Left Main Bronchus Stenosis Lesion, Neutrophil Count, and Platelet Count Are Predictors of Post-Tuberculosis Bronchomalacia.

BACKGROUND Post-tuberculosis bronchomalacia (PTBM) is one of the main conditions occurring in patients after tracheobronchial tuberculosis (TBTB), and is also associated with the recurrence of symptoms. The present study aimed to investigate the predictors of PTBM in patients who had been undergoing appropriate TB treatment. MATERIAL AND METHODS Clinical data of 104 patients with symptomatic airway stenosis after TBTB between January 01, 2019 and June 31, 2020 were recorded and analyzed. The association between baseline clinical characteristics, laboratory results, and PTBM was calculated with logistical regression. The time from onset of bronchoscopic intervention was examined by Kaplan-Meier estimates; differences between the 2 groups were tested by the log-rank test. RESULTS Fifty-seven patients (54.81%) had PTBM. In the multivariate logistical analysis, the left main bronchus stenosis lesion (odds ratio [OR]=3.763), neutrophil (NEUT) count (OR=1.527), and platelet (PLT) (OR=1.010) count were predictors of PTBM. During follow-up, patients with BM had a significantly longer duration from onset of bronchoscopic intervention than patients without BM (hazard ratio=2.412, P<0.0001). Further, all patients needing long-term bronchoscopic intervention therapy were subsequently identified as having PTBM. Additionally, blood PLT counts were significantly decreased to normal levels in the non-BM group (P<0.05), but not in the BM group (P>0.05). CONCLUSIONS PTBM is most likely to occur in the left main bronchus. The inflammatory and immune responses associated with NEUT and PLT may represent therapeutic targets of PTBM. Our study is the first to report that decreased blood PLT count has the potential to monitor the treatment response.

Vitamin D deficiency and exercise-induced laryngospasm in young competitive rowers.

Exercise-induced dyspnea is common among adolescents and young adults and often originates from exercise-induced bronchoconstriction (EIB). Sometimes, dyspnea corresponds to exercise-induced laryngospasm (EILO), which is a paradoxical decrease in supraglottic/glottic area. Vitamin D deficiency, which occurs frequently at northern latitudes, might favor laryngospasm by impairing calcium transport and slowing striate muscle relaxation. The aim of this study was to evaluate whether vitamin D status has an influence on bronchial and laryngeal responses to exercise in young, healthy athletes. EIB and EILO were investigated during winter in 37 healthy competitive rowers (24 males; age range 13-25 years), using the eucapnic voluntary hyperventilation test (EVH). EIB was diagnosed when forced expiratory volume in the first second decreased by 10%, EILO when maximum mid-inspiratory flow (MIF50) decreased by 20%. Most athletes (86.5%) had vitamin D deficiency (below 30 ng/mL), 29 mild-moderate (78.4%) and 3 severe (8.1%). EVH showed EIB in 10 subjects (27%), EILO in 16 (43.2%), and combined EIB and EILO in 6 (16.2%). Athletes with EILO had lower vitamin D (19.1 ng/mL vs. 27.0 ng/mL, p < 0.001) and higher parathyroid hormone (30.5 pg/mL vs. 19.2 pg/mL, p = 0.006) levels. The degree of laryngoconstriction (post-EVH MIF50 as a percentage of pre-EVH MIF50) was related directly with vitamin D levels (r = 0.51; p = 0.001) and inversely with parathyroid hormone levels (r = -0.53; p = 0.001). We conclude that vitamin D deficiency is common during winter in young athletes living above the 40th parallel north and favors laryngospasm during exercise, probably by disturbing calcium homeostasis. This effect may negatively influence athletic performance.

Bronchoalveolar lavage fluid and serum canine surfactant protein A concentrations in dogs with chronic cough by bronchial and interstitial lung diseases.

We measured bronchoalveolar lavage fluid (BALF) and serum canine surfactant protein (cSP)-A concentrations in dogs with chronic cough. There were no significant differences between bronchial and interstitial lung diseases in BALF cSP-A concentrations. However, serum cSP-A concentrations in dogs with the interstitial lung disease as diffuse panbronchiolitis and idiopathic pulmonary fibrosis were significantly higher than those in dogs with the bronchial disease as chronic bronchitis. These results suggest that serum cSP-A concentrations may be a useful and noninvasive biomarker to understand the existence of interstitial lung damage in dogs with chronic cough.

