Pulmonary Hemorrhage Research Articles

Leptospirosis manifested with severe pulmonary hemorrhagic syndrome successfully treated with veno-venous extracorporeal membrane oxygenation: A case report and literature review.

The mortality rate associated with pulmonary hemorrhage induced by leptospirosis is notably high. Available treatment modalities are limited, and their efficacy has not been fully demonstrated. Here, we present the case report of a patient with leptospirosis-induced pulmonary hemorrhagic syndrome. A 49-year-old male patient was admitted to the Surgical Ward of the Department of Intensive Care Medicine of Fuyang Infectious Disease Clinical College of Anhui Medical University. The patient had initially sought medical attention at a local hospital due to symptoms of fever persisting for 4 days and chest tightness accompanied by hemoptysis for 1 day. We present the case report of a patient with leptospirosis-induced pulmonary hemorrhagic syndrome. Hemoptysis persisted in our patient during VV-ECMO, although we adjusted the heparin regimen to maintain an activated partial thromboplastin time target value of 50 to 55 seconds. Leptospirosis-induced pulmonary hemorrhagic syndrome. He was immediately intubated and mechanically ventilated and then transferred to our hospital for further medical intervention. Upon arrival at our hospital, he was treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO). Consequently, he was administered penicillin and omacycline for anti-infective therapy. Anti-inflammatory agents, high-dose vasoactive drugs to enhance blood pressure, continuous renal replacement therapy, tracheal sputum aspiration, and ventilator-assisted ventilation were also administered as part of the treatment protocol. After treatment, his inflammation index was significantly decreased, the amount of pulmonary bleeding was reduced, his oxygenation ratio was improved, and the pulmonary lesions were absorbed. Consequently, he was discharged on the 34th day of hospitalization. We successfully treated a case of leptospirosis pulmonary hemorrhagic syndrome using VV-ECMO combined with prudent anticoagulant therapy.

Pulmonary metastases and bleeding in the anticoagulated oncology patient with thrombosis: is the risk solely influenced by the location of distant disease?

Pulmonary metastases and bleeding in the anticoagulated oncology patient with thrombosis: is the risk solely influenced by the location of distant disease?

Pulmonary Hemorrhage Management Practices in Extremely Preterm Infants: A Global Survey

Pulmonary Hemorrhage Management Practices in Extremely Preterm Infants: A Global Survey

A case of glucocorticoid-refractory IgA vasculitis with diffuse alveolar hemorrhage: a therapeutic strategy for aberrant immunoglobulin depletion.

Diffuse alveolar hemorrhage (DAH) is a rare and severe complication of IgA vasculitis (IgAV). Although glucocorticoids and immunosuppressive agents are used for its treatment, there is no consensus on the optimal form of treatment. We herein report the case of a 53-year-old, female patient with IgAV. She was initially resistant to glucocorticoid therapy and experienced acute respiratory failure due to DAH but responded well to rituximab (RTX) and plasma exchange (PLEX). While some previous case reports have suggested that RTX or PLEX can be effective for severe IgAV, there are no reports of a combination of RTX and PLEX being used successfully to treat IgAV-associated DAH. In the model of IgAV pathogenesis proposed herein, aberrant IgA1 and IgA-specific IgG autoantibodies play a pivotal role. PLEX may facilitate the prompt removal of these circulating, aberrant immunoglobulins while RTX inhibits their further production. Consequently, a combination of RTX and PLEX may represent an effective treatment approach for severe glucocorticoid-refractory cases of IgAV.

