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1.
Medicine (Baltimore) ; 100(35): e27040, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477134

RESUMO

ABSTRACT: To investigate the clinical and pathological characteristics in patients with pulmonary inflammatory pseudotumors (PIP).This retrospective study included 31 patients with PIP from 2001 to 2019. Preoperative computed tomography scan was performed in all patients. Clinical and pathological characteristics were collected and analyzed.Thirty-one patients (16 female and 15 male) were recruited, with a median age of 57 years (range, 11-72 years). Eight (25.8%) patients were asymptomatic, and the others had symptoms characterized by cough with sputum, chest and back pain, dry cough, fever and blood in sputum, or hemoptysis. All cases were single lesions, including 23 cases in the right lung, and 8 cases in the left lung. Computed tomography scan demonstrated irregular lobulated nodules or masses in 14 patients, and regular round or oval nodules or masses in 11 cases. The blurred edge of tumors and spiculation was found in 12 cases. Microscopic results were characterized by the collection of inflammatory mesenchymal cells. Immunohistochemical examination showed vimentin, smooth muscle actin, and anaplastic lymphoma kinase positive. Complete tumor resection was obtained in all cases. No recurrence or metastasis was observed during the follow-up period.PIP has a variety of manifestations. Preoperative diagnosis is difficult to reach. The final diagnosis still depends on the pathological and immunohistochemical examination. Complete surgical resection is the main treatment at present, and the overall prognosis is good.


Assuntos
Granuloma de Células Plasmáticas/patologia , Adolescente , Adulto , Idoso , Criança , Feminino , Granuloma de Células Plasmáticas/epidemiologia , Granuloma de Células Plasmáticas/fisiopatologia , Humanos , Pulmão/patologia , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome , Tomografia Computadorizada por Raios X/métodos
2.
Sci Rep ; 11(1): 17798, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493765

RESUMO

There is increasing evidence of cardiac involvement post-SARS-CoV-2 infections in symptomatic as well as in oligo- and asymptomatic athletes. This study aimed to characterize the possible early effects of SARS-CoV-2 infections on myocardial morphology and cardiopulmonary function in athletes. Eight male elite handball players (27 ± 3.5 y) with past SARS-CoV-2 infection were compared with four uninfected teammates (22 ± 2.6 y). Infected athletes were examined 19 ± 7 days after the first positive PCR test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed (- 17.7% vs. - 18.1%). However, magnetic resonance imaging showed minor signs of acute inflammation/oedema in all infected athletes (T2-mapping: + 4.1 ms, p = 0.034) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (- 292 ml/min, - 7.0%), oxygen pulse (- 2.4 ml/beat, - 10.4%), and respiratory minute volume (VE) (- 18.9 l/min, - 13.8%) in athletes with a history of SARS-CoV2 infection (p < 0.05, respectively). The parameters were unchanged in the uninfected teammates. SARS-CoV2 infection caused impairment of cardiopulmonary performance during physical effort in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection with spiroergometry to identify performance limitations and to guide the return to competition.


Assuntos
Atletas/estatística & dados numéricos , Desempenho Atlético/estatística & dados numéricos , COVID-19/fisiopatologia , Coração/fisiopatologia , Pulmão/fisiopatologia , Adulto , Infecções Assintomáticas , Desempenho Atlético/fisiologia , COVID-19/diagnóstico , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19/estatística & dados numéricos , Ecocardiografia/estatística & dados numéricos , Teste de Esforço/estatística & dados numéricos , Alemanha , Coração/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , RNA Viral/isolamento & purificação , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , SARS-CoV-2/patogenicidade , Espirometria/estatística & dados numéricos , Adulto Jovem
4.
Medicine (Baltimore) ; 100(33): e26976, 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34414971

