Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients With Cancer.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) on nasopharyngeal swab (NPS), remains the most reliable and practical test to diagnose coronavirus disease 2019 (COVID-19). Current literature is sparse regarding the rates of discordance between NPS and bronchoalveolar lavage (BAL) in patients with cancer. METHODS: We conducted a retrospective cohort study of adult patients with cancer who had BAL samples tested for SARS-CoV-2 at a comprehensive cancer center. Patients without NPS PCR for SARS-CoV-2 before BAL were excluded. RESULTS: In a cohort of 345 patients, 12% and 17% tested positive for SARS-CoV-2 on NPS and BAL, respectively. There was a 6.3% NPS-/BAL+ discordance rate and a 9.5% NPS+/BAL- discordance rate. Patients with lymphoma (adjusted odds ratio [aOR] = 4.06; P = .007) and Hispanic patients (aOR = 3.76; P = .009) were more likely to have NPS-/BAL+ discordance on multivariate analysis. Among patients with NPS- /BAL- for SARS-CoV-2, an alternate infectious (23%) and a noninfectious etiology (16%) were identified in BAL. CONCLUSIONS: Our discordance rates between NPS and BAL were sufficient to recommend BAL in certain patients with cancer with a high clinical suspicion of COVID-19. BAL has value in identifying alternative etiologies of illness in patients with suspected or confirmed COVID-19.

Effects of a Modified Chitosan Compound Combined with Lung Lavage after Inhalation of Depleted Uranium Dust.

ABSTRACT: When exposed to depleted uranium (DU), the respiratory tract is the main route for DU to enter the body. At present, lung lavage is considered to be a method for removing DU from the lung. However, there is still room for improvement in the efficiency of lung lavage. In this work, a model of DU dust inhalation injury was established in beagle dogs so that chitosan-diethylenetriaminepentaacetic nanoparticles (CS-DTPA NP) could be synthesized. The purpose of this work was to evaluate the removal efficiency of CS-DTPA NP combined with lung lavage in dogs. Results showed that 7 d after DU exposure, the diethylenetriaminepentaacetic (DTPA) and CS-DTPA NP groups showed lower U content in kidney tissue compared with the normal saline (NS) group. In the left lung tissue (lavage fluid and recovery rate of lavage fluid), the U content in the CS-DTPA NP group was higher than in the NS and DTPA groups. In terms of blood levels, the CS-DPTA NP group increased over time at 1, 3 and 7 d of DU exposure without lavage; however, the U levels in the 3 and 7 d lavage groups were significantly lower than in the non-lavage groups. IL-1 in the lavage fluid of the CS-DPTA NP and CS NPs group were lower than in the NS group. In summary, after respiratory exposure to DU, early inhalation of CS-DPTA NP may block insoluble DU particles in the lung, and if combined with lung lavage, the clearance efficiency of DU from lung tissue improves.

Methionine supplementation for multi-organ dysfunction in MetRS-related pulmonary alveolar proteinosis.

INTRODUCTION: Pulmonary alveolar proteinosis related to mutations in the methionine tRNA synthetase (MARS1) gene is a severe, early-onset disease that results in death before the age of 2 years in one-third of patients. It is associated with a liver disease, growth failure and systemic inflammation. As methionine supplementation in yeast models restored normal enzymatic activity of the synthetase, we studied the tolerance, safety and efficacy of daily oral methionine supplementation in patients with severe and early disease. METHODS: Four patients received methionine supplementation and were followed for respiratory, hepatic, growth and inflammation-related outcomes. Their course was compared to those of historical controls. Reactive oxygen species production by patient monocytes before and after methionine supplementation was also studied. RESULTS: Methionine supplementation was associated with respiratory improvement, clearance of the extracellular lipoproteinaceous material and discontinuation of whole-lung lavage in all patients. The three patients who required oxygen or noninvasive ventilation could be weaned off within 60 days. In addition, liver dysfunction, inflammation and growth delay improved or resolved. At a cellular level, methionine supplementation normalised the production of reactive oxygen species by peripheral monocytes. CONCLUSION: Methionine supplementation was associated with important improvements in children with pulmonary alveolar proteinosis related to mutations in the MARS1 gene. This study paves the way for similar strategies for other tRNA synthetase deficiencies.