Sequential pulmonary functions in survivors of leptospirosis pulmonary haemorrhage syndrome: a prospective cohort study

BackgroundLeptospirosis, a spirochaete infection, can lead to Leptospirosis Pulmonary Haemorrhage Syndrome (LPHS), which requires intensive care admission and has a high mortality. Although data on short-term outcomes are available, the long-term respiratory sequelae of LPHS survivors are not known. We aimed to identify the post-discharge pulmonary functions and functional limitations in survivors of LPHS.MethodsWe conducted a prospective cohort study from January to December 2022 at the Medical Intensive Care Unit (ICU) of the National Hospital of Sri Lanka to assess the sequential changes in the spirometry parameters in patients who survived LPHS. The Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) were measured on the day of discharge from the ICU (D0), 7th day after discharge (D7) and 28th day after discharge (D28). The predicted lung volume was calculated using the gender, age and height as per standard protocol. Physical and functional role limitations were assessed on D28 using the modified Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36).ResultsTwenty-one patients with a mean age of 44 years (SD 16.07) were enrolled for the study. The majority were male patients (n = 19, 90.5%). Leptospirosis was serologically confirmed in all individuals. Seventeen (81%) patients had reduced FEV1 and FVC on D0, indicating a restrictive lung abnormality. FVC and FEV1 improved during the first 7 days (p < 0.01) but did not change significantly afterwards. Only seven individuals (33.3%) achieved a normal FVC (exceeding 80% of the predicted volume) at D28. However, 19 (90.5%) individuals achieved a normal FEV1 (exceeding 80% of predicted volume) by D28. In our study, administering corticosteroids during ICU stay did not impact lung recovery in FVC (p = 0.521) or FEV1 (p = 0.798). The participants did not have significant physical, functional, and role limitations at D28.ConclusionsThe spirometry measurements of individuals diagnosed with LPHS significantly improved during the first 7 days. Most survivors did not have a functional impairment despite the FVC not recovering to normal by D28.

Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia

Background: The objective of this study was to evaluate demographic characteristics, clinical presentation, laboratory findings, treatments, and their impact on the outcome of systemic lupus erythematosus (SLE)-related diffuse alveolar hemorrhage (DAH) in our local setting. Methods: A total of seven patients were selected from our hospital’s local SLE database between 2013 and 2024 based on the inclusion criteria. Various variables were captured and analyzed using the Mann-Whitney [Formula: see text] test or Fisher’s exact test for comparison where appropriate. Results: All seven patients were female, with a median age of 26 years, and the median duration of SLE before DAH was 3 months. More than half were presented with all three symptoms: fever (57%), dyspnea (71.4%), and hemoptysis (85.7%). Kidney involvement was present in all cases. All patients received methylprednisolone as initial treatment with 71.4% subsequently received plasmapheresis, 57% received cyclophosphamide, 28.6% received intravenous immunoglobulin, and 14.3% received rituximab. Five out of the seven patients required invasive mechanical ventilation. The mortality rate was 57%. Two out of three survivors received a combination of multiple immunosuppressive agents. Non-survivors had significantly higher acute physiology and chronic health evaluation II (APACHE II) scores ([Formula: see text] = 0.034), while other variables were not statistically linked to mortality. In spite of that, all patients with nosocomial infection did not survive. Conclusion: Our observational study showed that a higher APACHE-II score was associated with a higher mortality rate. The efficacy of these treatment modalities cannot be conclusively determined due to the small sample size of this study. However, a combination of multiple immunosuppressive agents appeared to be associated with better outcomes in some patients.

Clinical features, radiological findings and prognosis of microscopic polyangiitis with interstitial lung disease: a retrospective matched control study