RESUMO

BACKGROUND: We sought to synthesize the evidence about aerobic exercise intervention during pulmonary rehabilitation, and to further explore the difference in rehabilitation effects between water and land-based aerobic exercise. This review's purpose is to provide a basis by which practitioners and therapists can select and create appropriate therapeutic programs. METHODS: Data of randomized and quasi-randomized controlled trials comparing training group (TG, aerobic exercise in water or land) and control group (CG, usual care) in chronic obstructive pulmonary disease (COPD) patients (January 1, 2000-December 28, 2019) were obtained from the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, and Wanfang databases. Two researchers independently reviewed the literature, extracted the data, and evaluated the quality of the literature. Review Manager software (Rev Man 5.3; Cochrane, London, UK) was used for meta-analysis. The rehabilitation effect of water- or land based aerobic exercise was evaluated by subgroup analysis. The proposed systematic review details were registered in PROSPERO (CRD 42020168331). RESULTS: Eighteen studies (1311 cases of COPD) were included. Meta-analysis results show that compared with the control group, the dyspnea level and functional and endurance exercise capacity in COPD patients were significantly improved after aerobic exercise (P < .05), but there was no significant change in lung function (P > .05). Compared with land-based aerobic exercise, water-based aerobic exercise significantly improved the endurance exercise capacity in COPD patients (mean difference [MD]: 270.18, 95% CI: 74.61-465.75). CONCLUSION: Medium to high-quality evidence shows that aerobic exercise can effectively improve dyspnea and exercise capacity in COPD patients. Compared with land-based aerobic exercise, water-based aerobic exercise had a significant additional effect in improving the endurance exercise capacity of COPD patients.


Assuntos
Dispneia/etiologia , Tolerância ao Exercício , Exercício Físico , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doença Pulmonar Obstrutiva Crônica/terapia , Dispneia/fisiopatologia , Dispneia/reabilitação , Dispneia/terapia , Exercício Físico/fisiologia , Tolerância ao Exercício/fisiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Água
5.
Br J Radiol ; 94(1125): 20201380, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415201

RESUMO

OBJECTIVE: There is limited and contradictory information about pulmonary perfusion changes detected with dual energy computed tomography (DECT) in COVID-19 cases. The purpose of this study was to define lung perfusion changes in COVID-19 cases with DECT, as well as to reveal any possible links between perfusion changes and laboratory findings. METHODS: Patients who had a positive RT-PCR for SARS-CoV-2 and a contrast-enhanced chest DECT examination were included in the study. The pattern and severity of perfusion deficits were evaluated, as well as the relationships between perfusion deficit severity and laboratory results and CT severity ratings. The paired t-test, Wilcoxon test, and Student's t-test were used to examine the changes in variables and perfusion deficits. p < 0.05 was regarded as statistically significant. RESULTS: Study population consisted of 40 patients. Mean age was 60.73 ± 14.73 years. All of the patients had perfusion deficits at DECT images. Mean perfusion deficit severity score of the population was 8.45 ± 4.66 (min.-max, 1-19). In 24 patients (60%), perfusion deficits and parenchymal lesions matched completely. In 15 patients (37.5%), there was partial match. D dimer, CRP levels, CT severity score, and perfusion deficit severity score all had a positive correlation. CONCLUSIONS: Perfusion deficits are seen not only in opacification areas but also in parenchyma of normal appearance. The CT severity score, CRP, D-dimer, and SpO2 levels of the patients were determined to be related with perfusion deficit severity. ADVANCES IN KNOWLEDGE: Findings of the current study may confirm the presence of micro-thrombosis in COVID-19 pneumonia.


Assuntos
COVID-19/fisiopatologia , Pulmão/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Adulto Jovem
6.
PLoS One ; 16(8): e0256469, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34432821

RESUMO

The current COVID-19 pandemic has led the world to an unprecedented global shortage of ventilators, and its sharing has been proposed as an alternative to meet the surge. This study outlines the performance of a preformed novel interface called 'ACRA', designed to split ventilator outflow into two breathing systems. The 'ACRA' interface was built using medical use approved components. It consists of four unidirectional valves, two adjustable flow-restrictor valves placed on the inspiratory limbs of each unit, and one adjustable PEEP valve placed on the expiratory limb of the unit that would require a greater PEEP. The interface was interposed between a ventilator and two lung units (phase I), two breathing simulators (phase II) and two live pigs with heterogeneous lung conditions (phase III). The interface and ventilator adjustments tested the ability to regulate individual pressures and the resulting tidal volumes. Data were analyzed using Friedman and Wilcoxon tests test (p < 0.05). Ventilator outflow splitting, independent pressure adjustments and individual tidal volume monitoring were feasible in all phases. In all experimental measurements, dual ventilation allowed for individual and tight adjustments of the pressure, and thus volume delivered to each paired lung unit without affecting the other unit's ventilation-all the modifications performed on the ventilator equally affected both paired lung units. Although only suggested during a dire crisis, this experiment supports dual ventilation as an alternative worth to be considered.


