Analysis of risk factors of radiation-induced toxicity in limited-stage small cell lung cancer treated with hypofractionated intensity-modulated radiotherapy / 中华肿瘤杂志

Objective: To compare the incidence of radiation-related toxicities between conventional and hypofractionated intensity-modulated radiation therapy (IMRT) for limited-stage small cell lung cancer (SCLC), and to explore the risk factors of hypofractionated radiotherapy-induced toxicities. Methods: Data were retrospectively collected from consecutive limited-stage SCLC patients treated with definitive concurrent chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2022. The enrolled patients were divided into two groups according to radiation fractionated regimens. Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) was used to evaluate the grade of radiation esophagus injuries and lung injuries. Logistic regression analyses were used to identify factors associated with radiation-related toxicities in the hypofractionated radiotherapy group. Results: Among 211 enrolled patients, 108 cases underwent conventional IMRT and 103 patients received hypofractionated IMRT. The cumulative incidences of acute esophagitis grade ≥2 [38.9% (42/108) vs 35.0% (36/103), P=0.895] and grade ≥ 3 [1.9% (2/108) vs 5.8% (6/103), P=0.132] were similar between conventional and hypofractionated IMRT group. Late esophagus injuries grade ≥2 occurred in one patient in either group. No differences in the cumulative incidence of acute pneumonitis grade ≥2[12.0% (13/108) vs 5.8% (6/103), P=0.172] and late lung injuries grade ≥2[5.6% (6/108) vs 10.7% (11/103), P=0.277] were observed. There was no grade ≥3 lung injuries occurred in either group. Using multiple regression analysis, mean esophageal dose ≥13 Gy (OR=3.33, 95% CI: 1.23-9.01, P=0.018) and the overlapping volume between planning target volume (PTV) and esophageal ≥8 cm(3)(OR=3.99, 95% CI: 1.24-12.79, P=0.020) were identified as the independent risk factors associated with acute esophagitis grade ≥2 in the hypofractionated radiotherapy group. Acute pneumonitis grade ≥2 was correlated with presence of chronic obstructive pulmonary disease (COPD, P=0.025). Late lung injuries grade ≥2 was correlated with tumor location(P=0.036). Conclusions: Hypofractionated IMRT are tolerated with manageable toxicities for limited-stage SCLC patients treated with IMRT. Mean esophageal dose and the overlapping volume between PTV and esophageal are independently predictive factors of acute esophagitis grade ≥2, and COPD and tumor location are valuable factors of lung injuries for limited-stage SCLC patients receiving hyofractionated radiotherapy. Prospective studies are needed to confirm these results.

Calidad de vida y lesiones radiológicas en pacientes con tuberculosis sensible en el cono norte de Lima, Perú / Quality of life and radiological injuries in patients with sensitive tuberculosis in Cono Norte, Lima, Perú

RESUMEN Objetivo Determinar la correlación entre calidad de vida y lesiones pulmonares por radiografía en pacientes con tuberculosis en Lima Norte (Lima, Perú), durante el periodo 2018. Métodos Se realizó un estudio descriptivo de correlación para evaluar la calidad de vida y lesiones pulmonares por radiografía de los pacientes en tratamiento con esquema sensible de la jurisdicción del Hospital Nacional Sergio Bernales. La muestra correspondió a 102 pacientes pertenecientes al programa de tuberculosis, para la cual se utilizó el cuestionario respiratorio de Saint George, que mide la calidad de vida, constituida por tres dimensiones: síntomas, actividad social o impacto. Las lesiones radiológicas se cuantificaron mediante la clasificación de Willcox. Para el análisis de los datos se utilizó el programa SPSS, versión 23. Se estimó Chi-cuadrado y el coeficiente de correlación para determinar asociación de las variables. Resultados La correlación de Spearman es 0,622, lo que indica una relación positiva alta entre calidad de vida y lesiones pulmonares en pacientes con tuberculosis (p<0,05). Se determinó asociación entre calidad de vida y tiempo de tratamiento, con cambios en el tercer mes. Conclusión Existe una asociación entre calidad de vida y lesiones pulmonares por radiografía de pacientes con tuberculosis.

ABSTRACT Objective To determine the correlation between quality of life and lung lesions by radiography of patients with tuberculosis in Lima Norte (Lima, Peru) during the 2018 period. Methods A descriptive correlation study was carried out to evaluate the quality of life and lung lesions by radiography of patients in sensitive scheme treatment of the jurisdiction of the Sergio Bernales National Hospital. The sample corresponded to 102 patients belonging to the tuberculosis program and the Saint George respiratory questionnaire was used, which measures the quality of life, which consists of three dimensions: symptoms, activity, social, or impact. Radiological lesions were quantified by Willcox classification. For the data analysis, the SPSS version 23 program was used. Chi square and the correlation coefficient were estimated to determine the association of the variables. Results Spearman's correlation is 0.622, which indicates a high positive relationship between quality of life and lung lesions in patients with tuberculosis (p<0.05). An association between quality of life and treatment time was determined, with changes in the third month. Conclusion There is an association between quality of life and lung lesions by radiography of patients with tuberculosis.