[Proteasomes and their role in the extracellular space].

The presented review concerns the intracellular proteasome and their possible functions. The ubiquitin-proteasome system (UPS) is responsible for the common regulated proteolysis in the cell. 26S proteasome is a central proteolytic unit of UPS and is a multisubunit protein complex consisting of a core catalytic complex, called 20S proteasome, capped at one or both ends by 19S regulatory complex. Proteasomes have been shown in the extracellular space: in alveolar and cerebrospinal fluids, blood plasma. Extracellular proteasomes are intact intracellular particles that exhibit three types of specific peptidase activity. Extracellular proteasomes have been detected in both healthy people and patients with different diseases. Its concentration has been found to be increased in patients suffering from autoimmune diseases, malignant tumors, trauma or sepsis and to correlate with the disease progression, which has both diagnostic and prognostic value.

[The endothelin-1 and von Willebrand factor in the development of lung hypertension in children with chronic bronchopulmonary pathology].

The assessment of the indicators of functional state of endothelium (endothelin-1 level and von Willebrand factor activity) was implemented in healthy children and patients with bronchopulmonary pathology with normal and high pressure in pulmonary artery It is established that pulmonary hypertension in children with chronic bronchopulmonary pathology is associated with the endothelium dysfunction (increase of endothelin-1 concentration and activity of von Willebrand factor). The direct dependence of evidence of the pulmonary hypertension from the level of endothelin-1 and activity of von Willebrand factor is proved. The increase of the level of endothelin-1 and the activity of von Willebrand factor is a risk factor of the development of pulmonary hypertension in children with chronic bronchopulmonary pathology.

Brief report: airways abnormalities and rheumatoid arthritis-related autoantibodies in subjects without arthritis: early injury or initiating site of autoimmunity?

OBJECTIVE: To evaluate the presence of pulmonary abnormalities in rheumatoid arthritis (RA)-related autoantibody-positive subjects without inflammatory arthritis. METHODS: Forty-two subjects who did not have inflammatory arthritis but were positive for anti-cyclic citrullinated peptide antibodies and/or ≥2 rheumatoid factor isotypes (a profile that is 96% specific for RA), 15 autoantibody-negative controls, and 12 patients with established seropositive early RA (<1-year duration) underwent spirometry and high-resolution computed tomography (HRCT) lung imaging. RESULTS: The median age of autoantibody-positive subjects was 54 years, 52% were female, and 38% were ever-smokers; these characteristics were not significantly different from those of autoantibody-negative control subjects. No autoantibody-positive subject had inflammatory arthritis based on joint examination. HRCT revealed that 76% of autoantibody-positive subjects had airways abnormalities including bronchial wall thickening, bronchiectasis, centrilobular opacities, and air trapping, compared with 33% of autoantibody-negative controls (P = 0.005). The prevalence and type of lung abnormalities among autoantibody-positive subjects were similar to those among patients with early RA. In 2 autoantibody-positive subjects with airways disease, inflammatory arthritis classifiable as articular RA developed ∼13 months after the lung evaluation. CONCLUSION: Airways abnormalities that are consistent with inflammation are common in autoantibody-positive subjects without inflammatory arthritis and are similar to airways abnormalities seen in patients with early RA. These findings suggest that the lung may be an early site of autoimmune-related injury and potentially a site of generation of RA-related autoimmunity. Further studies are needed to define the mechanistic role of lung inflammation in the development of RA.

[Management of malignant and benign airway stenosis by stent implantation]. / Malignus és benignus légúti szukületek megoldása légúti protézis (stent) beültetésével.

INTRODUCTION: In the last few decades the different bronchoscopic procedures have gained an important role in the treatment of airway stenosis, and the number of implanted airway stents has also greatly increased. PATIENTS: Between 1998 and 2004 the authors implanted altogether 108 airway prosthesis in 90 patients at the Institute of Pulmonology of Pest County. 58% of the patients were males, 42% females, the average age was 57.5 years, the average follow-up time was 7 months. RESULTS: On the basis of different etiology the patients were separated into two main groups. In 57% the airway stenosis was caused by malignant illnesses, in these cases stents can be used only with palliative purpose. However, in case of benign lesions they can offer a long-term solution and require an adequate follow-up of the patients. The authors' main aim was to get an overall picture of the interventions they had done by processing the data, with the help of the measurable characteristics that make possible to follow the airways' permeability and its changes. Analysing the results of the respiratory function and blood gas examinations they didn't find a significant difference inspite of the subjective improvement.