BackgroundThe association between interstitial lung disease (ILD) and microscopic polyangiitis (MPA) has received increasing attention in recent years. However, there are still no studies comparing clinical characteristics and prognoses between MPA-ILD patients and patients with ANCA-negative ILDs. Therefore, the purpose of this study was to analyse a group of patients presenting MPA-ILD matched with patients exhibiting ANCA-negative ILDs to identify differences in their clinical characteristics and survival.MethodsThis study retrospectively reviewed the data of 60 patients with MPA-ILD and 60 patients with ANCA-negative ILDs who were matched for age, sex, and patterns on chest high-resolution CT (HRCT) images. The baseline clinical information, laboratory parameters and chest CT data were collected and analysed at each patient’s initial diagnosis.ResultsSixty of the 682 (8.8%) ILD patients were diagnosed with MPA-ILD. MPA-ILD patients tended to be older and have higher CRP and ESR levels. ILD antedated MPA in 61.7% (37/60) of the patients, and MPA occurred on average (45.1 ± 33.4) months after the ILD diagnosis. Compared with matched ANCA-negative ILD patients, MPA-ILD patients had higher CRP and serum creatinine levels and lower haemoglobin levels. UIP (63.3%) was the most common chest HRCT pattern, and the proportion of patients with oddly shaped cysts (P = 0.04) was significantly greater in the MPA-ILD group than in the matched ANCA-negative ILD group. The number of MPA-ILD patients was significantly shorter than that of ANCA-negative ILD patients (P = 0.005). Survival analysis revealed that acute exacerbation (AE) of ILD (HR 2.40, 95% CI 1.03–5.59, P = 0.043) and diffuse alveolar haemorrhage (HR 3.42, 95% CI 1.09–10.73, P = 0.036) were independently associated with shorter survival and that receiving glucocorticoids combined with immunosuppressants (HR 0.11, 95% CI 0.03–0.37, P < 0.001) was independently associated with prolonged survival in MPA-ILD patients.ConclusionsThe proportion of MPA-ILD patients with total ILD is not low, and ANCA testing of ILD patients is necessary. Oddly shaped cysts with a UIP pattern may be a characteristic chest imaging manifestation of MPA-ILD. The prognosis of MPA-ILD is poor, especially for patients who are older, have DAH, and have experienced AEs.

Equine Asthma Diagnostics: Review of Influencing Factors and Difficulties in Diagnosing Subclinical Disease

This literature review focuses on diagnostics of equine asthma (EA), possible influencing factors on diagnostic techniques and latest developments in diagnosing horses during EA remission or with subclinical disease. Routine EA diagnostics include a clinical examination of the respiratory system with percussion and auscultation including a rebreathing examination, and clinical pathology including white blood cells and arterial blood gas analysis. Subsequent diagnostics include bronchoscopy to evaluate the amount and viscosity of respiratory secretion, bronchoalveolar lavage, and the cytology of tracheal aspirates (TAs) and bronchoalveolar lavage fluid (BALF). The grading of EA severity is built on respiratory effort at rest, which is increased in severe equine asthma. The inflammatory subtype is based on BALF cytology, while TA cytology helps to rule out previous bacterial infections. Different factors have an impact on the airways regarding the structure of the epithelium, cytology, and inflammatory markers possibly influencing the diagnosis of EA. Short-term exercise increases the total cell count and inflammatory mediators identified in the BALF of human patients, asymptomatic horses, and other species. Other factors involve cold or chlorinated air, long-term training effects, and concurrent additional respiratory disease, in particular exercise-induced pulmonary hemorrhage. As BALF cytology may be unremarkable during EA remission and low-grade disease, exercise tests and other factors stressing the bronchial epithelium may help to diagnose these patients.

Advances in the study of nebulized tranexamic acid for pulmonary hemorrhage.