Research progress in role and mechanism of damage-associated molecular patterns in lung injury after acute spinal cord injury / 中华创伤杂志

Acute spinal cord injury（ASCI），commonly seen in spinal surgery，is usually caused by mechanical injury to the spine. ASCI can lead to secondary lung injury and even acute respiratory distress syndrome（ARDS），seriously endangering the life safety of patients. Damage-associated molecular pattern（DAMP）is a sort of endogenous substances released after injury，including intracellular proteins，extracellular matrix，secretory factors and nucleic acid-related products. DAMP released after ASCI activates downstream signaling pathways and participates in lung injuries. DAMP-related studies have revealed molecular mechanism of lung injury after ASCI，and explored the possible therapeutic targets of lung injury. In this study，the authors review the mechanism of action of DAMP in lung injury after ASCI and the role of different kinds of DAMP in lung injury，so as to provide new ideas for clinical treatment of lung injury after ASCI.

Adrenaline, transient receptor potential vanilloid 1 channel and substance P in rats with acute spinal cord injury complicated with lung injury / 第二军医大学学报

ObjectiveTo study the changes and significance of adrenaline, transient receptor potential vanilloid 1 (TRPV1) channel and substance P in rats with acute spinal cord injury (ASCI) complicated with lung injury. Methods Two hundred and twenty eight female Sprague-Dawley rats were randomly divided into sham operation group (sham group, n=90), ASCI group (n=108), bilateral adrenalectomy group (n=15), and ASCI after bilateral adrenalectomy group (n= 15). The ASCI model was established on the T10 spinal cord segment using a modified Allen's strike model (10 g, 25 mm). The sham group only exposed the T10 spinal cord, and the ASCI after bilateral adrenalectomy group was established 5 days after bilateral adrenalectomy. High-performance liquid chromatography was used to detect the changes of serum adrenaline. The pulmonary tissue specimens were collected from rats. Wet-to-dry lung weight ratio was used to detect the changes of pulmonary edema, and H-E staining was used to detect the pathological changes of lung tissue. The expression of TRPV1 protein in lung tissue was detected by immunohistochemistry and Western blotting. The contents of substance P in the lung tissue were detected by enzyme-linked immunosorbent assay. Results Serum adrenaline levels in the ASCI group were significantly higher than those in the sham group at 2, 6, 12, 24, 48, and 72 h after spinal injury (all P<0.01). The pulmonary edema and lung injury gradually aggravated in the ASCI group at 24, 48 and 72 h after spinal injury, and began to recover at 1 week. The expression levels of TRPV1 protein and substance P contents in ASCI group were significantly upregulated compared with the sham group at 24, 48, and 72 h after spinal injury (all P<0.05, P<0.01). The edema of lung tissue and pathological injury in the ASCI after bilateral adrenalectomy group were alleviated compared with the ASCI group 72 h after spinal injury. Conclusion Adrenaline may involve in the pathogenesis of pulmonary edema and lung injury in rats with ASCI, which may be related to the upregulation of TRPV1 and P substance expression. The pulmonary edema and lung injury after ASCI can be alleviated by adrenalectomy.

Underwater shock wave induced lung and brain injuries in canines / 第二军医大学学报

[Abstract] Objective To explore underwater shock wave-induced injuries of the lung and brain in canines. Methods Eighteen Beagle dogs were randomly divided into six groups according to the distances to the explosion source: control group and 5 experimental groups (5 m, 7 m, 9 m, 11 m and 13 m groups). The animals were exposed to underwater shock wave via a self-designed underwater explosive instrument. The dynamic explosive process was recorded by the underwater high-speed camera. Computed tomography (CT) scans of brain and chest were performed 6 h after injury. Pathological examination and H-E staining for hippocampus and lung were conducted 24 h after injury. The expression levels of interleukin (IL)-6, IL-1β, IL-10, tumor necrosis factor α (TNF-α) and transforming growth factor β (TGF-β) in the hippocampus were measured by immunohistochemical staining. Results The underwater high-speed camera showed that the injury process included blast wave and bubble pulsation. The total mortality of the animals was 40.0% (6/15) in the experimental groups. CT examination revealed no major alterations in the brain of the animals, while there were pleural effusion and pneumothorax in the chest of animals in the experimental groups. H-E staining showed inflammatory cells infiltration in the hippocampal tissue and erythrocyte deposition in the alveoli of animals in the experimental groups. The expression levels of IL-6, IL-1β, IL-10, TNF-α, and TGF-β in the hippocampus of animals in the experimental groups were significantly elevated compared with those in control group (all P0.05). Conclusion Brain and chest are damaged significantly after underwater explosion, which may be the main causes for the death of animals. It is important to elucidate the underlying mechanisms of brain injury caused by underwater explosive wave for the protection of underwater blast injuries.