Low fasting serum triglyceride and high free fatty acid levels in pulmonary fibrosis: a previously unreported finding.

OBJECTIVE: The authors describe here the occurrence of low fasting serum triglyceride (TG) and high free fatty acid (FFA) levels in pulmonary fibrosis, a finding that has never been reported before. PATIENTS AND METHODS: TGs were measured in: (a) 44 patients (3 male and 41 female; mean age SEM: 63.06 +/- 4.04 years) who have been hospitalized in the authors' department in the past 2 years for chronic interstitial or fibrosing pulmonary disease (FP); (b) 20 patients (4 male and 16 female; mean age: 69.80 +/- 2.96 years) affected by various nonfibrosing pneumopathies or bronchopathies (NFP); (c) 110 control subjects (CS), composed of 15 male and 95 female consecutive patients (mean age: 67.52 +/- 1.52 years) hospitalized in 1999 for minor nonlung-related illnesses. In 24 FP and 36 CS patients, FFA have also been measured. All subjects investigated had no clinical or laboratory evidences of liver, kidney, or thyroid diseases, nor a history of hormonal treatment, alcohol consumption, smoking, or dietary disorders. None of the subjects investigated was under treatment with lipid lowering agents or with other drugs that could affect the levels of TG or FFA or their measurement (including ascorbic acid). RESULTS: Compared with CS, the FP group showed a 61% reduction of TG (0.64 +/- 0.03 vs 1.63 +/- 0.08 mmol/L; P <.001), whereas no significant difference was observed between NFP and CS groups. Serum FFA in FP showed a 63% increase compared with CS (P <.01). In the FP group, TGs were also low in 5 patients with type 2 diabetes (0.76 +/- 0.11 mmol/L, -53%, P <.001) and in 6 obese (body mass index [BMI] > 29 kg/m2) subjects (0.51 +/- 0.03, -69%, P <.01), although it is known that TGs are often elevated in diabetes and obesity. CONCLUSIONS: Chronic interstitial or pulmonary fibrosis is associated with low TG and high FFA levels. Although it is known that the lung contains lipoprotein lipase and is a significant source of plasma postheparin lipase activity, the mechanisms of this change remain to be clarified. Since insulin-like growth factor-I (IGF-I) is known to lower TG and increase FFA, a role could be played by the enhanced production of IGF-I that has been reported to occur in pulmonary fibrosis.

[Pulmonary surfactant and blood serum in patients with chronic obstructive bronchitis on differentiated therapy]. / Surfaktant legkikh i syvorotki krovi u bol'nykh khronicheskim obstruktivnym bronkhitom v usloviiakh differentsirovannoi terapii.

The paper analyzes particular features of the clinical course, endoscopic changes, and dynamics of parameters, characterizing surfactant homeostasis in 60 patients with chronic obstructive bronchitis. In the treatment of 30 patients it was only the basic therapy options that were employed, other thirty patients received cyclopheron in addition to the above basic therapy. A positive dynamics of the illness was to be seen in all patients but those patients in whom the basic therapy treatments were supplemented with cyclopheron exhibited a higher clinical effect. The outlined positive dynamics has been shown to be accompanied by improvement of parameters for dynamic interphase tensiometry and rheometry of blood serum and expired air humidity condensate reflecting the state of surfactant homeostasis.

[Alkaline phosphatase isoenzymes in serum and bronchoalveolar lavage from patients with bronchopulmonary disease]. / Isoenzimas de fosfatasa alcalina en el suero y lavado broncoalveolar de pacientes con patología broncopulmonar.