Effect of early whole lung lavage at different time-points for promoting the removal of depleted uranium from the lung.

PURPOSE: This study compared the effect of whole lung lavage (WLL) at different time-points early after exposure of the respiratory system to insoluble radioactive particles. MATERIALS AND METHODS: Forty adult beagles were randomized into a control group and the 3-h, 8-h, 24-h, and 48-h lavage groups (n = 8). A canine model of acute lung injury was established by spraying a depleted uranium (DU) suspension using a superfine fiber bronchoscope, at a dose of 20 mg/kg. The lavage groups were subjected to WLL at 3 h, 8 h, 24 h, and 48 h post-DU exposure, while the control group received no treatment after exposure. Measurement of U in serum was performed using inductively coupled plasma mass spectrometry; measurements in the lavage fluid and left lung tissue were performed using inductively coupled plasma atomic emission spectrometry. The color of the lavage fluid was analyzed using colorimetry, and shadow changes in the lung were observed using chest computed tomography (CT). RESULTS: The lavage groups showed similarly increasing trends for serum U levels from DU exposure to 3 and 7 days after exposure; however, these values were significantly lower than those in the control group (p < .01). The U content in the lavage fluid was significantly higher in the 3-h group than in the 8-h, 24-h, and 48-h groups (p < .01), while that in the 8-h group was markedly higher than those in the 24-h and 48-h groups (p < .05). The average clearance rate of DU in the lungs varied in the range of 0.63‒7.06%. The U content in the left lung tissue of each lavage group was significantly lower than that in the control group (p < .01), while the content in the 8-h, 24-h, and 48-h groups was significantly higher than that in the 3-h group (p < .05). The colorimetric score of the lavage fluid in the 3-h group was significantly lower than those in the 8-h, 24-h, and 48-h groups (p < .05). Chest CT showed different degrees of consolidation and ground glass shadow changes in all groups. The score of the left lung shadow volume in the 3-h group was significantly lower than in the control, 8-h, 24-h, and 48-h groups (p < .01), while the score in the 8-h group was significantly higher than those in the 48-h and control groups (p < .05). CONCLUSIONS: The best effect of WLL after exposure of the respiratory system to insoluble radioactive particles was achieved at 3 h, followed by 8 h; there was no difference in the effectiveness of lung lavage at 24 h and 48 h.

Effect of systemic photobiomodulation in the course of acute lung injury in rats.

Acute lung injury (ALI) is a severe, multifactorial lung pathology characterized by diffuse alveolar injury, inflammatory cell infiltration, alveolar epithelial barrier rupture, alveolar edema, and impaired pulmonary gas exchange, with a high rate of mortality; and sepsis is its most common cause. The mechanisms underlying ALI due to systemic inflammation were investigated experimentally by systemic lipopolysaccharide (LPS) administration. Photobiomodulation (PBM) has been showing good results for several inflammatory diseases, but there are not enough studies to support the real benefits of its use, especially systemically. Considering that ALI is a pathology with high morbidity and mortality, we studied the effect of systemic PBM with red light-emitting diode (LED) (wavelength 660 nm; potency 100 mW; energy density 5 J/cm; total energy 15 J; time 150 s) in the management of inflammatory parameters of this disease. For this, 54 male Wistar rats were submitted to ALI by LPS injection (IP) and treated or not with PBM systemically in the tail 2 and 6 h after LPS injection. Data were analyzed by one-way ANOVA followed by Student's Newman-Keuls. Our results point to the beneficial effects of systemic PBM on the LPS-induced ALI, as it reduced the number of neutrophils recruited into the bronchoalveolar lavage, myeloperoxidase activity, and also reduced interleukins (IL) 1ß, IL-6, and IL-17 in the lung. Even considering the promising results, we highlight the importance of further studies to understand the mechanisms involved, and especially the dosimetry, so that in near future, we can apply this knowledge in clinical practice.