Characteristics of pulmonary function and pathological changes following acute lung injury in rats / 中华创伤杂志

Objective To investigate the characteristics of pulmonary function and pathological changes in rats with acute lung injury (ALI) and provide experimental basis for further study on the mechanism of ALI.Methods Twenty five male SD rats were randomly divided into the control group (n =5) and acute lung injury (ALI) group (n =20).Lipopolysaccharide (LPS) (4.5 mg/kg) were injected into the ALI group rats to establish the ALI rat model.The rats in control group were given 150 μl isotonic saline.At 12,24,48,and 72 hours after injury,lung function of the rats were tested by Buxco small animal lung function test system,including the dynamic lung compliance (Cdyn),forced vital capacity (FVC),functional residual gas (FRC),quasi static compliance (Cchord),100th millisecond expiratory volume (FEV100),and airway resistance (RI).In addition,the bronchoalveolar lavage fluid (BALF) was collected for detection of protein level and tumor necrosis factor (TNF-alpha)concentration.At the same time,the changes of lung tissues were recorded,and the pathological changes were observed by HE staining.Results Compared with the control group,Cdyn,FVC,FRC,and FEV100 in ALI group were significantly decreased at each time point after injury (P ＜0.05 or ＜0.01),while the airway resistance (R1) in ALI group was significantly increased at 24 and 48 hours after injury (P ＜ 0.01).There was no significant difference in quasi static compliance (Cchord) between two groups (P ＞ 0.05).The protein level and TNF-alpha concentration of BALF in ALI group were increased significantly (P ＜0.05 or ＜0.01) 12-72 hours after injury (P ＜ 0.01).Compared with the control group,the whole lung was dark red in ALI group 12 hours after injury,and the most serious bleeding occurred in the pulmonary hilum area with single or multiple hemorrhagic foci of different sizes.Multiple punctate and focal bleeding of different sizes were seen on the lung surface,which were radially distributed around the pulmonary hilum.The color of lung tissue was gradually restored to normal at 72 hours after injury.Under the light microscope,pulmonary interstitial edema,inflammatory cell infiltration,pulmonary vascular congestion and focal pulmonary hemorrhage were observed 12 h after injury,showing typical ALl pathological changes.The pathological changes were the most significant at 24 hours and reduced obviously at 72 hours.Conclusions A single intratracheal injection of LPS can induce typical ALI pathological changes.There is a similar trend between the pulmonary function indexes,lung pathology characteristics,and the protein level of BALF and proinflammatory cytokine level,suggesting that the pulmonary function test parameters can provide reference for evaluation of ALI.

Shenmai injection improves lung injury induced by severe acute pancreatitis in rats / 第二军医大学学报

Objective To investigate the effect of Shenmai injection on severe acute pancreatitis (SAP)-associated lung injury and the possible mechanism in rats. Methods The animals were randomly divided into three groups: sham operation group (sham group, n = 10), severe acute pancreatitis (SAP group, n = 10) and Shenmai injection treatment group (SM group, n = 10). The rat model of SAP was induced by injection of 5% sodium taurocholate to the pancreatic duct. The rats in SM group were given Shenmai injection (8 mL/kg) via tail vein 10 min before sodium taurocholate injecting. 24 h after the model was made, 1 mL blood was drawn for serum amylase detection. Left lung tissues and pancreatic tissues were harvested for pathology and immunohistochemistry. Right lung tissue was homogenated for detection of myeloperoxidase (MPO) activity and levels of malondialdehyde(MDA), tumor necrosis factory (TNF-«) and interleukin-lp (IL-lp). Results There were no obvious damages to pancreas and lung in the sham group. While in the SAP group, the plasma amylase was greatly increased, the pancreatic lobular structures were severely damaged, and the pulmonary alveoli were destroyed with inflammatory cell infiltration. The MPO activity, MDA, TNF-«, and IL-lp levels in the SAP lung tissues were significantly increased compared with those in the sham group (P<0. 01). ICAM-1 and caspase-3 were strongly positive in the lung tissues of SAP group. These parameters in the SM group were improved compared with those in the SAP group. Conclusion Shenmai injection has a protective effect on SAP-associated lung injury, and the mechanism may be related to the inhibition of apoptosis and reduction of oxygen free radical and inflammatory content.