OBJECTIVE: In this study, we are looking at the principal isoenzymes of alkaline phosphatase (ALP), as injury markers of cellular membranes from bronchial epithelium, in 80 patients diagnosed with bronchopulmonary pathology from different ethology, using serum samples and bronchoalveolar lavage fluid (BAL). METHOD: Patients were grouped according to age as following: 26 preterm neonates suffering respiratory distress syndrome requiring mechanical ventilation; 32 children ranging from 2 to 12 years old, and 22 adults (30-65 years old) examined by bronchoscopy for the purpose of diagnosis. Results obtained from all pathological groups were compared with a control group showing similar characteristics. Isoenzymes were separated by electrophoresis on agarose gel and were quantified by desitometry. Total protein was measured in BAL; ALP activity was expressed in UI/mg x 10-3 of protein. RESULTS: We found that macromolecular ALP fraction was significantly increased in the serum of neonates with distress (p < 0.01), in the patients 2-12 years and adults affected by pulmonary pathology (p < 0.001). The electrophoresis of ALP isoenzymes showed a unique isoenzymatic band corresponding with its macromolecular fraction in the BAL fluid. CONCLUSIONS: We conclude that increased macromolecular fraction of alkaline phosphatase found in the serum of patients diagnosed with respiratory problems could have its origin in damaged pulmonary tissue.

Isoenzimas de fosfatasa alcalina en el suero y lavado broncoalveolar de pacientes con patología broncopulmonar / Alkaline phosphatase isoenzymes in serum and bronchoalveolar lavage from patients with bronchopulmonary disease

Objetivo: Se estudiaron las principales isoenzimas de la fosfatasa alcalina (ALP) como marcadores de lesión de las membranas celulares del epitelio bronquial, utilizando suero y líquido procedente del lavado broncoalveolar (LBA), en 80 enfermos con patología broncopulmonar de etiología diversa. Método: Los enfermos se clasificaron, atendiendo a su edad, en tres grupos, comparándose los resultados de cada grupo patológico con un grupo control de características similares: 26 recién nacidos prematuros, con distress respiratorio grave, que precisaron ventilación mecánica; 32 niños entre 2-12 años con broncopatía obstructiva y 22 adultos (30-65 años) sometidos a broncoscopia y LBA con fines diagnósticos. Las isoenzimas se separaron por electroforesis sobre gel de agarosa y se cuantificaron por densitometría. En el LBA se midieron proteínas totales, expresándose la actividad de ALP en UI/mg de proteína ¥ 10-3. Resultado: Encontramos la fracción macromolecular de ALP significativamente aumentada en el suero de los neonatos con distress (p<0,01), en los enfermos de 2-12 años y en los adultos patológicos estudiados (p<0,001). La electroforesis de isoenzimas de ALP en el LBA mostró una única banda isoenzimática, correspondiente a su fracción macromolecular. Conclusiones: El aumento de la fracción macromolecular de la ALP en el suero de los enfermos con problemas respiratorios podría tener su origen en el tejido pulmonar dañado. Fosfatasa Alcalina. Isoenzimas. Enfermedad Broncopulmonar. Lavado Broncoalveolar (AU)

Tracheobronchopathia osteochondroplastica.

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder with unknown aetiology. We report one case of TO in a patient with non-Hodgkin pulmonary lymphoma and benign epidermal and trichylemmal cysts on the periorbital region and scalp. To the authors' knowledge, the coincidence of these processes has never been described before. The case was evaluated with conventional X-ray, computed tomography, magnetic resonance imaging, fibre-optic bronchoscopy with 2 months interval, histopathological evaluation, Tc-99 m MDP bone scintigraphy and microbiological studies including PCR testing of bronchial biopsy and lavage specimens for Mycobacterium tuberculosis. Additionally, case reports of TO in the Turkish literature are summarized.

Priming of blood neutrophils in children with cystic fibrosis: correlation between functional and phenotypic expression of opsonin receptors before and after platelet-activating factor priming.

Blood phagocyte opsonin receptor CR1 (CD35) and CR3 (CD11b) functions were examined in cystic fibrosis (CF) patients with endobronchial Staphylococcus aureus or Pseudomonas aeruginosa chronic infection, CF patients without infection, heterozygous, non-CF patients with chronic pulmonary infection, and healthy controls. Circulating and platelet-activating factor (PAF)-primed phagocyte luminol luminescence responses to complement-opsonized zymosan were increased in both groups of infected CF and non-CF children relative to uninfected CF children and healthy control children and adults. The ratio between circulating and PAF-primed phagocyte responses was significantly elevated in all children with CF, and in these, the ratio could serve as an indicator of response to antibiotic treatment. The ratios of circulating and PAF-primed phenotypic expression for CR1, CR3, and FcgammaRIII (CD16), but not FcgammaRII (CD32), correlated with the functional ratios. Phagocyte opsonin receptor response capacity might be used for evaluation of inflammation and infection in CF patients.

