Evaluation of angles of the tracheobronchial tree with the 3-dimensional reconstruction method: a morphometric and radiologic study / Evaluación de los ángulos del árbol traqueobronquial con el método de reconstrucción tridimensional: un estudio morfométrico y radiológico

SUMMARY: The objective of the current research is to assess the branching angles of the tracheobronchial tree and the correlation between these angles and the lung volume using the 3-dimensional reconstruction method. Thorax CT (computed tomography) images of 150 individuals, who were over 18 years of age and did not have any pathology on CT, were obtained retrospectively. A 3-dimensional reconstruction of the trachea, bronchi, and lungs was carried out. External and internal angles between the trachea and main bronchi, between the main bronchi and lobar bronchi, and between the lobar bronchi were measured. The volume measurement of the right and left lungs was performed. The individuals included in the study were grouped by sex and age (20-40 years, 41-61 years, and 62-87 years). The left subcarinal angle (LSA), total subcarinal angle (TSA), and left interbronchial angle (LIA) were found to be greater in the 62-87 age group. Both the external angle (LULB-LMBE) and the internal angle (LULB- LMBI) between the left upper lobar bronchus and the left main bronchus were observed to be greater in males. In males, a statistically significant negative moderate correlation was identified between the right lung volume and the right subcarinal angle (RSA). In females, a statistically significant positive moderate correlation was revealed between the external (RULB-IBE) and internal angles (RULB-IBI) between the right upper lobar bronchus and the intermediate bronchus, and the right lung volume. In the literature review we performed, we did not find any studies investigating the correlation between the branching angles of the tracheobronchial tree and the lung volume using the 3-dimensional reconstruction method. Therefore, we are of the opinion that our study will contribute to the literature.

El objetivo de la investigación fue evaluar los ángulos de ramificación del árbol traqueobronquial y la correlación entre estos ángulos y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Se obtuvieron retrospectivamente imágenes de tomografía computarizada de tórax de 150 individuos mayores de 18 años sin patología. Se realizó una reconstrucción tridimensional de la tráquea, los bronquios y los pulmones. Se midieron los ángulos externo e interno entre la tráquea y los bronquios principales, entre los bronquios principales y los bronquios lobares, y entre los bronquios lobares. Se realizó la medición del volumen de los pulmones derecho e izquierdo. Los individuos incluidos en el estudio fueron agrupados por sexo y edad (20-40 años, 41-61 años y 62-87 años). Se encontró que el ángulo subcarinal izquierdo, el ángulo subcarinal total y el ángulo interbronquial izquierdo eran mayores en el grupo de edad de 62 a 87 años. Tanto el ángulo externo (LULB-LMBE) como el ángulo interno (LULB-LMBI) entre el bronquio lobular superior izquierdo y el bronquio principal izquierdo era mayor en los hombres. En los hombres, se identificó una correlación moderada negativa estadísticamente significativa entre el volumen pulmonar derecho y el ángulo subcarinal derecho. En mujeres, se reveló una correlación positiva moderada estadísticamente significativa entre los ángulos externos (RULB-IBE) e internos (RULB-IBI) entre el bronquio lobar superior derecho y el bronquio intermedio, y el volumen pulmonar derecho. En la revisión bibliográfica que realizamos, no encontramos ningún estudio que analizara la correlación entre los ángulos de ramificación del árbol traqueobronquial y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Por lo tanto, consideramos que nuestro estudio contribuirá a la literatura especializada del tema.