Effect of hemofiltration combined with hemoperfusionon serum TNF-« in severe acute pancreatitis patients with lung injury and on RhoA serine 188 phosphorylation in endotheliai cells / 第二军医大学学报

Objective To study the effect of hemofiltration plus hemoperfusion (HF+HP) on removal of serum TNF-a in severe acute pancreatitis (SAP) patientswith lung injury and on RhoA serine 188 phosphorylation (p-RhoA) in endothelial cells. Methods Totally 35 SAP patients, including 28 with acute lung injury (ALI)/ acute respiratory distress syndrome (ARDS), and 20 healthy subjectswere involved in this study. All the SAP patients were treated in ICU, and the 9 combined with ARDS underwent continuous veno-venous hemofiltration (CVVH) and HP therapy (HF+HP group). The serum TNF-a in SAP patients with different degrees of lung injury and the serum TNF-« in SAP patients with ARDS was determined by ELISA at different time points during HF+HP. For in vitro study the human umbilical vein endothelial cells (HUVECs) were treated with sera from SAP patientswith ARDS during HF+HP, and those treated with recombinant TNF-a were taken as a positive control. The changes of p-RhoA and total RhoA were observed by Western blotting analysis. Subcellular distribution of p-RhoA protein was observed by immunofluorescence staining. Results We found that, compared withSAP patients without ALI/ARDS, those with ALI/ARDS, especially those with ARDS (about 7 folds that of the normal control) had a significantly increased serum TNF-« level (P 0. 05). Immunofluorescence indicated that p-RhoA was largely distributed in the cytoplasm of HUVECs, and the changes were consistent with the data from Western blotting analysis. Conclusion SAP patientswith ALI/ARDS have high circulation TNF-α. Treatment with HF+HP can effectively remove the excessive TNF-α in the blood of SAP patients with ALI/ARDS and inhibit activation of RhoA, subsequently decreasing the high permeability of endothelial cells.

Resveratrol protects against bleomycin-induced lung injury in mice / 第二军医大学学报

Objective To study the protective effects of the resveratrol on bleomycin-induced lung injury in mice and its underlying mechanism. Methods Male ICR mice were randomly divided into four groups (n = 10): control group, bleomycin group, resveratrol group, and bleomycin+resveratrol group. Micewere anesthetized and infused intratracheally with 3 mg/kg bleomycin to create lung injury model. Resveratrol (0. 3 mg/kg) was administered intraperitoneally before bleomycin infusion. The severity of pulmonary injuries was evaluated 24 h after inducing lung injury. H-E staining was used to assess the lung pathology. The levels of lipid peroxidation marker malondialdehyde (MDA), neutrophil infiltration marker myeloperoxidase (MPO) activity, and cytokines IL-6, IL-8, and IL-10 were determined by commercial kits. Results Resveratrol treatment improved the bleomycin-induced lung injury in mice by significantly inhibiting the oxidative stress and decreasing lipid peroxidation marker MDA level (P<0. 01). Resveratrol treatment also attenuated the bleomycin-induced pulmonary infection by significantly decreasing MPO activity (P<0. 01) and the production of pro-inflammatory cytokines IL-6 (P<0. 01) and IL-8 (P< 0. 05) and increasing anti-inflammatory cytokine IL-10 production (P<0. 01). Conclusion Resveratrol can protect against bleomycin-induced lung injury in mice, probably through its antioxidant and anti-inflammatory effects.

Expression of C3a, C5a, TXA2, LT in pulmonary injury of infant open heart surgery improved with the modified ultrafiltration technique / 中国医师杂志

Objective To study the mechanism of pulmonary injury and protective effect of modified ultrafiltration on lung function in infant open heart surgery.Methods According to the wishes of parents,40 cases of congenital heart disease were divided into without modified ultrafiltration control group (C) and modified ultrafiltration group (M),and parents signed informed consent.The cardiopulmonary bypass (CPB) was used without ultrafiltration in Group C,while with modified ultrafiltration in group M.The pneumodynamic parameters and C3a,C5a,TXA2,LT were measured at specific time points.Results The static pulmonary compliance (Cstat) and oxygen index (OI) were lower,and alveolar-arteria oxygen difference (AaDO2) was higher after CPB in the two groups(P ＜ 0.05).At T3,T4 and T5 time points,the Cstat and OI in Group M was higher than that in Group C; AaDO2 in Group M was lower than that in Group C (P ＜0.05).The levels of C3a and C5a were lower after CPB in the two groups; levels of TXA2,LT were higher after CPB in the C groups.At T2,T3,T4 and T5 time points,the TXA2 and LT in Group M were lower than that in Group C(P ＜0.05).Conclusions The pulmonary injury in pediatric open heart surgery may be concerned with the the alexin(C3a,C5a) activation and I/R.The level of C3a and C5a was considered earlier index of inflammatory reaction and pulmonary injury.Modified ultrafiltration improves pulmonary function due to elevating coloid osmotic pressure and degrading the plasma level of TXA2,LT.