Assuntos
Pulmão/fisiopatologia , Síndrome do Desconforto Respiratório/fisiopatologia , Ventiladores Mecânicos , Animais , Pressão Sanguínea , Dióxido de Carbono/química , Simulação por Computador , Modelos Animais de Doenças , Frequência Cardíaca , Concentração de Íons de Hidrogênio , Suínos , Volume de Ventilação Pulmonar
8.
Medicine (Baltimore) ; 100(31): e26813, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397840

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) as a fatal epidemic has swept across the world, especially in India where the epidemic situation is the most serious. For COVID-19 patients, pulmonary rehabilitation training plays a significant role. However, it is still a controversial issue regarding the efficacy of WeChat APP-based pulmonary rehabilitation training in improving lung function, quality of life and bad mood of COVID-19 patients. To clarify this issue, a meta-analysis was conducted in this present study, so as to provide a basis for rehabilitation guidance of COVID-19 patients. METHODS: We systematically searched PubMed, medRxiv, Web of Science, Scopus, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and Wan-fang databases in May 2021 to identify randomized controlled trials and evaluate the effects of WeChat APP-based pulmonary rehabilitation training for COVID-19. Two researchers independently carried out data extraction. On the other hand, literature quality evaluation on the quality and meta-analysis of the included literature was performed with Revman5.3 software. RESULTS: The results of this meta-analysis will be submitted to a peer-reviewed journal for publication. CONCLUSION: This study will provide reliable evidence-based evidence on the effects of WeChat APP-based pulmonary rehabilitation training on lung function, bad mood, and quality of life in patients with COVID-19. ETHICS AND DISSEMINATION: Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/MKXCH.


Assuntos
Protocolos Clínicos , Reabilitação/instrumentação , Mídias Sociais/instrumentação , Ensino/normas , COVID-19/psicologia , COVID-19/terapia , Humanos , Pulmão/fisiopatologia , Metanálise como Assunto , Transtornos do Humor/etiologia , Transtornos do Humor/psicologia , Qualidade de Vida/psicologia , Reabilitação/métodos , Reabilitação/psicologia , Revisões Sistemáticas como Assunto
9.
Medicine (Baltimore) ; 100(31): e26866, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397864

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak began in late 2019 and spread rapidly throughout China and then the rest of the world. COVID-19 is a serious respiratory disease and many patients' exhibit varying levels of persistent parenchymal lung damage. However, there is currently a lack of effective rehabilitation treatments for COVID-19 patients with lung damage. Several clinical trials have shown that Liuzijue Qigong (LQG) can enhance the strength of respiratory muscles and overall quality of life. In this study, a meta-analysis approach was used to assess the effects of LQG on the lung function of COVID-19 patients during disease recovery. METHODS: Eight databases will be explored for relevant investigations including China National Knowledge Infrastructure, Wanfang, VIP, China Biology Medicine, EMBASE, PubMed, Web of Science, and the Cochrane Library. All databases will be explored for articles published from inception through July 2021. Data will be extracted independently by 2 researchers according to the eligibility criteria. Finally, RevMan 5.3.0 will be implemented for statistical analyses. RESULTS: The results of this study will show the effects of LQG on the lung function of COVID-19 patients during disease recovery and will be submitted to a peer-reviewed journal for publication. CONCLUSIONS: This study will provide reliable evidence based on the effects of LQG on the lung function of COVID-19 patients during disease recovery. TRIAL REGISTRATION NUMBER: CRD42021268102.


Assuntos
COVID-19/terapia , Protocolos Clínicos , Pulmão/anormalidades , Qigong/normas , COVID-19/psicologia , Humanos , Pulmão/fisiopatologia , Metanálise como Assunto , Qigong/métodos , Testes de Função Respiratória/métodos , Revisões Sistemáticas como Assunto , Resultado do Tratamento
10.
Clin Immunol ; 230: 108827, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34428741