Morphometric examination of the trachea and bronchi in follow-up computed tomography scans of COVID-19 patients / Examen morfométrico de la tráquea y los bronquios en tomografías computarizadas de seguimiento de pacientes con COVID-19

SUMMARY: The purpose of this study is to evaluate changes in the trachea and bronchi using 3-dimensional reconstruction images obtained from the initial and follow-up computed tomography (CT) scans of COVID-19 patients. A hundred COVID-19 patients over the age of 18 were included in our study. CT images were transferred to Mimics software, and a 3-dimensional reconstruction of the trachea and bronchi was performed. The initial and follow-up CT images of COVID-19 patients were graded as none (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3) according to the total lung severity score. The patients were divided into progression and regression groups according to the grade increase/decrease between the initial and follow-up CTs. Moreover, the patients were divided into groups as 0-2 weeks, 2-4 weeks, 4-12 weeks, and over 12 weeks according to the duration between the initial and follow-up CTs. The mean cross-sectional area, circumference, and diameter measurements of the right upper lobar bronchus, intermediate bronchus, middle lobar bronchus, and left lower lobar bronchus decreased in the follow-up CTs of the progression group. This decrease was not found to be statistically significant. In the follow-up CTs of the regression group, the left upper lobar bronchus and left lower lobar bronchus measurements increased but not statistically significant. Upon comparing the onset of the disease and the follow-up period, statistically significant changes did not occur in the trachea, main bronchus, and lobar bronchus of COVID-19 patients.

El propósito de este estudio fue evaluar los cambios en la tráquea y los bronquios utilizando imágenes de reconstrucción tridimensionales obtenidas de las tomografías computarizadas (TC) iniciales y de seguimiento de pacientes con COVID-19. En nuestro estudio se incluyeron 100 pacientes con COVID-19 mayores de 18 años. Las imágenes de TC se transfirieron al software Mimics y se realizó una reconstrucción tridimensional de la tráquea y los bronquios. Las imágenes de TC iniciales y de seguimiento de los pacientes con COVID-19 se calificaron como ninguna (grado 0), leve (grado 1), moderada (grado 2) y grave (grado 3) según la puntuación total de gravedad pulmonar. Los pacientes se dividieron en grupos de progresión y regresión según el aumento/disminución del grado entre las TC iniciales y de seguimiento. Además, los pacientes se dividieron en grupos de 0 a 2 semanas, de 2 a 4 semanas, de 4 a 12 semanas y de más de 12 semanas según la duración entre la TC inicial y la de seguimiento. Las mediciones medias del área transversal, la circunferencia y el diámetro del bronquio lobar superior derecho, el bronquio intermedio, el bronquio lobar medio y el bronquio lobar inferior izquierdo disminuyeron en las TC de seguimiento del grupo de progresión. No se encontró que esta disminución fuera estadísticamente significativa. En las TC de seguimiento del grupo de regresión, las mediciones del bronquio lobar superior izquierdo y del bronquio lobar inferior izquierdo aumentaron pero no fueron estadísticamente significativas. Al comparar el inicio de la enfermedad y el período de seguimiento, no ocurrieron cambios estadísticamente significativos en la tráquea, el bronquio principal y el bronquio lobar de los pacientes con COVID-19.

Reverse partial pulmonary resection: a new surgical approach for pediatric pulmonary cysts / 南方医科大学学报

OBJECTIVE@#To evaluate the safety and efficacy of reverse partial lung resection for treatment of pediatric pulmonary cysts combined with lung abscesses or thoracic abscess.@*METHODS@#We retrospectively analyzed the clinical data of children undergoing reverse partial lung resection for complex pulmonary cysts in our hospital between June, 2020 and June, 2021.During the surgery, the patients lay in a lateral position, and a 3-5 cm intercostal incision was made at the center of the lesion, through which the pleura was incised and the fluid or necrotic tissues were removed.The anesthesiologist was instructed to aspirate the sputum in the trachea to prevent entry of the necrotic tissues in the trachea.The cystic lung tissue was separated till reaching normal lung tissue on the hilar side.The proximal end of the striated tissue in the lesion was first double ligated with No.4 silk thread, the distal end was disconnected, and the proximal end was reinforced with continuous sutures with 4-0 Prolene thread.The compromised lung tissues were separated, and the thoracic cavity was thoroughly flushed followed by pulmonary inflation, air leakage management and incision suture.@*RESULTS@#Sixteen children aged from 3 day to 2 years underwent the surgery, including 3 with simple pulmonary cysts, 11 with pulmonary cysts combined with pulmonary or thoracic abscess, 1 with pulmonary cysts combined with tension pneumothorax and left upper lung bronchial defect, and 1 with pulmonary herpes combined with brain tissue heterotaxy.All the operations were completed smoothly, with a mean operation time of 129 min, an mean hospital stay of 11 days, and a mean drainage removal time of 7 days.All the children recovered well after the operation, and 11 of them had mild air leakage.None of the children had serious complications or residual lesions or experienced recurrence of infection after the operation.@*CONCLUSION@#Reverse partial lung resection is safe and less invasive for treatment of complex pediatric pulmonary cysts complicated by infections.