Detection of Carbapenemase and CTX-M Encoding Genes Directly from Bronchoalveolar Lavage Using the CRE and ESBL ELITe MGB Assays: Toward Early and Optimal Antibiotic Therapy Management of Critically Ill Patients with Pneumonia.

The detection of carbapenemase extended-spectrum ß-lactamase (ESBL)-producing Enterobacterales (EB) has become a major issue among critically ill patients, especially due to their impact on appropriate antimicrobial therapy. This study aimed at evaluating the potential contribution of molecular assays to early optimization of empirical antibiotic therapy among critically ill patients with carbapenemase- and/or CTX-M-producing EB pneumonia. The CRE and ESBL ELITe MGB® assays were evaluated directly on 197 bronchoalveolar lavage (BAL) samples obtained from 120 patients. Molecular results were then compared to routine culture-based diagnostic results, and a retrospective analysis of the therapeutic antimicrobial management was performed. Among the 197 clinical specimens, blaKPC-like and blaCTX-M-like were detected in 20 (10.2%) and 12 (6.1%) specimens belonging to 15 and 11 patients, respectively. Positive predictive value (PPV) and negative predictive value (NPV) of the CRE ELITe MGB Kit were 85% [95% confidence interval [CI]: 64.9-94.6] and 100%, respectively. PPV and NPV of the ESBL ELITe MGB Kit were 75% [95% CI: 49.4-90.2] and 100%, respectively. Retrospective analysis of the therapeutic antimicrobial management at the time of BAL collection showed that in ∼50% of patients with carbapenemase- and CTX-M-producing EB pneumonia empirical antibiotic therapy could have been optimized at least 48-72 hr earlier if positive molecular data had been used. The CRE and ESBL ELITe MGB assays might be an interesting tool for expediting optimization of empirical antibiotic therapy in critically ill patients with pneumonia, depending on local epidemiology of antibiotic resistance, patient risk stratification for EB infection, and availability of an antimicrobial stewardship team.

Of onions and men: Report of cavitary community acquired pneumonia due to Burkholderia cepacia complex in an immunocompetent patient and review of the literature.

Burkholderia cepacia complex consists of highly antibiotic resistant gram negative bacilli that are plant symbionts and also potential agents of human infection.  This bacterial family's claim to fame in clinical medicine is as the scourge of cystic fibrosis patients, in whom it is a notorious respiratory pathogen.  Outside of cystic fibrosis, it rarely comes to mind as an etiology of community acquired pneumonia with or without lung cavitation in immunocompetent hosts.  We describe a case of an otherwise healthy, community-dwelling man who presented with subacute cavitary lung disease, the causative organism of which turned out to be Burkholderia cepacia complex.  Our report is accompanied by a review of the literature, which identified an additional eleven cases in the same category.  We analyze all of the available cases for the emergence of any identifiable patterns or peculiarities.

[Structure of microorganisms isolated from bronhoalveolar lavage from patients in the department of reanimation and intensive therapy.] / Структура микроорганизмов, Ð²Ñ‹Ð´ÐµÐ»ÐµÐ½Ð½Ñ‹Ñ Ð¸Ð· Ð±Ñ€Ð¾Ð½Ñ Ð¾Ð°Ð»ÑŒÐ²ÐµÐ¾Ð»ÑÑ€Ð½Ð¾Ð³Ð¾ лаважа от пациентов отделения реанимации и интенсивной терапии.

The aim of the work was to determine and compare the structure of microorganisms isolated from bronchoalveolar lavage from patients in the ICU of Clinics in 2016 and 2019. This work presents the results of a bacteriological examination of 229 samples from 139 patients for 2016 and 387 samples from 218 patients for 2019. The predominant microorganism in 2016 was Acinetobacter baumanii - 75 (26.2%). Less common were Klebsiella pneumoniae - 55 (19.2%), Pseudomonas aeruginosa - 35 (12.2%), Escherichia coli - 19 (6.6%). In 2019, the prevailing microorganism was K.pneumoniae - 158 (19.1%). As in 2016, A.baumanii - 115 (13.9%) and P. aeruginosa - 57 (6.9%) were most often found, but unlike 2016, in 2019 there was a high incidence of such pathogens as Enterococcus faecalis - 52 (6.3%), Candida albicans - 43 (5.2%), Staphylococcus aureus and Stenotrophomonas maltophilia - 40 (4.8%). One of the features is the presence of polymicrobial associations. In 2016, microorganisms isolated in monoculture predominated (53.4%), while in 2019 the frequency of occurrence of monocultures decreased and amounted to 24.7%. At the same time, a two-component association prevailed (31.5%). Thus, in ICU it is necessary to regularly monitor nosocomial pathogens not only to make the right decision when choosing antimicrobial therapy, but also to identify new potential nosocomial pathogens.