RESUMO

BAL cellularity and lymphocyte immunophenotyping offer insights into lung inflammatory status. Natural killer (NK) cells are efficient effector cells, producing pro-inflammatory cytokines. A better understanding of the biology of NK cells in BAL in the lungs is necessary to improve the pathogenesis of fibrotic ILD and develop prospective targeted treatments. Our aim was to analyse NK and NKT-like cell percentages in BAL from 159 patients with different ILD: f-HP, f-NSIP, IPF and CTD-ILD, to evaluate their potential diagnostic/prognostic role. BAL NK cell percentages showed significantly higher values in IPF than in f-HP and f-NSIP, while BAL NKT-like cells showed significantly lower values in the f-NSIP than the f-HP and IPF. A cut-off of 4%NK cells in BAL of IPF showed a significant difference in survival rate. It suggests a possible new marker of survival and raises the possibility of new targeted approach in treatment and management of IPF.


Assuntos
Células Matadoras Naturais/imunologia , Doenças Pulmonares Intersticiais/imunologia , Idoso , Idoso de 80 Anos ou mais , Alveolite Alérgica Extrínseca/imunologia , Alveolite Alérgica Extrínseca/patologia , Alveolite Alérgica Extrínseca/fisiopatologia , Líquido da Lavagem Broncoalveolar/citologia , Líquido da Lavagem Broncoalveolar/imunologia , Doenças do Tecido Conjuntivo/imunologia , Doenças do Tecido Conjuntivo/patologia , Doenças do Tecido Conjuntivo/fisiopatologia , Feminino , Fibrose , Humanos , Fibrose Pulmonar Idiopática/imunologia , Fibrose Pulmonar Idiopática/patologia , Fibrose Pulmonar Idiopática/fisiopatologia , Imunofenotipagem , Estimativa de Kaplan-Meier , Células Matadoras Naturais/classificação , Células Matadoras Naturais/patologia , Pulmão/imunologia , Pulmão/patologia , Pulmão/fisiopatologia , Doenças Pulmonares Intersticiais/patologia , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Células T Matadoras Naturais/classificação , Células T Matadoras Naturais/imunologia , Células T Matadoras Naturais/patologia , Prognóstico , Testes de Função Respiratória
11.
Ulus Travma Acil Cerrahi Derg ; 27(4): 410-420, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34212994

RESUMO

BACKGROUND: Organ failures that develop due to acute pancreatitis (AP), some laboratory values and the anthropometric characteristics of the patients have been shown to play a role in the prognosis AP and have been increasingly used to investigate the prognosis of the disease although classification systems, such as Ranson's criteria, are still used habitually. In this stud, we aimed to investigate the relationship of the organ failures observed during the course of AP, the biochemical parameters and the anthropometric characteristics of the patients and compare using Ranson's and Atlanta Classifica-tion (AC) systems. METHODS: Laboratory values, anthropometric data, including the waist circumference and body mass index, Systemic inflammatory response syndrome (SIRS) and organ failures developed during the course of the disease, were investigated prospectively in 153 AP patients and the Ranson and Modified Atlanta Classifications (MAC) were made. RESULTS: A relationship was observed between the organ failures that were established in the course of the disease (lung, liver, kidney, heart and MOF (multiple organ failure)) and higher Ranson's and MAC scores (p<0.05). Among the patients included in this study, 13 (8.4%) had multiple organ failure and 17 (11.1%) had SIRS. Exitus occurred in 10 patients (6.5%). A statistically significant relationship was found with organ failure, multiple organ failure and SIRS; and ensuing exitus (p<0.05). While no relationship was observed between the waist circumference, body mass index, Ranson's score, there was a significant relationship between the MAC and the waist circumference (p<0.01). Among the laboratory values, high urea and ALT values showed a relationship with the Ranson and MAC (p<0.001), while between the CRP values tested at the 0 time point and the 48th hour, only the CRP value at the 48th hour had a relationship with Ranson's score (p<0.05). Organ failure, MOF, and SIRS showed a correlation with both the severity scores and the mortality rate. In addition, a significant corre-lation was observed between the cholesterol, triglycerides and the CRP level at the time of hospitalisa-tion and mortality. On the contrary, no significant relationship was observed with the other laboratory results, including calcium, lipase and hematocrit. CONCLUSION: In conclusion, to determine the severity and prognosis of acute pancreatitis, and ex-pect the organ failures that may occur in severe pancreatitis, the body mass index, waist circumference and laboratory values, including cholesterol, triglycerides, ALT, and CRP may supply important prog-nostic data besides the conventional disease severity scoring methods.


