Regulatory Roles of Human Surfactant Protein B Variants on Genetic Susceptibility to Pseudomonas Aeruginosa Pneumonia-Induced Sepsis
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Abstract:
Surfactant protein B (SP-B) is essential for life and plays critical roles in host defense and lowering alveolar surface tension. A single-nucleotide polymorphism (SNP rs1130866) of human SP-B (hSP-B) alters the N-linked glycosylation, thus presumably affecting SP-B function. This study has investigated the regulatory roles of hSP-B genetic variants on lung injury in pneumonia-induced sepsis.Wild-type (WT) FVB/NJ and humanized transgenic SP-B-T and SP-B-C mice (expressing either hSP-B C or T allele without mouse SP-B gene) were infected intratracheally with 50 μL (4 × 10 colony-forming units [CFUs]/mouse) Pseudomonas aeruginosa Xen5 or saline, and then killed 24 or 48 h after infection. Bacterial dynamic growths were monitored from 0 to 48 h postinfection by in vivo imaging. Histopathological, cellular, and molecular changes of lung tissues and bronchoalveolar lavage fluid (BALF) were analyzed. Surface tension of surfactants was determined with constrained drop surfactometry.SP-B-C mice showed higher bioluminescence and CFUs, increased inflammation and mortality, the higher score of lung injury, and reduced numbers of lamellar bodies in type II cells compared with SP-B-T or WT (P < 0.05). Minimum surface tension increased dramatically in infected mice (P < 0.01) with the order of SP-B-C > SP-B-T > WT. Levels of multiple cytokines in the lung of infected SP-B-C were higher than those of SP-B-T and WT (P < 0.01). Furthermore, compared with SP-B-T or WT, SP-B-C exhibited lower SP-B, higher NF-κB and NLRP3 inflammasome activation, and higher activated caspase-3.hSP-B variants differentially regulate susceptibility through modulating the surface activity of surfactant, cell death, and inflammatory signaling in sepsis.Keywords:
Ex vivo
Objective To assess whether distal bronchoalveolar lavage(DBAL) with plastic tubing allowed recovery of more fluid in comparison with common bronchoalveolar lavage(CBAL), and whether tubing had a favorable impact on operative procedure and complications. Methods A randomized study was performed in the hospital. Patients scheduled for BAL were randomly assigned to DBAL (n = 66) and CBAL (n = 56) group. Results In DBAL group,5.55% more fluid was recovered,9. 19% fewer technical failures,and 7.41% fewer complications were recorded. Conclusions Based on these results, we recommend performing DBAL using plastic tubing to replace CBAL.
Key words:
Bronchoalveolar lavage; Methods; Distal bronchoalveolar lavage; Common bronchoalveolar lavage
Therapeutic irrigation
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Objective
To investigate the clinical practicability of the (1, 3)-β-D glucan in bronchoalveolar lavage fluid in diagnosis of invasive pulmonary fungal infection(IPFI).
Methods
A total of 134 patients with lung disease were selected, of which 32 cases were confirmed or clinically diagnosed with pulmonary fungal infection, 48 patients were suspected cases, 54 cases were non IPFI. All patients were given normal bronchoalveolar lavage clysis, the contents of the (1, 3)-β-D glucan and galactomannan of the bronchoalveolar lavage fluid and serum were detected, the clinical practicability of the two methods for detection in diagnosis of invasive pulmonary fungal infection were compared.
Results
Thirty-two patients suffered invasive fungal infection, of which 10 cases of the patients were diagnosed with pneumocystis carinii pneumpnia with G test of the bronchoalveolar lavage positive, the sensitivity was 100%, while bronchoalveolar lavage G test and GM test which were used for the diagnosis of invasive fungal infection had similar sensitivity, but specificity of broncho-alveolar lavage G test was lower. The specificity of dextran in serum was higher.
Conclusions
The (1, 3)-β-D glucan test in the bronchoalveolar lavage fluid shows a low specificity, so identifying the special factors which will interfere the experimental performance may improve the clinical practicability of the (1, 3)-β-D glucan in bronchoalveolar lavage fluid in fungal glucan monitoring.
Key words:
Invasive fungal infection; Aspergillus; Bronchoalveolar lavage fluid
Galactomannan
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Pulmonary alveolar proteinosis
Parenchyma
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AbstractBronchoalveolar lavage was performed in 62/63 patients with suspected pulmonary tuberculosis and gastric lavage in 60 of the 63. Mycobacteria could be cultured from 14 of the patients. Cultures on bronchoalveolar lavage were positive in 13 of them, while gastric lavage was positive in only 7. Our conclusion is that bronchoalveolar lavage should be performed instead of gastric lavage when pulmonary tuberculosis is suspected.