Pulmonary hemorrhage is a life-threatening condition characterized by blood leakage into lung tissues, leading to severe respiratory distress. Nebulized tranexamic acid (TXA) has emerged as a promising treatment option for pulmonary hemorrhage due to its localized hemostatic effects and minimal systemic side effects. This review aims to summarize the research progress on the effectiveness and safety of nebulized TXA in pulmonary hemorrhage. A comprehensive search of the Embase, PubMed, and Scopus databases was conducted to identify relevant studies published between the date of inception of each database and November 2023. A comprehensive search was conducted in the PubMed, Embase, Scopus, and Google Scholar databases using the following keywords: "hemoptysis," "haemoptysis," "pulmonary hemorrhage," "tranexamic acid," "antifibrinolytic," "nebulize," and "inhale." Additional articles were identified by reviewing the references of the retrieved studies. Studies were selected based on their focus on the application of nebulized TXA for pulmonary hemorrhage. The authors and dates of publication, study type, patients, diseases, intervention and main outcomes of these papers are tabulated. This consisted of two randomized controlled trials (RCTs), six case series, and nine case reports. The commonly used dosage of nebulized TXA in the studies reviewed was 500mg/5ml, administered 3-4 times daily. Evidence suggests that nebulized TXA effectively controls bleeding in pulmonary hemorrhage with a hemostatic efficacy comparable to systemic administration, but with a lower risk of venous thrombosis. Safety data indicates that nebulized TXA is generally well-tolerated, with no significant systemic adverse reactions reported. Local reactions, such as bronchospasm, were rare and resolved with short-term bronchodilator treatment. Nebulized TXA appears to be an innovative and minimally invasive therapy for pulmonary hemorrhage, providing targeted hemostatic effects with a favorable safety profile. However, the predominance of small-scale studies and case reports highlights the need for large-scale, high-quality research to establish standardized guidelines.

Emergency thoracotomy of chest trauma: A cohort of 30 case series

Background: Chest trauma is one of the leading causes of death in all age groups and accounts for 25–50% of all traumatic injuries. A small but significant proportion of individuals with thoracic injuries need an emergency thoracotomy (ET) during their primary resuscitation, although the majority can be managed conservatively. Surgical intervention has been recommended for the withdrawal of pericardial tamponade, control of large air leaks, open cardiac massage, direct management of pulmonary hemorrhage, and cross-clamping of the thoracic aorta. Thoracotomy can be used to define emergency thoracotomies. The aim of the study was to evaluate the demographic characteristics and outcomes of ET for chest trauma. The study also examined the indications for ET and the outcomes of mortality and prognosis in chest trauma patients who underwent ET in the operating room. Methodology: A cross-sectional study was conducted on 30 patients who were randomly chosen and admitted to Al-Imamain Al-Kadhymain Teaching Hospital between March 2022 and March 2023. Results: The mean age of the sample population was 31.1 years. Males made up 21 (70%) of the sample, while females made up 9 (30%). There were 22 penetrating chest injuries (73.3%), compared with 8 blunt chest injuries (26.7%): 26 (86.7%) were alive, while 4 (13.3%) were dead. Conclusion: The need for an ET to save the life of a trauma patient must be made better known. Patient delays in transport to the hospital play a crucial role in saving the lives of trauma victims. We must provide the emergency department with all the necessary equipment to perform an urgent thoracotomy.

Liver failure after Bacillus cereus food poisoning, an under-recognized entity: A case report

BACKGROUND Bacillus cereus (B. cereus ) is known to cause 2 types of foodborne diseases; the diarrheal and emetic syndromes. They are largely underreported due to their usually self-limiting course. Rare and sometimes fatal cases of liver failure, pulmonary hemorrhage and cerebral oedema have been reported mainly in children and young adults. We present here a case of liver failure associated with B. cereus food poisoning in a middle-aged patient. CASE SUMMARY A 48-year-old female patient presented to the emergency department for emesis, diarrhea, chills without fever, asthenia and diffuse abdominal cramps that started less than 30 minutes after eating a rice salad. Her past medical history was relevant for cholecystectomy and a cured Hashimoto’s disease. She did not take any medication, drugs and declared a consumption of one glass of wine per week. In the emergency department, she was treated with acetaminophen, metoclopramide, ondansetron, and an intravenous normal saline infusion. Blood gas analysis revealed a metabolic acidosis with hyperlactatemia, coagulation revealed a low prothrombin activity [32 %; normal values (N): 70-140] and a low Factor V activity (15%; N: &gt; 70). Transaminases were elevated with hyperbilirubinemia, elevated lipase and rhabdomyolysis. N-acetylcysteine treatment was introduced. Abdominal echography revealed no signs of chronic hepatopathy or hepatomegaly. Day after the admission, psychomotor activity improved, transaminases and lipase started decreasing. Rhabdomyolysis gradually worsened to peak on day 3. Screening tests for liver disease were negative for viral and autoimmune cause of liver failure. Stools cultures were positive for colonies of the B. cereus group which were also identified in the rice salad samples processed whereas blood cultures were negative. The patient’s condition improved gradually including her liver function parameters and psychomotor activity which allowed her discharged home on day 9. CONCLUSION We describe a rare case of hepatocellular dysfunction due to a foodborne B. cereus intoxication in an adult patient. Even if it is uncommon, the severity of liver dysfunction reported and mechanism of the cereulide toxin toxicity on liver suggest that acetaminophen should be avoided in case of a foodborne intoxication and n-acetylcysteine could be a potential therapy helping to prevent hepatocytes necrosis due to the oxidative stress induced by mitochondrial dysfunction.