Assuntos
Insuficiência de Múltiplos Órgãos , Pancreatite , Humanos , Pulmão/fisiopatologia , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/fisiopatologia , Pâncreas/fisiopatologia , Pancreatite/diagnóstico , Pancreatite/fisiopatologia , Prognóstico
12.
Physiol Rep ; 9(13): e14802, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34250766

RESUMO

In severe acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) is a life-prolonging treatment, especially among COVID-19 patients. Evaluation of lung injury progression is challenging with current techniques. Diagnostic imaging or invasive diagnostics are risky given the difficulties of intra-hospital transportation, contraindication of biopsies, and the potential for the spread of infections, such as in COVID-19 patients. We have recently shown that particle flow rate (PFR) from exhaled breath could be a noninvasive, early detection method for ARDS during mechanical ventilation. We hypothesized that PFR could also measure the progress of lung injury during ECMO treatment. Lipopolysaccharide (LPS) was thus used to induce ARDS in pigs under mechanical ventilation. Eight were connected to ECMO, whereas seven animals were not. In addition, six animals received sham treatment with saline. Four human patients with ECMO and ARDS were also monitored. In the pigs, as lung injury ensued, the PFR dramatically increased and a particular spike followed the establishment of ECMO in the LPS-treated animals. PFR remained elevated in all animals with no signs of lung recovery. In the human patients, in the two that recovered, PFR decreased. In the two whose lung function deteriorated while on ECMO, there was increased PFR with no sign of recovery in lung function. The present results indicate that real-time monitoring of PFR may be a new, complementary approach in the clinic for measurement of the extent of lung injury and recovery over time in ECMO patients with ARDS.


Assuntos
COVID-19/fisiopatologia , Lipopolissacarídeos/toxicidade , Lesão Pulmonar/fisiopatologia , Pulmão/fisiopatologia , Material Particulado/análise , Síndrome do Desconforto Respiratório/fisiopatologia , Animais , Gasometria/métodos , COVID-19/induzido quimicamente , Oxigenação por Membrana Extracorpórea/métodos , Pulmão/efeitos dos fármacos , Lesão Pulmonar/induzido quimicamente , Material Particulado/efeitos adversos , Respiração Artificial/métodos , Síndrome do Desconforto Respiratório/induzido quimicamente , Suínos
13.
Rev Cardiovasc Med ; 22(2): 315-327, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34258900

RESUMO

There has been an apparent association between the risks of complications with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with a history of existing chronic respiratory diseases during the pandemic of coronavirus disease 2019 (COVID-19). SARS-CoV-2 poses a severe risk in cardiopulmonary management. Moreover, chronic respiratory diseases may further amplify the risk of morbidity and mortality among the afflicted population in the pandemic era. The present review outlines the importance of pulmonary rehabilitation (PR) in persons with chronic respiratory diseases (Chronic obstructive pulmonary disease (COPD) and Asthma) during the COVID-19 era. In this context, amongst the population with a pre-existing pulmonary diagnosis who have contracted SARS-CoV-2, following initial medical management and acute recovery, exercise-based pulmonary rehabilitation (PR) may play a crucial role in long-term management and recovery. The energy conservation techniques will play a pragmatic role in PR of mild to moderate severity cases to counter post-COVID-19 fatigue. Moreover, there is also an urgent need to effectively address post-COVID-19 anxiety and depression, affecting the PR delivery system.


Assuntos
Asma/reabilitação , COVID-19/terapia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/reabilitação , Terapia Respiratória , Asma/fisiopatologia , COVID-19/fisiopatologia , COVID-19/virologia , Interações Hospedeiro-Patógeno , Humanos , Pulmão/virologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Recuperação de Função Fisiológica , SARS-CoV-2/patogenicidade , Fatores de Tempo , Resultado do Tratamento
14.
Inflamm Res ; 70(8): 847-858, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34286362