Pulmonary granular cell tumors: a clinicopathological analysis of five cases / 中华病理学杂志

Objective: To investigate the clinicopathological features of pulmonary granular cell tumors (pGCTs) and to improve the diagnostic accuracy of the tumor. Methods: A total of 5 pGCTs were diagnosed from February 2016 to January 2022 at Shanghai Pulmonary Hospital, Tongji University School of Medicine and Fudan University Shanghai Cancer Center, China. Immunohistochemical staining, and analysis of the clinicopathological characteristics were performed. Results: The average age of the pGCTs patients was 46 years (ranging from 24 to 54 years), with 3 females and 2 males. One case occurred in the bronchus with multiple nodules in the lung, 2 cases occurred in the bronchial opening, and 2 cases were solitary nodules in the lung. The maximum diameter of the tumors ranged from 12 to 15 mm (mean size 14 mm). Microscopically, the tumor showed infiltrative growth and consisted of round, oval or polygonal cells. Abundant eosinophilic cytoplasm was noted, and the nucleoli were prominent. None of the 5 cases showed any mitosis or necrosis. Immunohistochemical and histochemical study showed positive staining for S-100 (5/5), SOX10 (5/5), Vimentin (5/5), TFE3 (4/5), PAS (3/5), and amylase-digested-PAS (3/5), while 4 cases were negative for CD68. TFE3 FISH analyses on 2 cases showed that no signal abnormality was detected in these 2 cases. The average proliferation index of Ki-67 was 2.2% (range 0-5%). There was no recurrence in 4 cases of pGCTs with a follow-up time ranging from 2 months to 60 months. Conclusions: pGCTs are very rare tumors, most likely originating from Schwann cells. Immunohistochemical staining is the conventional diagnostic tool for pGCTs diagnosis. Recognition of this entity is essential for pathologists to avoid misdiagnosis and unnecessary treatments.

Perfil epidemiológico dos casos de neoplasias pulmonares durante a pandemia da COVID-19 no Brasil / Epidemiological profile of lung cancer cases during the COVID-19 pandemic in Brazil

Objetivo: analisar o perfil epidemiológico dos casos de neoplasia do sistema respiratório que foram diagnosticados e tratados nos anos de 2017 a 2019 e comparar com os casos ocorridos durante a pandemia da COVID-19 no Brasil. Método: estudo transversal com dados de neoplasia maligna da traqueia, dos brônquios e dos pulmões fornecidos pelo Departamento de Informática do Sistema Único de Saúde. Os casos foram coletados e analisados conforme a modalidade terapêutica e o sexo, por meio da incidência anual para cada região brasileira, comparando-se o período da pandemia e os anos de 2017, 2018 e 2019. Resultados: durante a pandemia, nos casos de neoplasias do sistema respiratório, que acometeram o sexo masculino, foram observadas reduções da realização de procedimentos terapêuticos em todas as regiões brasileiras, notando-se, principalmente, diminuições de 68,22%, 19,58% e 57,24% dos casos tratados com cirurgias, quimioterapia e radioterapia na Região Nordeste. Nos casos de neoplasias que acometeram o sexo feminino, foram detectados aumentos de cirurgias e reduções de radioterapia em todas as regiões federativas, notando-se, principalmente, um aumento de 64,03% e uma redução de 59,73%, respectivamente, dos casos tratados com cirurgia no Centro-Oeste e com radioterapia no Sudeste. Conclusão: o remanejamento dos tratamentos está correlacionado aos aumentos e às reduções dos casos tratados de neoplasias do sistema respiratório. Nesse contexto, os serviços de saúde devem adotar medidas para reduzir a exposição e a contaminação dos indivíduos com a COVID-19, de modo que os tratamentos oncológicos não sejam afetados, e evitar desfechos graves.