Sex-specific NLRP3 activation in neutrophils promotes neutrophil recruitment and NETosis in the murine model of diffuse alveolar hemorrhage.

Diffuse alveolar hemorrhage (DAH) is a life-threatening complication of systemic lupus erythematosus and small vessel vasculitis. We previously showed that neutrophil extracellular traps (NETs) were associated with the pathogenesis of pristane-induced DAH and demonstrated that neutrophil NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome assembly participated in NET generation under sterile stimulation. We investigated whether NLRP3 inflammasome assembly in neutrophils may drive pulmonary NETosis in a mouse model of pristane-induced DAH. C57BL/6J mice received a single intraperitoneal injection of 0.5mL of pristane. Neutrophil NLRP3 inflammasome assembly and NETs were characterized by immunofluorescence staining of apoptosis-associated speck-like protein a CARD (ASC), co-staining of DNA, and citrullinated histones, respectively. Clinical status of mice was assessed 11 days after pristane injection by measurement of arterial oxygen saturation and of weight loss; severity of lung injury was determined using a quantification score from hematoxylin-eosin-stained slides. Pristane induced ASC speck formation in neutrophils and we confirmed that NLRP3 inflammasome was involved in NET generation after pristane stimulation in vitro. NLRP3 deficiency reduced the severity of pristane-induced DAH in female, but not male mice. Interestingly, NLRP3 deficiency reduced the number of neutrophils and NETs in the lungs of females compared to males. Our results suggest a link between female sex-specific NLRP3 inflammasome activation and subsequent pulmonary NETosis in the development of pristane-induced DAH. Therefore, we identified NLRP3 inflammasome as a potential new therapeutic target in this severe complication of pro-female autoimmune disease for which specific inhibitors of NLRP3 are currently developed.

Safety concerns of aztreonam: a real-world disproportionality analysis based on FDA Adverse Event Reporting System

ABSTRACT Background Aztreonam was approved by the FDA for treating Gram-negative infections, including metallo-β-lactamase producers. This study extensively evaluated aztreonam-related adverse events (AEs) from the FDA Adverse Event Reporting System (FAERS) database for a better understanding of toxicities. Methods The signals of aztreonam-related AEs were quantified using disproportionality analyses, like reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker algorithms. Results Among the 18,182,912 records retrieved from the FAERS 11,627 cases were identified where aztreonam was the primary suspect drug. A total of 127 preferred terms with significant disproportionality that simultaneously met the criteria of all algorithms were retained. Unexpected safety signals such as cholestatic liver injury, hypoprothrombinemia, hemoptysis, pulmonary hemorrhage, drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis and so on may also manifest in adults, particularly in elderly patients. The median onset time for AEs related to intravenous aztreonam was 4 days, compared to a year after the initiation of inhaled aztreonam. Conclusions Our study identified potential new adverse event signals and offered a thorough understanding of aztreonam’s safety profiles. This information is crucial for enhanced cliggnical monitoring and risk assessment, aiding healthcare professionals in tailoring their approach.

Is therapeutic plasma exchange effective in leptospirosis-associated severe pulmonary haemorrhagic syndrome? A systematic review.