Exogenous lipoid pneumonia in children: A systematic review.

OBJECTIVES: To describe the clinical-radiological-pathological characteristics and treatment outcomes of children with suspected exogenous lipoid pneumonia (ELP). DESIGN: Systematic review. We searched electronic databases and reference lists published between 1967 and 2018, restricted to non-accidental cases. RESULTS: Forty-four studies including 489 participants aged 1 day to 17 years from 13 countries were included. Cultural, medical, and behavioural rationale for oil-use was described. The clinical-radiological presentation varied widely. Diagnostic certainty was deemed highest if ELP was confirmed on bronchoalveolar lavage/frozen section lung biopsy with documented extracellular lipid on cytological staining and/or fat analysis. Non-tuberculous mycobacteria infection was identified in six studies: Mycobacterium fortuitum/chelonei, Mycobacterium smegmatis and Mycobacterium abscessus. Treatment comprised supportive therapy, corticosteroids, stopping oil, therapeutic lung-lavage and surgical resection. Outcomes were reported inconsistently. CONCLUSION: Paediatric ELP resulting from cultural and medical practices continues to be described globally. Preventive interventions, standardized reporting, and treatment efficacy studies for cases not averted, are lacking. Protocol registration: PROSPERO CRD42017068313.

Macmoondongtang modulates Th1-/Th2-related cytokines and alleviates asthma in a murine model.

OBJECTIVE: Macmoondongtang has been used as a traditional medicine to treat pulmonary disease in Korea. However, the mechanism underlying its therapeutic effect has yet to be reported. In the present study, the role of macmoondongtang as a respiratory medicine, especially as an anti-asthmatic agent, has been attributed to the down-regulation of interleukin (IL)-4 and tumor necrosis factor (TNF)-α. MATERIALS & METHODS: BALB/c mice were divided into five groups: control, asthma-induced control, dexamethasone treatment, treatment with 150 mg/kg macmoondongtang, and treatment with 1500 mg/kg macmoondongtang. To evaluate the anti-asthmatic effect of macmoondongtang, we investigated its suppressive or inhibitory effects against typical asthmatic changes such as differential cell count in bronchioalveolar fluid (BALF), serum IgE levels, lung morphology, expression of Th1/Th2 cell transcription factors such as T-bet and GATA-3, and Th1-/Th2-/Th17-related cytokines such as interferon (IFN)-γ, IL-12p40, IL-4, -5, -13, TNF-α, and IL-6. The active ingredients in macmoondongtang were further analyzed. RESULTS: Macmoondongtang treatment down-regulated serum IgE level, a very important marker of hyper-responsiveness. It reversed typical morphological changes such as mucous hypersecretion, lung epithelial cell hyperplasia, and inflammatory cell infiltration near bronchioalveolar space and veins. Macmoondongtang significantly decreased neutrophil count in BALF, as well as reduced T-bet, IFN-γ, and TNF-α expression in the lung. It also showed a dose-dependent control of inflammatory cells in BALF, controlled the expression of IL-12, IL-4, and IL-5 genes in the lung, and the protein expression of IL12p40, GATA-3, IL-4, IL-5, and IL-13. The component analysis revealed glycyrrhizin and liquiritin as the active ingredients. CONCLUSIONS: Macmoondongtang treatment alleviates asthma symptoms and modulate the Th1-/Th2- related cytokines. Glycyrrhizin and liquiritin could be the major the active therapeutic components.