Objective: to analyze the epidemiological profile of cases of neoplasms of the respiratory system, which were diagnosed and treated in the years 2017 to 2019, and to compare with the cases that occurred during the COVID-19 pandemic in Brazil. Method: a cross-sectional study with data on the malignant neoplasm of the trachea, bronchi, and lungs provided by the Department of Informatics of the Unified Health System. The cases were collected and analyzed according to the therapeutic modality and sex through the annual incidence for each Brazilian region, comparing the period of the pandemic and the years 2017, 2018, and 2019. Results: during the pandemic, cases of respiratory system neoplasms that affected males and reductions in the performance of therapeutic procedures were observed in all Brazilian regions, noting mainly, decreases of 68.22%, 19.58%, and 57.24% of cases treated with surgeries, chemotherapy, and radiotherapy in the Northeast region. In the cases of neoplasms that affected females, increases in surgeries and reductions in radiotherapy were detected in all federative regions, noting, mainly, an increase of 64.03% and a reduction of 59.73%, respectively, of the cases treated with surgery in the Midwest and with radiotherapy in the Southeast. Conclusion: the relocation of treatments is correlated with increases and decreases in cases of treated respiratory system neoplasms. In this context, health services must adopt measures to reduce the exposure and contamination of individuals with COVID-19 so that cancer treatments are not affected and avoid serious outcomes.

Asociación del complejo ring-sling con pig bronchus: a propósito de un caso pediátrico / Ring-sling complex association with pig bronchus: a pediatric case report

El complejo ring-sling es una asociación entre el sling de la arteria pulmonar y la estenosis traqueal congénita por anillos traqueales completos. El sling de la arteria pulmonar es una forma rara de anillo vascular dentro de las cardiopatías congénitas. Se presenta el caso clínico de un niño con estridor laríngeo asociado a dificultad respiratoria evaluado en otro centro, donde se realizó endoscopia respiratoria y se observó compresión traqueal extrínseca. Ante la sospecha clínica de anillo vascular, se solicitó angiotomografía computada (angioTC) y se confirmó diagnóstico de sling de arteria pulmonar. Fue derivado a nuestro hospital y durante la intervención quirúrgica se realizó nueva endoscopia respiratoria y traqueobroncografía. Se llegó al diagnóstico de estenosis traqueal congénita con bronquio derecho accesorio (pig bronchus) y anillos vasculares completos, ambos reparados en el mismo acto quirúrgico.

The ring-sling complex is an association between pulmonary artery sling and congenital tracheal stenosis. Pulmonary artery sling is a rare form of vascular ring in congenital heart disease. The clinical case of a child with inspiratory laryngeal stridor associated with respiratory distress is presented, evaluated in another center where respiratory endoscopy was performed, observing extrinsic tracheal compression. Given the clinical suspicion of a vascular ring, CT angiography was requested, confirming the diagnosis of pulmonary artery sling. He was referred to our hospital and during the surgical intervention a new respiratory endoscopy and tracheobronchography were performed, reaching the diagnosis of congenital tracheal stenosis, right accessory bronchus (pig bronchus) and complete vascular rings, both repaired in the same surgical act.