Leptospirosis is a re-emerging zoonosis fast becoming a global burden. Pulmonary haemorrhages are a deadly complication, with case fatality rates >50%. Systemic vasculitis is thought to be the pathological process responsible for pulmonary haemorrhages and therapeutic plasma exchange (TPE) is one of the treatments offered. This systematic review aims to evaluate the effectiveness of TPE in managing leptospirosis-associated severe pulmonary haemorrhagic syndrome (SPHS). A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. The search used Medical Subject Headings in PubMed with keywords 'Leptospirosis' OR 'Leptospira' OR 'Weil disease' AND 'plasmapheresis' OR 'plasma exchange' AND 'pulmonary haemorrhage' OR 'alveolar haemorrhage'. The search was widened to include the Google Scholar database. The review was confined to English-language articles and focused on primary research studies. Nineteen articles were considered for analysis. There were no randomized controlled trials. A non-randomized trial and a retrospective cohort documented recovery following adjuvant TPE treatment. Most case reports mention significant improvement and complete recovery following administration of TPE. One case reported the death of a patient despite treatment. However, this review revealed a lack of strong evidence endorsing the routine application of TPE as a therapeutic intervention for cases of SPHS. Thus we recommend the initiation of a well-structured randomized controlled trial to ensure an accurate assessment of the efficacy of TPE.

Development of a simplified model and nomogram for the prediction of pulmonary hemorrhage in respiratory distress syndrome in extremely preterm infants

BackgroundPulmonary hemorrhage (PH) in respiratory distress syndrome (RDS) in extremely preterm infants exhibits a high mortality rate and poor long-term outcomes. The aim of the present study was to develop a machine learning (ML) predictive model for RDS with PH in extremely preterm infants.MethodsWe performed a retrospective analysis of extremely preterm infants with RDS at the Children’s Hospital of Soochow University between January 2015 and January 2021. We applied three ML algorithms—logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost)—to evaluate the performance of each model using the area under the curve (AUC), and developed a predictive model based on the optimal model. We calculated SHapley Additive exPlanations (SHAP) values to determine variables importance and show visualization results, and constructed a nomogram for individualized prediction.ResultsA total of 309 patients with RDS were enrolled, including 48 (15.5%) with PH. A total of 29 variables were collected, including demographic and clinical characteristics, laboratory data, and image classification. According to the AUC values, the RF model performed best (AUC = 0.868). Based on the SHAP values, the top five important variables in the RF model were gestational age, PaO2/FiO2, birth weight, mean platelet volume, and Apgar score at 5 min.ConclusionsOur study showed that the RF model could be used to predict the risk of PH in RDS in extremely preterm infants. The nomogram provides clinicians with an effective tool for early warning and timely management.

Useful central mechanical circulatory support system for critical biventricular heart failure associated with high pulmonary vascular resistance.

Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) is a powerful life-saving tool; however, it can sometimes induce severe pulmonary edema in patients with critical heart failure. We report favorable outcomes in critically ill patients by using a central ECMO system with an innovative blood perfusion method. We analyzed 10 patients with severe heart failure and pulmonary edema who were treated with the central ECMO system at our institution between April 2022 and October 2023. The system consists of central cannulation with two inflows from the right atrium and left ventricle, and two outflows to the aorta and pulmonary artery, connected by two Y-connectors to a single ECMO circuit (RALV-AOPA ECMO). In this system, blood flow to the pulmonary artery is adjusted and mean pulmonary artery pressure is limited to <20 mm Hg, which reduces right ventricular afterload and prevents the worsening of pulmonary edema and hemorrhage. Six patients were diagnosed with fulminant lymphocytic myocarditis, and four were diagnosed with coronavirus disease 2019-related myocardial injury. The ejection fraction was 6.5 ± 4.1%. The average intraoperative pulmonary vascular resistance was 4.6 ± 1.3 Wood units. After 24 h, the mean pulmonary arterial pressure was 12.8 ± 4.3 mm Hg, and pulmonary vascular resistance was 1.5 ± 0.3 Wood units. The duration of central RALV-AOPA ECMO was 3.7 ± 2.1 days. Finally, six patients were weaned, three received HeartMate3, and one received heart transplantation. At follow-up, all patients remained alive (428 ± 208 days), and two patients experienced cerebrovascular accidents without any lasting sequelae. The central RALV-AOPA ECMO is an innovative system that achieves early improvement in pulmonary vascular resistance and is safe and feasible for patients with acute biventricular failure and pulmonary edema.