RESUMO

BACKGROUND: Recognizing only sharp elevation in a short period of time, the COVID-19 SARS-CoV-2 propagation is more and more marked in the whole world. Induced inflammation afterwards infection engenders a high infiltration of immune cells and cytokines that triggers matrix metalloproteinases (MMPs) activation. These endopeptidases are mediators of the lung extracellular matrix (ECM), a basic element for alveoli structure and gas exchange. METHODS: When immune cells, MMPs, secreted cytokines and several other mediators are gathered a pathological matrix remodeling occurs. This phenomenon tends to tissue destruction in the first place and a pulmonary hypertrophy and fibrosis in the second place. FINDINGS: After pathological matrix remodeling establishment, pathological diseases take place even after infection state. Since post COVID-19 pulmonary fibrosis is an emerging complication of the disease, there is an urge to better understand and characterize the implication of ECM remodeling during SARS-CoV-2 infection. CONCLUSION: Targeting MMPs and their inhibitors could be a probable solution for occurred events since there are many cured patients that remain with severe sequels even after the end of infection.


Assuntos
COVID-19/imunologia , COVID-19/virologia , Matriz Extracelular/metabolismo , Metaloproteinases da Matriz/metabolismo , SARS-CoV-2 , Comunicação Celular , Linhagem da Célula , Citocinas/metabolismo , Citoplasma/metabolismo , Fibrose/imunologia , Homeostase , Humanos , Hipertrofia , Sistema Imunitário , Interferon gama/metabolismo , Pulmão/fisiopatologia , Alvéolos Pulmonares/metabolismo , Fibrose Pulmonar , Troca Gasosa Pulmonar
15.
Chest ; 160(1): e39-e44, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34246387

RESUMO

CASE PRESENTATION: A 65-year-old man presented with shortness of breath, gradually worsening for the previous 2 weeks, associated with dry cough, sore throat, and diarrhea. He denied fever, chills, chest pain, abdominal pain, nausea, or vomiting. He did not have any sick contacts or travel history outside of Michigan. His medical history included hypertension, diabetes mellitus, chronic kidney disease, morbid obesity, paroxysmal atrial fibrillation, and tobacco use. He was taking amiodarone, carvedilol, furosemide, pregabalin, and insulin. The patient appeared to be in mild respiratory distress. He was afebrile and had saturation at 93% on 3 L of oxygen, heart rate of 105 beats/min, BP of 145/99 mm Hg, and respiratory rate of 18 breaths/min. On auscultation, there were crackles on bilateral lung bases and chronic bilateral leg swelling with hyperpigmented changes. His WBC count was 6.0 K/cumm (3.5 to 10.6 K/cumm) with absolute lymphocyte count 0.7 K/cumm (1.0 to 3.8 K/cumm); serum creatinine was 2.81 mg/dL (0.7 to 1.3 mg/dL). He had elevated inflammatory markers (serum ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and creatinine phosphokinase). Chest radiography showed bilateral pulmonary opacities that were suggestive of multifocal pneumonia (Fig 1). Nasopharyngeal swab for SARS-CoV-2 was positive. Therapy was started with ceftriaxone, doxycycline, hydroxychloroquine, and methylprednisolone 1 mg/kg IV for 3 days. By day 3 of hospitalization, he required endotracheal intubation, vasopressor support, and continuous renal replacement. Blood cultures were negative; respiratory cultures revealed only normal oral flora, so antibiotic therapy was discontinued. On day 10, WBC count increased to 28 K/cumm, and chest radiography showed persistent bilateral opacities with left lower lobe consolidation. Repeat respiratory cultures grew Pseudomonas aeruginosa (Table 1). Antibiotic therapy with IV meropenem was started. His condition steadily improved; eventually by day 20, he was off vasopressors and was extubated. However, on day 23, he experienced significant hemoptysis that required reintubation and vasopressor support.


Assuntos
Aspergillus niger/isolamento & purificação , COVID-19 , Hemoptise , Aspergilose Pulmonar Invasiva , Pseudomonas aeruginosa/isolamento & purificação , SARS-CoV-2/isolamento & purificação , Superinfecção , Voriconazol/administração & dosagem , Idoso , Antifúngicos/administração & dosagem , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/fisiopatologia , COVID-19/terapia , Deterioração Clínica , Estado Terminal/terapia , Procedimentos Clínicos , Diagnóstico Diferencial , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/terapia , Humanos , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/fisiopatologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Radiografia Torácica/métodos , Respiração Artificial/métodos , Superinfecção/diagnóstico , Superinfecção/microbiologia , Superinfecção/fisiopatologia , Superinfecção/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
J Cancer Res Clin Oncol ; 147(10): 2837-2849, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34318357

