcrystalline cellulose embolism from IVDA can be difficult to diagnose due to nonspecific clinical and radiographic findings. CONCLUSIONS: High index of suspicion is needed for the diagnosis of microvascular embolism of foreign material from IVDA of crushed pharmaceutical drugs as an etiology of transient pulmonary hypertension3, PE3, and centrilobular nodules2 as it can induce potentially fatal angiogranulomatous reaction2. Reference #1: Fields TA, etal. Pulmonaryembolization ofmicrocrystallinecellulose in alungtransplantrecipient. J Heart Lung Transplant.2005;24(5):624-627. Reference #2: Nguyen VT, etal. Pulmonaryeffectsof i.v. injectionof crushedoraltablets: “Excipient lungdisease”. AJR Am J Roentgenol.2014;203(5):W506-15. Reference #3: Houck RJ, etal. Pentazocineabuse. Reportof a casewith pulmonaryarterialcellulosegranulomas and pulmonaryhypertension. Chest.1980;77(2):227-230. DISCLOSURE: The following authors have nothing to disclose: Sahar Mansoor, Margaret DiGuardo, Michael Waisberg, Robin LeGallo, Mark Stoler, Howard Malpass No Product/Research Disclosure Information

IL-17A, but not IL-17F, is indispensable for airway vascular remodeling induced by exaggerated Th17 cell responses in prolonged ovalbumin-challenged mice.

We previously demonstrated an essential role of Th17 cells in excessive mucous secretion and airway smooth muscle proliferation in a prolonged OVA-challenged C57BL/6 mouse model. However, the impact of Th17 cells in vascular remodeling, another characteristic feature of airway remodeling in asthma, remains elusive. This issue was further investigated in this study. The time-course experiments showed that progressively increasing levels of Th17 cells and IL-17A (not IL-17F) in the lungs of prolonged allergen-challenged mice were positively correlated with microvessel density in peribronchial tissues. In addition, exaggerated airway vascular remodeling in this mouse model was exacerbated by airway administration of IL-17A or adoptive transfer of Th17 cells. This effect was dramatically alleviated by the administration of anti-IL-17A Ab, but not anti-IL-17F Ab. Boyden chamber assays indicated that IL-17A accelerates endothelial progenitor cell (EPC) migration. Furthermore, EPC accumulation in the airways of allergen-exposed mice after adoptive transfer of Th17 cells was eliminated by blockade of IL-17A. We found that IL-17A promoted tubule-like formation rather than proliferation of pulmonary microvascular endothelia cells (PMVECs) in vitro. In addition, IL-17A induced PMVEC tube formation via the PI3K/AKT1 pathway, and suppression of the PI3K pathway markedly reduced the formation of tubule-like structures. Collectively, our results indicate that Th17 cells contribute to the airway vascular remodeling in asthma by mediating EPC chemotaxis, as well as PMVEC tube formation, via IL-17A rather than IL-17F.

Imaging Findings of Isolated Bronchial Anthracofibrosis: A Computed Tomography Analysis of Patients With Bronchoscopic and Histologic Confirmation

BackgroundTo evaluate the chest computed tomography (CT) findings of patients with isolated bronchial anthracofibrosis confirmed by bronchoscopy and histopathology. MethodologyFifty-eight patients with isolated bronchial anthracofibrosis (29 females; mean age, 70 years) were enrolled in this study. The diagnosis of bronchial anthracofibrosis was made based on both bronchoscopy and pathology findings in all patients. The various chest CT images were retrospectively reviewed by two chest radiologists who reached decisions in consensus. ResultsCentral peribronchial soft tissue thickening (n=37, 63.8%) causing bronchial narrowing (n=37, 63.8%) or obstruction (n=11, 19%) was identified as an important finding on imaging. Multiple bronchial stenoses with concurrent involvement of 2, 3, and 5 bronchi were seen in 12 (21%), 9 (15%), and 2 (3.4%) patients, respectively. Segmental atelectasis and lobar or multilobar collapse were detected. These findings mostly occurred in the right lung, predominantly in the right middle lobe. Mosaic attenuation patterns, scattered parenchymal nodules, nodular patterns, and calcified or non-calcified lymph nodes were also observed. ConclusionsOn chest CT, isolated bronchial anthracofibrosis appeared as peribronchial soft tissue thickening, bronchial narrowing or obstruction, segmental atelectasis, and lobar or multilobar collapse. The findings were more common in the right side, with simultaneous involvement of multiple bronchi in some patients.