Trained Mesenchymal Stromal Cell-Based Therapy HXB-319 for Treating Diffuse Alveolar Hemorrhage in a Pristane-induced Murine Model.

Mesenchymal stromal cells (MSCs) can modulate immune responses and suppress inflammation in autoimmune diseases. Although their safety has been established in clinical trials, the efficacy of MSCs is inconsistent due to variability in potency among different preparations and limited specificity in targeting mechanisms driving autoimmune diseases. We utilized High-Dimensional Design of Experiments methodology to identify factor combinations that modulate gene expression by MSCs to mitigate inflammation. This led to a novel MSC-based cell therapy, HXB-319. Its anti-inflammatory properties were validated in vitro by flow cytometry, RT-PCR, and mass spectrophotometry. To evaluate in vivo efficacy, we treated a diffuse alveolar hemorrhage (DAH) mouse model (C57Bl/6). Seven days post-DAH induction with pristane, mice received either MSCs or HXB-319 (2X106 cells, IP). On day 14, peritoneal lavage fluid (PLF) and lung tissue were collected for flow cytometry, histopathological examination and mRNA. HXB-319 increased gene expression levels of anti-inflammatory, angiogenic and anti-fibrotic factors (e.g. TSG-6, VEGF and HGF). KEGG pathway analysis confirmed significant activation of relevant anti-inflammatory, angiogenic, and anti-fibrotic proteins, corroborating RT-PCR results.In the DAH model, HXB-319 significantly reduced lung inflammation and alveolar hemorrhage compared to MSC treated and untreated DAH mice. HXB-319 treatment also significantly decreased neutrophils, plasmacytoid dendritic cells and RORγT cells, and increased FoxP3+ cells in PLF, and reversed alterations in mRNA encoding IL-6, IL-10 and TSG-6 in lung tissue compared to DAH mice. HXB-319 effectively controls inflammation and prevents tissue damage in pristane induced DAH, highlighting its therapeutic potential for autoimmune inflammatory diseases.

Association Between Antiphospholipid Antibodies and Diffuse Alveolar Hemorrhage Risk in Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis.

To assess the association of antiphospholipid antibodies (aPL) and diffuse alveolar hemorrhage (DAH) in patients with systemic lupus erythematosus (SLE) by performing a systematic review and meta-analysis. Multiple databases were systematically searched from inception to February 2024. Studies were eligible if they included patients with SLE (population), reported aPL status (exposure), and DAH (outcome). We pooled the estimates as odds ratio (OR) using fixed-effect models. We examined the association between aPL and DAH, as well as associations based on aPL subtypes or concomitant antiphospholipid syndrome (APS). Out of 454 screened studies, nine were included in meta-analysis, encompassing 7,746 patients with SLE, of whom 2016 (26.0%) were aPL positive and 163 (2.1%) had DAH. Patients with SLE and positive aPL (any) were more likely to develop DAH than aPL-negative patients (OR = 1.76, 95% CI 1.24-2.49; I2= 0%). Patients with SLE and positive lupus anticoagulant (LA; OR = 1.76, 95% CI 1.06-2.93, I2= 35%) or positive anticardiolipin IgG (OR = 1.62, 95% CI 1.13-2.34, I2=0%) had a higher likelihood of developing DAH compared with patients that were negative for these aPL. An APS diagnosis was associated with a 2.5-fold increased likelihood of DAH compared with subjects without APS (OR = 2.46, 95% CI 1.23-4.92, I2=0%). Positivity of anti-β2 glycoprotein I IgG was not significantly associated with DAH among patients with SLE (OR = 0.78, 95% CI 0.45-1.36, I2=0%). In patients with SLE, aPL positivity increases the risk of DAH compared with aPL-negative patients, particularly in those positive for LA and anticardiolipin IgG.