RESUMO

BACKGROUND: Since little consensus has been reached on whether milder reduction in forced expiratory volume in 1 s (FEV1) increases lung cancer incidence, we conducted a meta-analysis and performed Mendelian randomization (MR) analysis to explore the association and causal relationship between FEV1 and lung cancer incidence. METHODS: We conducted a comprehensive search from PubMed, Medline, EMBASE, and Cochrane Library databases as of February 2020. MR analysis was performed using summary data obtained from two large consortia [International Lung Cancer Consortium (ILCCO) and Neale Lab] to assess the possible causality between FEV1 and lung cancer risk. RESULTS: Eight studies involving 88,743 cases were included. The incidence of lung cancer increased with decreasing FEV1.The combined odds ratio (OR) of decreased FEV1 for lung cancer incidence was 1.91 [95% confidence interval (CI) 1.67-2.19; P < 0.001]. Compared with the highest quintile of FEV1 (quintile 5, > 100% of predicted), the OR was 3.06 (95% CI 2.20-4.24; P < 0.001) for quintile 1 (< 70% of predicted), 1.89 (95% CI 1.50-2.38; P < 0.001) for quintile 2 (70-80% of predicted), 1.53 (95% CI 1.31-1.79; P < 0.001) for quintile 3 (80-90% of predicted), and 1.64 (95% CI 1.18-2.28; P = 0.003) for quintile 4 (90-100% of predicted). In subgroup meta-analysis, the correlation between FEV1 and lung cancer risk was different among men (OR = 1.74; 95% CI 1.49-2.03; P < 0.001) and women (OR = 2.80; 95% CI 1.87-4.19; P < 0.001). However, MR analysis showed no causality between the FEV1 and lung cancer risk (OR = 1.199; 95% CI 0.958-1.500; P = 0.114). CONCLUSION: FEV1 is likely to be a predictor of lung cancer, especially for women. However, genetically decreased FEV1 is not causally correlated with lung cancer incidence.


Assuntos
Predisposição Genética para Doença , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/patologia , Pulmão/fisiopatologia , Análise da Randomização Mendeliana , Polimorfismo de Nucleotídeo Único , Estudos de Coortes , Estudo de Associação Genômica Ampla , Humanos , Incidência , Metanálise como Assunto , Fatores de Risco
18.
Nat Commun ; 12(1): 4566, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34315881

RESUMO

The airway epithelium serves as the interface between the host and external environment. In many chronic lung diseases, the airway is the site of substantial remodeling after injury. While, idiopathic pulmonary fibrosis (IPF) has traditionally been considered a disease of the alveolus and lung matrix, the dominant environmental (cigarette smoking) and genetic (gain of function MUC5B promoter variant) risk factor primarily affect the distal airway epithelium. Moreover, airway-specific pathogenic features of IPF include bronchiolization of the distal airspace with abnormal airway cell-types and honeycomb cystic terminal airway-like structures with concurrent loss of terminal bronchioles in regions of minimal fibrosis. However, the pathogenic role of the airway epithelium in IPF is unknown. Combining biophysical, genetic, and signaling analyses of primary airway epithelial cells, we demonstrate that healthy and IPF airway epithelia are biophysically distinct, identifying pathologic activation of the ERBB-YAP axis as a specific and modifiable driver of prolongation of the unjammed-to-jammed transition in IPF epithelia. Furthermore, we demonstrate that this biophysical state and signaling axis correlates with epithelial-driven activation of the underlying mesenchyme. Our data illustrate the active mechanisms regulating airway epithelial-driven fibrosis and identify targets to modulate disease progression.


Assuntos
Epitélio/fisiopatologia , Fibrose Pulmonar Idiopática/fisiopatologia , Pulmão/fisiopatologia , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Anfirregulina/genética , Anfirregulina/metabolismo , Fenômenos Biofísicos/efeitos dos fármacos , Epitélio/efeitos dos fármacos , Receptores ErbB/metabolismo , Fibroblastos/efeitos dos fármacos , Fibroblastos/metabolismo , Fibroblastos/patologia , Predisposição Genética para Doença , Humanos , Fibrose Pulmonar Idiopática/genética , Queratina-5/genética , Queratina-5/metabolismo , Pulmão/efeitos dos fármacos , Mucina-5B/genética , Mucina-5B/metabolismo , Quinazolinas/farmacologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Fatores de Risco , Transdução de Sinais/efeitos dos fármacos , Fatores de Transcrição/metabolismo , Tirfostinas/farmacologia , Verteporfina/farmacologia
19.
PLoS One ; 16(7): e0254134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34197556