Regulation of Th17/Treg function contributes to the attenuation of chronic airway inflammation by icariin in ovalbumin-induced murine asthma model

Icariin which is a flavonoid glucoside isolated from Epimedium brevicornu Maxim, has been reported to have anti-osteoporotic, anti-inflammatory and anti-depressant-like activities. In this study, we observed the effect of icariin on airway inflammation of ovalbumin (OVA)-induced murine asthma model and the associated regulatory mode on T-helper (Th)17 and regulatory T (Treg) cell function. Our data revealed that chronic OVA inhalation induced a dramatic increase in airway resistance (RL) and decrease in the lung dynamic compliance (Cdyn), and icariin and DEX treatment caused significant attenuation of such airway hyperresponsiveness (AHR). BALF cell counts demonstrated that icariin and DEX led to a prominent reduction in total leukocyte as well as lymphocyte, eosinophil, neutrophil, basophil and monocyte counts. Histological analysis results indicated that icariin and DEX alleviated the inflammatory cells infiltrating into the peribronchial tissues and goblet cells hyperplasia and mucus hyper-production. Flow cytometry test demonstrated that icariin or DEX administration resulted in a significant percentage reduction in CD4+RORγt+ T cells and elevation of CD4+Foxp3+ T cells in BALF. Furthermore, icariin or DEX caused a significant reduction in IL-6, IL-17 and TGF-β level in BALF. Unfortunately, icariin had no effect on IL-10 level in BALF. Western blot assay found that icariin or DEX suppressed RORγt and promoted Foxp3 expression in the lung tissue. qPCR analysis revealed that icariin and DEX resulted in a notable decrease in RORγt and increase in Foxp3 mRNA expression in isolated spleen CD4+ T cell. In conclusion, our results suggested that icariin was effective in the attenuation of AHR and chronic airway inflammatory changes in OVA-induced murine asthma model, and this effect was associated with regulation of Th17/Treg responses, which indicated that icariin may be used as a potential therapeutic method to treat asthma with Th17/Treg imbalance phenotype.

AcCystatin, an immunoregulatory molecule from Angiostrongylus cantonensis, ameliorates the asthmatic response in an aluminium hydroxide/ovalbumin-induced rat model of asthma.

Epidemiological surveys have demonstrated that helminth infections are negatively related to atopic diseases, including asthma. Defining and characterising specific helminth molecules that have excellent immunomodulatory capacities as potential therapeutics for the treatment or prophylaxis of allergic manifestations are of great interest. AcCystatin, a cystatin protease inhibitor of Angiostrongylus cantonensis, is a homologue of other nematode cystatins with immunoregulatory properties. Here, we aim to determine the effects of AcCystatin on an ovalbumin/aluminium hydroxide (OVA/Al[OH]3)-induced rat model of asthma. Wistar rats were randomly divided into four groups, including a control group, an OVA/Al[OH]3-induced asthma group, a group receiving AcCystatin immunisation prior to OVA/Al[OH]3-induced asthma and a group receiving AcCystatin treatment after OVA/Al[OH]3-induced asthma. The numbers of eosinophils, basophils, neutrophils, lymphocytes and monocytes in the peripheral blood and of eosinophils in the bronchoalveolar lavage fluid (BALF) were counted for each animal. The expression levels of the cytokines interferon-γ, interleukin (IL) 4, IL-5, IL-6, IL-10, IL17A and tumour necrosis factor receptor-α in BALF, of OVA-specific immunoglobulin E in BALF and serum and of the chemokines eotaxin-1, eotaxin-2, eotaxin-3, MCP-1 and MCP-3 in lung tissue were measured. In addition, the degree of peribronchial and perivascular inflammation and the intensity of goblet cell metaplasia were qualitatively evaluated. The sensitised/challenged rats developed an extensive cell inflammatory response of the airways. AcCystatin administration significantly reduced the cellular infiltrate in the perivascular and peribronchial lung tissues and reduced both goblet mucous production and eosinophil infiltration. The rats that were treated with AcCystatin before or after sensitisation with OVA showed significant decreases in eotaxin-1, eotaxin-3 and MCP-1 expression in the lung tissue. The production of IL-4, IL-5, IL-6 and IL-17A and of OVA-specific IgE antibodies was also significantly reduced in AcCystatin-treated rats compared with untreated asthmatic rats. The AcCystatin treatment was associated with a significant increase in IL-10 levels. Our present findings provide the first demonstration that AcCystatin is an effective agent in the prevention and treatment of the airway inflammation associated with asthma.