Protective effect of ulinastatin against cholestasis-associated lung injury in rats / 第二军医大学学报

Objective To observe the inflammatory infiltration and morphological changes of lung after treatment with unlinastatin in cholestatic rats, so as to study the protective effect of unlinastatin on the lung of cholestatic rats. Methods Rat obstructive jaundice models were established by bile duct ligation (n = 48). Ulinastatin (UTI, 100 000 U/kg) was injected intrapertioneally after operation. The lung tissues were collected at day 1, 3, 7, and 14 after operation. The hepatic function and pulmonary pathology were observed after treatment; dry/wet ratio and water content were calculated. The parameters for alveolar capillary permeability, content of myeloperoxidase (MPO), and activity of malondialdehyde (MDA) were also assessed. Expression of TNF-α and IL-β was exammed by immunohistochemical method. Results The serum bilirubin, dry to wet ratio and water content of the lung tissues were not significantly different between UTI group and jaundice group (P> 0. 05). The levels of evans blue dyes (EBD), MPO, and the activity of MDA m UTI group were significantly lower than that in the jaundice group and UTI groups at the same time points (P<0. 05). The pulmonary histology showed alleviated edema, lessneutrophil infiltration and RBC in alveolar space in UTI group compared to jaundice group. The pulmonary expression of and IL- 1β and TNF-α was significantly lower in UTI group than that in jaundice group on day 1 and day 14 (P<0. 01). Conclusion Uiinastatin can inhibit pulmonary expression of pro-inflammatory cytokines TNF-α and IL-1β and decrease MPO activity and MDA levels in bile duct-ligated rats, thus improving the permeability of the pulmonary capillary membrane in obstructive jaundice rats and decreasing the pulmonary inflammatory reactions.

Ex-pulmonary adult stem cell engraftment in treatment of acute lung injury: Recent progress / 第二军医大学学报

Engraftment with ex-pulmonary adult stem cells has great potential for treatment of acute lung injury (ALI). The engrafted adult ex-pulmonary stem cells can migrate to the injured lung tissue guided by a series of signal factors released by injured pulmonary tissue cells. Stem cells localized in the injured lung tissue and inflammatory area can differentiate into lung tissue cells (including lung epithelial cells and pulmonary vascular endothelial cells) and exert their functions. The engrafted expulmonary adult stem cells are not only capable of differentiation, but also have anti-inflammatory effect and immunomodulatory effect, making the related area a focus of study.

Comparison of lung injuries induced by drowning with equal volume of seawater and freshwater in rabbits / 第二军医大学学报

Objective: To compare the lung injuries caused by drowning with equal volume of seawater and freshwater in rabbits. Methods: Twenty-four healthy New Zealand rabbits were randomly allocated to three groups (n = 8): control group(CG), seawater-drowning group (infused with seawater, 2 ml/kg) and freshwater-drowning group (infused with freshwater, 2 ml/kg). All rabbits were observed for 3 hours for breathing frequency, heart rate, mean arterial pressure (MAP), blood gas analysis and levels of TNF-α and IL-6. Pulmonary histopathology, ratio of wet/dry lung weight and permeation index of pulmonary capillary were recorded after the animals were sacrificed at the end of the experiment. Results: After infusion of seawater or freshwater, the respiration rates, serum levels of TNF-α and IL-6 were significantly increased (P<0.01), and the MAP was decreased (P<0.01), leading to hypoxemia and hypocapnia. Lung injuries were noticed in both seawater-drowning group and freshwater-drowning groups, with those in the former more persistent. The wet/dry ratio and permeation index of lung capillary were significantly increased after infusion in the seawater group compared with those in the other two groups (P<0.05). The cell number in the bronchoalveolar lavage fluid was significantly larger in the seawater-drowning group compared with that in the control group (P<0.01), and the lung injury was more severe than that in the freshwater group. Conclusion: Seawater infusion can lead to more serious and persistent lung injury in rabbits compared with equal volume of freshwater.