Veterinary practice and occupational health. An epidemiological study of several professional groups of Dutch veterinarians. I. General physical examination and prevalence of allergy, lung function disorders, and bronchial hyperreactivity.

The prevalence of allergy, lung function disorders, and bronchial hyperreactivity was studied in 102 Dutch veterinarians, subdivided into five professional groups (predominantly working with either swine, cattle, poultry, companion animals, or as a non-practitioner). The mean age of the participants was 43 years; 6 participants were females. Twenty-two per cent of the participants were overweight, and relatively more non-practitioners than practitioners were overweight. Approximately 23% of the vets reported complaints of prolonged fatigue. The data suggest a relationship between complaints of prolonged fatigue and a more than average number of daily working hours. Only a small proportion of vets were sensitized against several allergens. There were no significant differences in prevalence of distinct lung function disorders or bronchial hyperreactivity between professional groups. It is hypothesized that the respiratory complaints (chronic coughing, chronic phlegm production, stuffed nose, sneezing) reported by the vets predominantly working in swine and/or poultry practice could be caused by irritation and/or inflammation of the first part of the trachea-bronchial tree that has no measurable and permanent consequences for changes in lung function or increased bronchial hyperreactivity. The results of a skin test against allergens and determination of allergen-specific IgE in blood indicated that the respiratory complaints were probably not related to allergy against the panel of allergens tested.

[CYFRA 21-1 and bronchial cancer]. / CYFRA 21-1 et cancers bronchiques.

CYFRA is a new marker which measures a fragment of cytokeratin 19 in the serum by an immune radiometric method. The test is based on the preservation of the cytokeratin expression on the epithelial cells during the course of malignant transformation. In immuno-histochemistry the antibodies which selectively recognise cytokeratin react with all histological types of bronchial cancer. The presence of cytokeratin in the serum of patients suffering from cancer would be linked to their liberation during the course of cellular death. The threshold of specificity for CYFRA 21-1 is 3.3.3.6 ng/ml in a population suffering from benign respiratory diseases. The study performed in bronchial cancer produced the following conclusions: the marker is, above all, useful for epidermoid cancer; it is more discriminating than other markers to separate bronchial cancers and non-malignant respiratory disease. An elevated level of CYFRA 21-1 is predictive of advanced disease but does not permit any prediction as to inoperability. In 65% of cases, variations of CYFRA 21-1 are concordant with the stage of the disease during chemotherapy. Finally, elevated levels of CYFRA 21-1 predict a poor prognosis independent of the state of the disease.

[Disorders of interferon status in bronchopulmonary diseases in children living under conditions of elevated background radiation]. / Narushenie interferonovogo statusa pri bronkholegochnykh zabolevaniikh u detei, prozhivaiushchikh v usloviiakh povyshennogo radiatsionnogo fona.

Impairments in the interferon status of children with chronic and recurring diseases of the respiratory organs were investigated and its correction was shown possible with the use of alpha 2-interferon (reaferon). Suppression of the interferon-producing capacity of the immunocytes was observed in all the cases of the disease aggravation. The level of the suppression correlated with the severity of the infection. In the patients affected by radiation the suppression of the interferonogenesis was more marked. However, in these cases no dependence of the detected impairments in the interferon status on the level of the radiation pollution of the territory of the children residence was shown. The inclusion of reaferon to the basal therapy resulted in a significant increase of the alpha-interferon production in the cases of bronchial asthma and asthmatic bronchitis as well as its recovery to the normal in the cases of recurring bronchitis and chronic pneumonia. In all the cases of bronchopulmonary diseases only a tendency towards normalization of the alpha-interferon indices was recorded.

[Polyglobulia and bronchopneumopathies: correlations of ferritin and other ferric parameters with various erythrocytic indexes]. / Poliglobulia y bronconeumopatías: correlaciones de la ferritina y otros parámetros férricos con diversos índices eritrocíticos.