Diagnóstico por la imagen de la antracofibrosis bronquial aislada: un análisis de tomografía computarizada de pacientes con confirmación broncoscópica e histológica

BackgroundTo evaluate the chest computed tomography (CT) findings of patients with isolated bronchial anthracofibrosis confirmed by bronchoscopy and histopathology. MethodologyFifty-eight patients with isolated bronchial anthracofibrosis (29 females; mean age, 70 years) were enrolled in this study. The diagnosis of bronchial anthracofibrosis was made based on both bronchoscopy and pathology findings in all patients. The various chest CT images were retrospectively reviewed by two chest radiologists who reached decisions in consensus. ResultsCentral peribronchial soft tissue thickening (n=37, 63.8%) causing bronchial narrowing (n=37, 63.8%) or obstruction (n=11, 19%) was identified as an important finding on imaging. Multiple bronchial stenoses with concurrent involvement of 2, 3, and 5 bronchi were seen in 12 (21%), 9 (15%), and 2 (3.4%) patients, respectively. Segmental atelectasis and lobar or multilobar collapse were detected. These findings mostly occurred in the right lung, predominantly in the right middle lobe. Mosaic attenuation patterns, scattered parenchymal nodules, nodular patterns, and calcified or non-calcified lymph nodes were also observed. ConclusionsOn chest CT, isolated bronchial anthracofibrosis appeared as peribronchial soft tissue thickening, bronchial narrowing or obstruction, segmental atelectasis, and lobar or multilobar collapse. The findings were more common in the right side, with simultaneous involvement of multiple bronchi in some patients.

Clinical and characteristic features of surgically treated endobronchial hamartoma cases: analysis of twenty-two cases.

Endobronchial hamartomas are tumors originating from peribronchial mesenchymal tissues. Generally, endobronchial methods are used in the treatment of these tumors, which are usually benign. Surgery is used in cases of endobronchial hamartoma that cannot be fully treated with endobronchial methods, or that developed parenchyma destruction due to bronchial obstruction. The objective of this study is to assess clinical and characteristic features of surgically treated cases of endobronchial hamartoma. Twenty-two patients who underwent anatomic resection between 1988 and 2011 in our clinic were diagnosed with hamartoma. Clinical and characteristic features of these patients (17 males and 5 females) were assessed retrospectively via patient records. Patients were aged between 43 and 72 (average 54.4). Fifteen patients underwent lobectomy (lobectomy for 13 patients, bilobectomy for 1), 6 patients underwent bronchotomy, 1 patient underwent tracheotomy and 1 underwent pneumonectomy. Pathologic diagnosis was chondromatosis hamartoma for 9 patients and lipomatosis hamartoma for 6 patients; dominant cell type was not detected for 7 patients. No surgery-related mortality was observed. No recurrence was observed for patients after the surgery. Endoscopic treatment methods yield successful results in endobronchial hamartomas. However, surgery is required in cases that develop irreversible parenchymal destruction due to chronic obstruction and suppuration, or those that cannot be treated via endobronchial methods.

Endobronchial Actinomycosis After Airway Stenting

Actinomycosis is a chronic suppurative infection with filamentous, gram-positive, nonspore forming anaerobic bacteria of the genus Actinomyces. Actinomyces species are commensals of the human oropharynx, gastrointestinal tract, and female genitalia. Involvement of the thorax accounts for 15% to 20% of actinomycosis cases. Thoracic actinomycosis classically presents as an intrapulmonary infection of the alveoli, peribronchial tissue, and/or bronchioles. Endobronchial actinomycosis is a rare condition that has been reported in association with aspiration of a foreign body or broncholithiasis. A critical component in the pathogenesis is disruption of the mucosal barrier, thereby allowing invasion of the microorganisms from aspirated oropharyngeal secretions. Even with a high clinical suspicion, actinomycosis is a diagnostic challenge. The most common symptoms of endobronchial actinomycosis include cough, sputum production, and fever. The disease is often confused with lung cancer, tuberculosis, fungal infections, nocardiosis, and poorly responding pneumonia. The present case highlights the first reported case of endobronchial actinomycosis associated with a covered nitinol endobronchial stent.