[Acute Respiratory Failure after Silicone Injection]. / Akutes respiratorisches Versagen durch Silikon-Injektion.

A 35-year-old male patient presented to the emergency department with complains of fever, dyspnea and petechiae. The chest X-ray revealed signs of bipulmonary infiltration. 5 days ago, an illicit silicone injection was performed into the penis for cosmetic reasons. Due to progressive respiratory failure the patient required mechanical ventilation. Bronchoalveolar lavage revealed diffuse alveolar hemorrhage. Silicone pneumonitis with a severe acute respiratory failure based on silicone embolization syndrome was diagnosed. Prone positioning, lung-protective ventilation and corticosteroid therapy were initiated. The patient was discharged from ICU after 19 days. In an outpatient follow up, lung function was fully recovered. CONCLUSION: Silicone pneumonitis should be considered in case of fever, respiratory distress and alveolar hemorrhage linked to cosmetic procedures. High dose corticosteroid therapy and lung-protective ventilation strategies may help for complete recovery of lung function.

Pseudomonas aeruginosa eradication therapy and risk of acquiring Aspergillus in young children with cystic fibrosis.

BACKGROUND: While Aspergillus detection rates in adults, adolescents and older children with cystic fibrosis (CF) have increased, the risk of acquiring this fungal pathogen in young children is unknown. AIM: To determine the risk and explanatory factors of acquiring Aspergillus in children with CF by age 5 years. METHODS: Cross-sectional analysis of clinical, bronchoalveolar lavage and treatment data from the Australasian Cystic Fibrosis Bronchoalveolar Lavage study was used to identify predictive factors for detecting Aspergillus at age 5 years. A parametric repeated time-to-event model quantitatively described the risk and factors associated with acquiring Aspergillus and Pseudomonas aeruginosa from birth until age 5 years. RESULTS: Cross-sectional analysis found that the number of P. aeruginosa eradication courses increased the odds of detecting Aspergillus at age 5 years (OR 1.61, 95% CI 1.23 to 2.12). The median (IQR) age for the first P. aeruginosa positive culture was 2.38 (1.32-3.79) years and 3.69 (1.68-4.74) years for the first Aspergillus positive culture. The risk of P. aeruginosa and Aspergillus events changes with time after the first year of study entry. It also decreases for P. aeruginosa after completing P. aeruginosa eradication (HR 0.15, 95% CI 0.00 to 0.79), but increases for Aspergillus events (HR 2.75, 95% CI 1.45 to 5.41). The risk of acquiring both types of events increases after having had a previous event. CONCLUSION: In young children with CF, completing P. aeruginosa eradication therapy and previous Aspergillus events are associated with increased risk of acquiring Aspergillus.

Clinical and radiological manifestations of lipoid pneumonia according to etiology: Squalene, omega-3-acid ethyl esters, and idiopathic.

OBJECTIVES: Clinical manifestations of lipoid pneumonia (LP) vary depending on the causative agents or underlying causes. The aim of the present study was to investigate the clinical and radiological features of LP, classified according to etiologic agents. METHODS: The clinico-radiological characteristics of LP patients were retrospectively compared among groups: exogenous versus idiopathic and squalene versus omega-3-acid ethyl esters (O-3-AEE) versus idiopathic. Idiopathic group was defined as LP with no proven or reported etiological evidence. RESULTS: Twenty-two patients met the diagnostic criteria for LP: squalene (9 [41%]), O-3-AEE (6 [27%]), olive oil (1 [5%]), and idiopathic (7 [32%]). Compared with the exogenous group, the idiopathic group showed a higher recurrence rate; higher frequencies of bronchial anthracofibrosis (BAF) and bronchoalveolar lavage (BAL) lymphocytosis; and a higher rate of crazy-paving pattern and lower rate of consolidation on computed tomography scan. In three-group tests, compared with the O-3-AEE group, the squalene group exhibited a significantly higher percentage of neutrophils and a higher rate of right middle lobe (RML) involvement. CONCLUSIONS: In comparison with the exogenous group, the idiopathic group demonstrated BAL lymphocytosis, higher rates of recurrence and BAF, and a higher rate of crazy-paving pattern. Compared with the O-3-AEE group, the squlaene group showed a higher percentage of BAL neutrophils and predominant RML involvement.