Acoustic radiation force impulse (push pulse)-induced lung hemorrhage: investigating the effect of ultrasound contrast agent in rabbits.

Acoustic radiation force impulse (ARFI) elastography and contrast-enhanced ultrasonography (CEUS) are emerging techniques that are becoming common in ultrasound examinations. We previously reported that ARFI (push pulse) induced lung hemorrhage in rabbits, indicating that greater risks are associated with ARFI than with conventional ultrasound. In this study, we assessed the risk of lung hemorrhage under a combination of ARFI elastography and CEUS, considering potential exacerbation of ARFI-induced lung hemorrhage as a result of the ultrasound contrast agent (UCA) used in CEUS. Twenty-three rabbits were divided into non-UCA and UCA groups. ARFI exposure parameters were set at six mechanical index (MI) levels (0.29, 0.45, 0.60, 0.88, 1.0, 1.39) in non-UCA groups and five MI levels (0.29, 0.66, 0.88, 0.97, 1.25) in UCA groups. Lung exposure was performed bilaterally through the intercostal space in each rabbit. Lung damage was assessed through macroscopic and microscopic observation post euthanasia. Lung hemorrhage was detected at MI0.3 levels of 0.88 or higher. Logistic regression analyses showed that MI0.3 was a statistically significant factor for occurrence of lung hemorrhage in both non-UCA and UCA groups, and the MI0.3 threshold (ED05) for inducing lung hemorrhage was 0.68 and 0.71, respectively. However, multivariate logistic regression and linear regression analyses across all samples indicated that UCA did not significantly affect the occurrence or area of lung hemorrhage. This study demonstrates that UCA does not significantly worsen ARFI-induced lung hemorrhage in terms of occurrence or severity. However, risks and benefits of ARFI elastography on the lung should be considered, irrespective of UCA administration.

Bronchoscopy in children with diffuse alveolar hemorrhage under general anesthesia with spontaneous respiration by face mask ventilation.

To improve the management level of general anesthesia during bronchoscopy in the children with diffuse alveolar hemorrhage (DAH). A retrospective study was conducted in the children with DAH who had performed bronchoscopy under general anesthesia with spontaneous respiration by face mask ventilation initially from June 2021 to June 2022 in our hospital. (1) Thirty-four children who had underwent 38 bronchoscopy procedures were included. (2) General anesthesia induction was performed by bolus of propofol intravenous in all the procedures. For maintaining anesthesia, combination use of propofol and remifentanil intravenously infusion were given in 31 procedures (81.6%) and propofol intravenously infusion alone was given in the rest 7 procedures (18.4%). An intravenous bolus of ketamine or propofol was given as an anesthetic adjuvant in 21 procedures (55.3%). Thirty-five procedures (92.1%) were successfully completed under non-tracheal intubation ventilation, whereas the rest 3 procedures (7.9%) needed change to tracheal intubation ventilation. (3) Respiratory depression was found in 7 procedures (18.4%), laryngospasm was found in 2 procedure (2.6%), and bronchospasm was found in 17 procedures (44.7%). Intraoperative hypoxemia occurred in 16 procedures (42.1%). The incidence of intraoperative hypoxemia in the procedures at the active phage of disease was significantly higher compared to those at the remission phage of the disease (P < .05). Intraoperative hypercapnia also occurred in 16 procedures (42.1%). Two procedures (5.3%) were complicated by severe pulmonary hemorrhage. General anesthesia with spontaneous respiration by face mask ventilation is feasible and relatively safe for the children with DAH undergoing bronchoscopy, whereas the anesthetic protocol still needs to be improved.