RESUMO

A reliable, remote, and continuous real-time respiratory sound monitor with automated respiratory sound analysis ability is urgently required in many clinical scenarios-such as in monitoring disease progression of coronavirus disease 2019-to replace conventional auscultation with a handheld stethoscope. However, a robust computerized respiratory sound analysis algorithm for breath phase detection and adventitious sound detection at the recording level has not yet been validated in practical applications. In this study, we developed a lung sound database (HF_Lung_V1) comprising 9,765 audio files of lung sounds (duration of 15 s each), 34,095 inhalation labels, 18,349 exhalation labels, 13,883 continuous adventitious sound (CAS) labels (comprising 8,457 wheeze labels, 686 stridor labels, and 4,740 rhonchus labels), and 15,606 discontinuous adventitious sound labels (all crackles). We conducted benchmark tests using long short-term memory (LSTM), gated recurrent unit (GRU), bidirectional LSTM (BiLSTM), bidirectional GRU (BiGRU), convolutional neural network (CNN)-LSTM, CNN-GRU, CNN-BiLSTM, and CNN-BiGRU models for breath phase detection and adventitious sound detection. We also conducted a performance comparison between the LSTM-based and GRU-based models, between unidirectional and bidirectional models, and between models with and without a CNN. The results revealed that these models exhibited adequate performance in lung sound analysis. The GRU-based models outperformed, in terms of F1 scores and areas under the receiver operating characteristic curves, the LSTM-based models in most of the defined tasks. Furthermore, all bidirectional models outperformed their unidirectional counterparts. Finally, the addition of a CNN improved the accuracy of lung sound analysis, especially in the CAS detection tasks.


Assuntos
COVID-19/fisiopatologia , Pulmão/fisiopatologia , Sons Respiratórios/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Benchmarking , COVID-19/diagnóstico , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Respiração
20.
Int J Mol Sci ; 22(12)2021 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-34204767

RESUMO

Increased airway wall thickness and remodeling of bronchial mucosa are characteristic of asthma and may arise from altered integrin signaling on airway cells. Here, we analyzed the expression of ß1-subfamily integrins on blood and airway cells (flow cytometry), inflammatory biomarkers in serum and bronchoalveolar lavage, reticular basement membrane (RBM) thickness and collagen deposits in the mucosa (histology), and airway geometry (CT-imaging) in 92 asthma patients (persistent airflow limitation subtype: n = 47) and 36 controls. Persistent airflow limitation was associated with type-2 inflammation, elevated soluble α2 integrin chain, and changes in the bronchial wall geometry. Both subtypes of asthma showed thicker RBM than control, but collagen deposition and epithelial α1 and α2 integrins staining were similar. Type-I collagen accumulation and RBM thickness were inversely related to the epithelial expression of the α2 integrin chain. Expression of α2ß1 integrin on T-cells and eosinophils was not altered in asthma. Collagen I deposits were, however, more abundant in patients with lower α2ß1 integrin on blood and airway CD8+ T-cells. Thicker airway walls in CT were associated with lower α2 integrin chain on blood CD4+ T-cells and airway eosinophils. Our data suggest that α2ß1 integrin on inflammatory and epithelial cells may protect against airway remodeling advancement in asthma.


Assuntos
Asma/metabolismo , Asma/patologia , Progressão da Doença , Integrina alfa2beta1/metabolismo , Pulmão/patologia , Substâncias Protetoras/metabolismo , Adulto , Idoso , Remodelação das Vias Aéreas , Asma/sangue , Asma/imunologia , Membrana Basal/patologia , Brônquios/diagnóstico por imagem , Brônquios/patologia , Brônquios/fisiopatologia , Lavagem Broncoalveolar , Feminino , Humanos , Inflamação/patologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Membrana Mucosa/patologia , Subunidades Proteicas/metabolismo , Ventilação Pulmonar , Solubilidade , Linfócitos T/metabolismo , Tomografia Computadorizada por Raios X
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