Early treatment with small dose dexamethasone attenuates seawater immersion-induced acute lung injury in dogs with open chest trauma / 第二军医大学学报

Objective: To investigate the effect of early dexamethasone treatment on seawater immersion-induced acute lung injury after open chest trauma. Methods: Twenty-four animals were evenly randomized into three groups: control group (CG), seawater group(SG), and dexamethasone treatment group (DG). Animals in CG group only had open chest trauma, those in the SG group were exposed to seawater after open chest trauma, and those in the DG group were treated with dexamethasone (1 mg/kg) after exposed to seawater. The vital signs of animals, plasma osmotic pressure, lung permeability index (LPI), and peripheral white blood cell count were observed 0,2,4,6, and 8 h after trauma. The plasma samples and bronchoalveolar lavage fluid (BALF) were collected for testing the levels of cytokines (IL-1ß, IL-8, and vWF, etc.) with ELISA kit. H-E staining was used to observe the pathological changes of the lung. Results: Compared with the SG group, the pathological changes were improved in the DG group; the plasma osmotic pressures were similar between the two groups; and the pulmonary permeability index was markedly decreased in the DG group (0.039±0.006 vs 0.055±0.002, P<0.05). Besides,the count of peripheral leukocyte(X 109) and plasma IL-Iß, IL-8, and vWF(pg/ml) were all markedly decreased in the DG group compared with the SG group(WBC: 21.52± 3.21 vs 24.8±2.08; IL-Iß:72. 84±38.42 vs 131.90±35.39; IL-8:45.21± 16.39 vs 88.26± 6.66;vWF:0.47±0.08 vs 1.03± 0.09,P< 0.05). Conclusion: Early dexamethasone treatment can attenuate the inflammatory injury of the lung in dogs with open chest trauma after seawater immersion, providing more chance for further management.

Intervention of Astragalus membranaceus on radioactive lung injuries and influence on TNF-α and ET expression / 中华放射医学与防护杂志

Objective To observe the lung protection of Astragalus membranaceus against radiotherapy to intermediate-stage and terminal thoracic neoplasm, and its influence on TNF-α and ET expression.Methods The patients with intermediate-stage and terminal thoracic neoplasm under radiotherapy were divided into a treatment group and a control group.Patients in the treatment group took 10 ml of Asragalus membranaceus twice a day.for consecutive 6 months from the beginning of radio therapy.TNF-α and ET in the plasma were measured before and after the radiotherapy.The clinical symptom,iconographic changes and lung diffusion were observed from the 15th day of radiotherapy.Results The TNF-α and ET in plasma afterthe radiotherapy were(2.48±0.75)as/ml and(69.32±23.03)pg/ml for the treatment group,and(5.12±1.01)ns/ml and(97.87±37.83)pg/ml for the control group with the statistial difference(x2=7.49,6.57,P<0.001).The decrease of CO diffusion 5 and 10 months after the radiotherapy in the treatment group was statistically different compared with that in the control group(x2=3.98,3.78,P<0.05).There was a statistical difference of the incidence of acute radiation pneumonitis and pulmonary fibrosis between these two groups(P<0.05).Conclusions Astragalus membranaceus could inhibit the excess expression of TNF-α and ET in plasma and reduce the deterioration of diffusion after radiotherapy,so that it can be used for intervention of lung injuries from radiotherapy.

Effect on blockade of MCP 1 in early course of experimental acute necrotizing pancreatitis / 中华胰腺病杂志

Objective To investigate the potential role of MCP-1/CCL2 in experimental acute necrotizing pancreatitis (ANP) and complications. Methods 60 SD male rats were randomly divided into 3 groups: sham operation group ( n = 20 ), ANP group ( n = 20 ) and MCP-1 group ( n = 20 ). ANP model was induced by retrograde infusion of 3.5% sodium taurocholate, MCP-1 group received subcutaneous injection of MCP-1 antibody 0 h and 6 h after ANP induction. The serum levels of amylase, MCP-1, D-lactic acid,histological changes and the expression of MCP-1 mRNA of lung, small intestine and pancreas, the expression of MCP-1 protein in pancreas, MPO levels of small intestine MPO were determined. Results The serum levels of amylase, MCP-1, D-lactic acid in MCP-1 group at 12 h were (4666 ±412)U/L, (39.53 ±8.25)pg/ml and (6.3 ±2.2)mg/L, which were significantly lower than those in ANP group [ (9611 ±363)U/L, (63.42 ±9.32) pg/ml, (9.3 ± 2. 1 ) mg/L, P< 0.05 ) ]; the expression of MCP-1 mRNA in pancreas, small intestine and lung were 0.431 ± 0.009, 0. 211 ± 0.018 and 0.442 ± 0.017, which were significantly lower than those in ANP group [ (0.624 ±0. 010, 0. 523 ±0. 019 and 0. 569 ±0. 024, P <0.05) ]; the expression of MCP-1 protein in pancreas was 2.0 ± 0. 1, which was significantly lower than that in ANP group (4. 0 ± 0. 2, P <0.05). Lung and small intestine MPO were (11.1 ±3.0)U/g and ( 19.2 ±2.0)U/g, which were significantly lower than those in ANP group[(39.2±3.1)U/g and(13.1±2.1)U/g, P<0.05]. Conclusions Early blockade of MCP-1 not only attenuates the severity of ANP, but also decreases the degree of acute lung injury and intestine barrier dysfunction.