Effect of omega-3 fatty acid supplementation on resolvin (RvE1)-mediated suppression of inflammation in a mouse model of asthma.

Objective: ResolvinE1 (RvE1), an endogenous lipid mediator derived from omega 3 fatty acids contributes to resolution of allergic inflammatory responses. We investigated effects of RvE1 (R) and omega 3 fatty acids (O) on airway reactivity and inflammation using allergic mice. Methods: Mice were divided into control (nonasthmatic; CON) and allergen sensitized-challenged (asthmatic; SEN) groups, and were sensitized i.p. on days 1, 6 with 0.2 µg ovalbumin (OVA) followed by 5% OVA aerosol challenges on days 11-13. RvE1 was administered i.p. postallergen challenge, while omega 3 fatty acids (fish oil) were administered via oral gavage once daily (days 1-13). Whole body plethysmography and bronchoalveolar lavage (BAL) studies were performed on day 14. Results: RvE1 attenuated airway responsiveness to methacholine (48 mg/ml) in treated asthmatic mice vs. nontreated (150 ± 27.88% in SEN vs. 54 ± 7.52% in SEN + R, p < .05). No difference was observed with omega-3 supplementation (115 ± 19.28% in SEN + O) or treatment with both RvE1 and omega 3 fatty acids (39 ± 12.37% in SEN + R + O vs. 54 ± 7.52% in SEN + R). Differential BAL cell analysis showed that RvE1 decreased eosinophils and neutrophils in SEN mice (p < .005) while no difference was observed with omega-3 fatty acids. SEN + R + O group had similar results as RvE1 treated mice, suggesting that only RvE1 attenuated inflammation. Conclusions: RvE1 attenuated airway responsiveness and inflammation in asthmatic mice. Omega-3 fatty acids, although a precursor for RvE1 formation, had no additive effects on RvE1 decreases in airway inflammation and airway reactivity. Our data suggests that omega-3 supplementation has little effect on airway inflammation and reactivity in our model of asthma.

Photobiomodulation modulates the resolution of inflammation during acute lung injury induced by sepsis.

Sepsis is a big health problem and one of the most common causes of acute lung injury (ALI) leading to high mortality. Pro-resolving mediators play an important role in abrogating the inflammation and promoting tissue homeostasis restoration. ALI treatment is still a clinical health problem, so new therapies are needed. Here, we evaluated the effect of photobiomodulation treatment on the resolution process of ALI induced by lipopolysaccharide (LPS). Male Balb/c mice were submitted to LPS (ip) or vehicle and irradiated or not with light emitting diode (LED) 2 and 6 h after LPS or vehicle injection, and the parameters were investigated 3 and 7 days after the injections. Our results showed that after 3 days of LED treatment the blood and bronchoalveolar lavage (BAL) cells as well as interleukins (IL) including IL-6 and IL-17 were reduced. No differences were observed in the bone marrow cells, tracheal reactivity, and lipoxin A4 and resolvin E2. Indeed, after 7 days of LED treatment the bone marrow cells, lymphocytes, and lipoxin A4 were increased, while IL-6, IL-17, and IL-10 were decreased. No differences were observed in the blood cells and tracheal reactivity. Thus, our results showed that LED treatment attenuated ALI induced by sepsis by modulating the cell mobilization from their reserve compartments. In addition, we also showed later effects of the LED up to 7 days after the treatment. This study proposes photobiomodulation as therapeutic adjuvant to treat ALI.

Effect of Daiqin phlegm-expelling pill on development of inflammation in rats with chronic obstructive pulmonary disease induced by lipopolysaccharide and smoke.