In 15 patients with chronic bronchopneumopathy (7 with polyglobulia and 8 without it), we observed that polyglobulic patients had higher average levels of sideremia and basal saturation of transferrin and lower levels of HCM, CHCM and VCM. No significant differences were observed in the average levels of ferritin between both groups. Overall, in this series of 15 patients, a significant inverse correlation was observed between sideremia and HCM (r = -0.52; p < 0.05) and between sideremia and CHCM (r = -0.55, p < 0.5), as well as a trend towards a direct correlation between sideremia and the red blood cells count (r = 0.45, N.S.). There was also a direct correlation between serum ferritin and the sedimentation rate (r = 0.72, p < 0.01) and trends towards inverse correlations although not significant, between ferritin and sideremia (r = -0.25, N.S.). These data reflect a hyperconsumption of iron in the respiratory polyglobulia, with some relative deficit, suggesting as well that serum ferritin is not a good enough criteria in these cases for the evaluation of iron deposits, because it behaves like the sedimentation rate with respect to acute phase reactants when there is inflammation.

Polymyxin B-induced bronchial neutrophilia does not alter airway responsiveness to methacholine in cynomolgus monkeys.

The purpose of this study was to develop a primate model of chronic bronchial neutrophilia to investigate the role of neutrophils in the pathogenesis of airway hyperresponsiveness. Ten adult male cynomolgus monkeys (Macaca fascicularis) were anaesthetized and intubated for each study. Six animals each received a total of seven inhalation treatments with polymyxin B (200 micrograms) over a 24 day period. Four control animals received an identical treatment regime with vehicle inhalations. Airway cellular composition was assessed by bronchoalveolar lavage (BAL). Airway responsiveness was assessed by methacholine cumulative dose response determinations. There were no significant changes in airway cellular composition or airway responsiveness in the control group. In contrast, Polymyxin B inhalation resulted in an influx of neutrophils (PMN) into the lungs which peaked at day 10 of the study (%PMN in BAL fluid rose from 5 +/- 2 to 51 +/- 8, P less than 0.001) and persisted out to day 24 (41 +/- 8, P less than 0.01). Increases in PMNs were associated with an increase in BAL levels of myeloperoxidase (MPO levels in BAL fluid increased from 2 +/- 3 to 180 +/- 23 OD P less than 0.05). Although airway PMN percentages and MPO concentrations were chronically elevated, airway responsiveness did not change. These results suggest that the neutrophil does not play a functional role in the onset of hyperresponsive airways in primates.

[Study of cells harvested in nasal secretions after lavage. Improvement of the cytologic technique and application to ORL and bronchial pathology]. / Etude des cellules recueillies dans les secrétions nasales apres lavage. Mise au point de la technique cytologique et application aux pathologies orl et bronchiques.

The study of the cells found in the nasal lavage fluid is now a very used method. It has many advantages and it is better than the study of nasal smears obtained by nose blowing and/or swabbing. In this work, we have studied the nasal cytology of patients with a nasal or bronchial pathology. A count of inflammatory cells in a hemocytometer is performed in 301 noses then the percentage of various cell types (eosinophils, lymphocytes and neutrophils) is performed on a glass slide stained by May Grunwald Giemsa. The results are correlated with the literature. The patients with a known NARES have a mean nasal eosinophilia of 26.8%; in the allergic rhinitis, the eosinophilia is 41.4%; the patients with a Fernand Widal Syndrome or with a nasosinusal polyposis have respectively a eosinophil percentage of 24.2% and 18.8%.

[Effect of infusion hemodilution on the indicators of the blood coagulation system in children during planned thoracic operations]. / Vliianie infuzionnoi gemodiliutsii na pokazateli svertyvaiushchei sistemy krovi u detei pri provedenii planovykh torakal'nykh operatsii.

The blood coagulation system and fibrinolysis were studied in 16 children with chronic bronchopulmonary diseases, aged from 4 to 15 years, before surgery, immediately, and on the first day after the operation. The method of infusion hemodilution, under the control of hematocrit, hemoglobin and total protein, was used for the treatment of operation hemorrhage. The investigations conducted have revealed hypercoagulation signs in the patients before the beginning of the operation (as compared to normal children). Operative intervention has intensified many signs of hypercoagulation, however, in the postoperative period no clinical signs of hypercoagulation were observed in all the cases, that was associated with the positive effect of hemodilution.