Gastric lavage
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Bronchoalveolar lavage (BAL) is a well-established diagnostic tool for the assessment of pulmonary diseases in adults. How BAL contributes to the diagnostic process in childhood lung diseases is less clear. One of the problems in interpreting BAL findings in children is that there are few reference data for BAL fluid constituents in children. This report addresses some of the technical problems of bronchoalveolar lavage in children and summarizes current knowledge on cellular and noncellular bronchoalveolar lavage fluid components in children without lung disease.
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Objective: To take the opportunity of a bronchoalveolar lavage to challenge the transpulmonary thermodilution for detecting the time course of changes in extravascular lung water. Design: Observational study. Setting: Medical ICU. Patients: Mechanically ventilated patients in whom a bronchoalveolar lavage by bronchoscopy was performed. Intervention: Transpulmonary thermodilution before and after bronchoalveolar lavage. Measurements and Main Results: Before and at different times after bronchoalveolar lavage, transpulmonary thermodilution was performed to record the value of indexed extravascular lung water. For each measurement, the values of three thermodilution measurements were averaged at the following steps: before bronchoalveolar lavage, after bronchoalveolar lavage, and 1 hour, 2 hours, 4 hours, and 6 hours after bronchoalveolar lavage. The amount of saline infusion left in the lungs after bronchoalveolar lavage was also recorded. Twenty-five patients with suspicion of pneumonia were included. Twenty-eight bronchoalveolar lavages were finally analyzed. On average, 200 mL (180–200 mL) of saline were injected and 130 mL (100–160 mL) were left in the lungs. Between before and immediately after bronchoalveolar lavage, indexed extravascular lung water significantly increased from 12 ± 4 to 15 ± 5 mL/kg, respectively, representing a 169 ± 166 mL increase in nonindexed extravascular lung water. After bronchoalveolar lavage, the value of indexed extravascular lung water was significantly different from the baseline value until 2 hours after bronchoalveolar lavage and became similar to the baseline value thereafter. Conclusions: Transpulmonary thermodilution enabled to detect small short-term changes of indexed extravascular lung water secondary to bronchoalveolar lavage.
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Objectives: To evaluate the yield of mini-bronchoalveolar lavage compared with that of directed bronchoalveolar lavage in critically ill patients with suspected coronavirus disease 2019–associated pulmonary aspergillosis. Design: A retrospective cohort study. Setting: The ICU of the Amsterdam University Medical Centers. Patients: Patients with confirmed coronavirus disease 2019 screened for coronavirus disease 2019–associated pulmonary aspergillosis. INTERVENTIONS: Mini-bronchoalveolar lavage and/or directed bronchoalveolar lavage. Measurements and Main Results: In total, 76 patients were included, 20 of whom underwent bronchoalveolar lavage, 40 mini-bronchoalveolar lavage, and 16 both mini-bronchoalveolar lavage and bronchoalveolar lavage. The percentage of samples with one or more positive Aspergillus detecting test (galactomannan, culture, polymerase chain reaction) did not differ significantly between bronchoalveolar lavage and mini-bronchoalveolar lavage (16.7% vs 21.4%). However, in mini-bronchoalveolar lavage samples, this was more frequently driven by a positive polymerase chain reaction than in bronchoalveolar lavage samples (17.9% vs 2.8%; p = 0.030). In 81% of patients (13/16) with both mini-bronchoalveolar lavage and bronchoalveolar lavage, the test results were in agreement. In 11 of 12 patients (92%) with first a negative mini-bronchoalveolar lavage, the subsequent bronchoalveolar lavage sample was also negative. Conclusions: We found a similar percentage of positive test results in mini-bronchoalveolar lavage and bronchoalveolar lavage samples in patients with suspected coronavirus disease 2019–associated pulmonary aspergillosis. Our findings indicate that mini-bronchoalveolar lavage could be a useful tool for coronavirus disease 2019–associated pulmonary aspergillosis screening in ICU patients.
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Thorax (insect anatomy)
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Examination of bronchoalveolar lavage fluid is a method based on obtaining biological material in the from of cells and fluid derived directly from the alveoli of the bronchi. Cytological and biochemical examination of the bronchoalveolar fluid enables to understand pathomechanisms of various interstitial and obstructive pulmonary diseases. Bronchoalveolar lavage (BAL) is a sensitive and safe diagnostic method, which becomes to be widely employed in the pneumonologic++ diagnosis.
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