Efeito da poluição atmosférica urbana da cidade de São Paulo nas células sangüíneas e no sistema cardiopulmonar: estudo morfo-funcional em camundongos in vivo / Effect of urbain air pollution of Sao Paulo city in the blood and cardiopulmonary system: a morpho-functional study in mice in vivo

Objetivo: checar se poluentes do ar urbano de São Paulo induzem alterações sangüíneas e cardiopulmonares. MM: camundongos Balb/c foram expostos por 7, 14, 21, 30 e 45 dias em 3 câmaras: Limpa (controle), Intermediária (seletiva ao PM) e Suja (ar externo). Após exposição, os animais foram ventilados (FlexiVent) e coletados dados de mecânica pulmonar, sangue, coração e pulmão. Foram registrados PM, CO, SO2 e NO2 diários. Resultados: aos 21 e 45 dias coincidentes com picos de poluição houve aumento da resistência de via aérea (45d p=0,012), leucocitose (21d p < 0,001 e 45d p=0,039) e vasoconstricção pulmonar (21d p=0,034) nos animais da Câmara Suja, sem alteração de coronárias. Nenhum poluente excedeu limites de qualidade de ar.

Objective: verify if air pollution of São Paulo city induces alterations in blood and cardiopulmonary systems. MM: Balb/c mice were exposed during 7, 14, 21, 30 and 45 days to 3 chambers: Clean (control), Intermediate (PM only) and Dirty (external air). After exposure, animals were ventilated (FlexiVent) and collected lung mechanics data and blood, heart and lung. PM, CO, SO2 e NO2 were measured daily. Results: on day 21 and 45, coincidently to peak of pollutions, there was proximal airway resistance increase (45d p=0.012), leukocytosis (21d p < 0.001 and 45d p=0.039) and vasoconstriction of peribronchiolar arterioles (21d p=0.034) in animals of Dirty Chamber with no alterations of coronaries. Neither pollutants exceeded the standard limits.

Spontaneous Pneumomediastinum Accompanied by Bleomycin-Induced Lung Toxicity / 대한흉부외과학회지

Pneumomediastinum is a rare, but well recognized complication of bleomycin-induced lung toxicity. Spontaneous pneumomediastinum has to be considered as one of the causes when the dyspnea becomes aggravated in patients with bleomycin induced lung toxicity. We describe here two patients who suffered with germ cell tumor and they developed spontaneous pneumomediastinum without pneumothorax, and this was caused by bleomycin-induced lung toxicity.

Estudo de três estratégias de ventilação artificial protetora: alta frequência, baixa frequência e baixa frequência associada à insuflação de gás traqueal, em modelo experimental de SARA / Comparing three protective mechanical ventilation strategies, HFOV, low-frequency-ventilation, and low-frequency-ventilation with TGI, in an ARDS experimental model

Introdução: Um dos principais objetivos na SARA é encontrar a melhor estratégia protetora de ventilação mecânica que minimize o stress pulmonar e otimize as trocas gasosas. Teoricamente, estas duas metas podem ser obtidas simultaneamente, evitando-se a hiperdistensão e colapso cíclico de unidades alveolares instáveis. Numa tentativa de radicalizar a minimização da hiperdistensão e da pressão motriz inspiratória, duas estratégias podem ser propostas: o uso da ventilação de alta freqüência oscilatória (HFOV) e o uso da insuflação intra-traqueal de gás (TGI), esta última associada à hipercapnia permissiva e baixas freqüências respiratórias. Objetivo: identificar qual (quais) entre as três estratégias de ventilação mecânica, HFOV, TGI e ventilação protetora de baixa freqüência (VP: volume corrente ~6 mL/kg), foi (foram) a (s) mais protetora (s) em um modelo de SARA em coelhos, durante seis horas de ventilação mecânica. Material e métodos: Os animais (n = 45) foram submetidos a repetidas lavagens pulmonar até uma PaO2 < 100 mmHg. Imediatamente após a injuria pulmonar, foi obtida uma curva P/V para calculo do trabalho inspiratório e energia dissipada durante insuflação pulmonar. Em seguida, os animais foram randomizados em um dos três grupos: HFOV, VP ou TGI. O PEEP ou PMEAN ideais foram obtidos através de uma curva PEEP/PaO2 (ou PMEAN/PaO2) que foi precedida por uma manobra de recrutamento. Os animais dos grupos VP e TGI foram inicialmente ventilados em PCV com um delta de pressão = 8 cmH2O e freqüência = 60 resp/min. A única diferença inicial entre os dois foi que o grupo TGI possuía um fluxo traqueal continuo = 1 L/min. Os animais do grupo HFOV foram inicialmente ventilados com uma amplitude de pressão = 45 cmH2O e freqüência = 10 Hz. Todos os animais foram ventilados com uma FiO2 = 1.0. Os deltas de pressão (ou pressão motriz)...