OBJECTIVE: To investigate the effect of Daiqin phlegm-expelling pill, prepared with Traditional Chinese Medicine (TCM), on the development of inflammation in Sprague-Dawley (SD) rats with chronic obstructive pulmonary disease (COPD) induced by lipopolysaccharide (LPS) and smoke, and to identity the possible underlying mechanism. METHODS: Sixty male rats were divided into 6 groups (healthy control group, untreated group, Daiqin phlegm-expelling pill low, middle and high dose, and ambroxol hydrochloride tablet group). COPD was established in SD rats by sootiness and tracheal instillation with LPS. The rats were treated with Daiqin phlegm-expelling pill at the indicated doses for 28 d, the inflammatory cells in bronchoalveolar lavage fluid (BALF), the concentration of tumor necrosis factor-α (TNF-α), interleukin (IL)-8 and IL-6 in blood and the inflammation in lung were evaluated. RESULTS: The number of inflammatory cells in the BALF and TNF-α, IL-8 and IL-6 level in plasma were significantly reduced in rats with COPD when treated with Daiqin phlegm-expelling pill or ambroxol hydrochloride tablet, compared with those without any treatment. The Daiqin phlegm-expelling pill treated rats with COPD had a attenuated inflammation in lung tissue, compared with the untreated group. CONCLUSION: Daiqin phlegm-expelling pill can significantly restrain the airway inflammation in rats with LPS-smoke induced COPD.

Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline.

The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.

Effect of a novel polyethylene glycol compound on lung lavage in dogs after the inhalation of depleted uranium dust.

PURPOSE: The purpose of this study was to assess the effect of a lavage solution containing methoxypolyethylene glycol 4-(3,4-dihydroxyphenethylamino)-4-oxobutanoate (MDO) for whole lung lavage (WLL) in dogs after the inhalation of depleted uranium (DU) dust at a dose of 30 mgUkg-1. MATERIALS AND METHODS: WLL was performed using lavage solutions made of normal saline (saline group) or normal saline plus MDO (MDO group) at 2 days post-DU exposure. Meanwhile, a control group was set up without any treatment. RESULTS: At 10 days post-DU exposure, the saline and MDO groups had a lower DU content in urine and lung compared with the DU group (without lavage), while the MDO group content was significantly lower than that in the saline group. In terms of blood urea nitrogen and creatinine levels, the DU group maintained relatively high levels from day 3 to day 10; the saline group levels were reduced compared with the DU group at day 8 and day 10, while the MDO group levels remained markedly lower than both the DU and saline group levels. Pathological changes in the lungs and kidneys showed that the saline group was improved compared with the DU group, but not as significantly as the MDO group. CONCLUSIONS: In brief, WLL has a remarkable effect in promoting the decorporation of inhaled DU dust in the lungs of dogs. By comparison, a MDO-containing lavage solution has a better lavage effect than normal saline.

Photobiomodulation therapy improves both inflammatory and fibrotic parameters in experimental model of lung fibrosis in mice.

Lung fibrosis (LF) is a chronic and progressive lung disease characterized by pulmonary parenchyma progressive lesion, inflammatory infiltration, and interstitial fibrosis. It is developed by excessive collagen deposition and other cellular matrix components, resulting in severe changes in the alveolar architecture. Considering the absence of effective treatment, the aim of this study was to investigate the effect of photobiomodulation therapy (PBMT) on the development of PF. For this purpose, we used C57BL6 mice subjected to induction of LF by bleomycin administration (1.5 U/kg) by orotracheal route and, after 14 days of the induction, mice were treated with PBMT applied to the thorax 1×/day for 8 days (wavelength 660 ± 20 nm, power 100 mW, radiant exposure 5 J/cm2, irradiance 33.3 mW/cm2, spot size 2.8cm2, total energy 15 J, time of irradiation: 150 s) and inflammatory and fibrotic parameters were evaluated with or without PBMT. Our results showed that PBMT significantly reduced the number of inflammatory cells in the alveolar space, collagen production, interstitial thickening, and static and dynamic pulmonary elastance. In addition, we observed reduced levels of IL-6 e CXCL1/KC released by pneumocytes in culture as well as reduced level of CXCL1/KC released by fibroblasts in culture. We can conclude that the PBMT improves both inflammatory and fibrotic parameters showing a promising therapy which is economical and has no side effects.