Introduction: One of the major goals in ARDS is to find the best protective mechanical ventilation strategy, which minimizes lung stress and optimizes gas exchange. Theoretically, these two goals can be accomplished by simultaneously avoiding alveolar overdistension and cyclic collapse of unstable alveolar units. Pushing further the rationale of this strategy, two new strategies have been proposed: high frequency oscillatory mechanical ventilation (HFOV) and intra-tracheal gas insufflation (TGI) associated with permissive hypercapnia and conventional frequencies. Objective: To determine which of the three protective modalities of mechanical ventilation, HFOV, low-frequency-protective ventilation (LFV), or LFV associated with tracheal gas insufflation (TGI), was the most protective strategy in an ARDS rabbit model during six hours of mechanical ventilation. Material and methods: The animals (n = 45) were submitted to repeated saline lavage until PaO2 < 100 mmHg. Immediately after lung injury, a P/V curve was obtained to calculate inspiratory/expiratory work and energy dissipated during lung inflation. Thereafter, the animals were randomized into one of three groups: LFV, HFOV or TGI. The optimal PEEP or PMEAN was obtained during a PEEP/PaO2 (or PMEAN/PaO2) curve which was preceded by a recruiting maneuver. The animals of the LFV and TGI groups were initially ventilated in PCV with diving pressure = 8 cmH2O and frequency = 60 b/m. The only initial difference between these two arms was that the TGI group had a continuous tracheal flow = 1 L/min. The animals in the HFOV were initially ventilated with an oscillatory pressure amplitude = 45 cmH2O and frequency = 10 Hz. All animals were ventilated with FiO2 = 1.0. Driving pressure was then adjusted in LFV and TGI groups to maintain a PaCO2 = 90-110 mmHg, while in HFO the pressure amplitude was adjusted to maintain a PaCO2 = 45-55 mmHg. At the end of the experiment, after 6 hours of ventilation...

The Histopathologic Reaction of Rabbit Lungs after Intrabronchial Application of Contrast Agents

PURPOSE: The aim of this study was to determine a safe gastrointestinal contrast agent that could be used in various clinical situations where there is a risk of aspiration using a rabbit model. MATERIALS AND METHODS: 30 healthy white rabbits were used. The rabbits were divided into 5 groups containing six animals each, one control group (anesthesia only) and 4 groups receiving various contrast agents [Solotop (Barium sulphate suspension), Gastrografin (Sodium and meglumine amidotrizoate), and Telebrix (Meglumine ioxitalamate), Visipaque (Iodixanol)]. The contrast agents were injected selectively into a main bronchus via a catheter inserted under fluoroscopy guidance. The rabbits were sacrificed either 1 day or 7 days after injecting the contrast agents, and the tissue reaction of the bronchi and lungs were examined both macro- and microscopically. The level of alveolar septal thickening, peribronchiolar lymphocytic infiltration, pulmonary congestion and edema, inflammatory exudate in the alveoli or bronchiolar lumina, microabscess formation, necrosis, pigmentation of materials injected, and fibropurulent pleurisy were evaluated and graded according to the severity as follows: no change, mild, moderate, marked in degree. RESULTS: The common microscopic findings were alveolar septal thickening and peribronchiolar lymphocytic infiltration. Pulmonary congestion and edema, inflammatory exudate in the alveoli or bronchiolar lumina were observed in 21 out of 24 rabbits receiving the contrast agents. Pigmentation of the materials injected was observed only in the group receiving Solotop. An inflammatory exudate in the alveoli and bronchiolar/bronchial lumina, microabscess formation, and necrosis were noted in most groups, but was more frequent and severe in the group receiving Gastrografin. CONCLUSION: The histopathological reactions of the rabbit lungs after the intrabronchial application of a contrast agent showed variable degrees of inflammatory reactions. Gastrografin produced most severe and extensive reaction, Solotop and Telebrix a moderate reaction, and Visipaque a minimal reaction. Therefore, a non-ionic dimeric contrast agent such as Visipaque may be the safest contrast agent in the lung when a GI tract examination is performed in clinical situations where there is a risk of aspiration.