Bronquio cardíaco diagnosticado por estudio endoscópico / Cardiac bronchus diagnosed by endoscopic study

Introducción: El bronquio cardíaco es una anomalía congénita poco frecuente, con una incidencia de aproximadamente 0,1 por ciento. Consiste en un bronquio supernumerario que nace de la pared medial del bronquio principal derecho o del bronquio intermediario, opuesto al origen del bronquio para el lóbulo superior derecho y proximal al bronquio del segmento apical del lóbulo inferior derecho. Objetivo: Presentar el caso de un bronquio cardíaco diagnosticado por estudio endoscópico. Presentación del caso: Se presenta el caso de un paciente que ingresa en el servicio de Neumología del Hospital Clínico Quirúrgico Hermanos Ameijeiras por presentar tos, expectoración blanca, disnea a los grandes esfuerzos y una radiografía de tórax con una radiopacidad en el lóbulo superior izquierdo y que como hallazgo incidental durante la realización de la broncoscopia se detecta un bronquio cardíaco o supernumerario. Conclusiones: El bronquio cardíaco es una malformación congénita infrecuente que puede cursar de manera asintomática, cuyo diagnóstico definitivo es por broncoscopia(AU)

Introduction: The cardiac bronchus is a rare congenital anomaly, with an incidence of approximately 0.1 percent. It consists of a supernumerary bronchus that arises from the medial wall of the right main bronchus or the bronchus intermediary, opposite the origin of the bronchus for the right upper lobe and proximal to the bronchus of the apical segment of the right lower lobe. Objective: To report the case of a cardiac bronchus diagnosed by endoscopic study. Case report: We report the case of a patient who was admitted to the Pneumology service at Hermanos Ameijeiras Surgical Clinical Hospital due to cough, white expectoration, dyspnea on exertion and a chest X-ray with radiopacity in the upper lobe, and that as an incidental finding during the bronchoscopy, a cardiac or supernumerary bronchus was detected. Conclusions: Bronchus is an infrequent congenital malformation that can be asymptomatic, whose definitive diagnosis is by bronchoscopy(AU)

Traqueobroncoplastia por malacia / Tracheobronchoplasty for malacia

RESUMEN La traqueobroncomalacia es una enfermedad de la vía aérea central caracterizada por una debilidad de la pared, con disminución dinámica de la luz de la tráquea y grandes bronquios principalmente durante la espiración. Genera síntomas crónicos que pueden evolucionar hasta la falla respiratoria grave, frecuentemente diagnosticados de forma errónea como asma o enfermedad pulmonar obstructiva crónica (EPOC). Presentamos el caso de una paciente femenina de 70 años, con antecedente de artritis reumatoide y múltiples internaciones por cuadros respiratorios infecciosos en los 3 años previos.

ABSTRACT Tracheobroncomalacia is a disease of the central airway due to weakness of the wall with dynamic narrowing of the lumen of the trachea and mainstem bronchi during exhalation. It produces chronic symptoms that can progress to severe respiratory failure, often misdiagnosed as asthma or chronic obstructive pulmonary disease (COPD). We report the case of a 70-year-old female patient with a history of rheumatoid arthritis and multiple hospitalizations for recurrent respiratory infections over the past 3 years.

Enfermedad relacionada con IgG4, según criterios ACR/EULAR 2019 sin evidencia de IgG4 en sangre / IgG4-related disease according to ACR/EULAR 2019 criteria without evidence of IgG4 in blood

INTRODUCCIÓN. La enfermedad relacionada con IgG4 es una patología fibroinflamatoria multiorgánica, de origen desconocido, que simula trastornos malignos, infecciosos e inflamatorios. Los criterios del American College of Rheumatology y la European League against Rheumatism 2019, son útiles para el diagnóstico diferencial de ésta enfermedad cuando se no se cuenta con evidencia de inmunoglobulina G4 en sangre. CASO CLÍNICO. Paciente hombre de 45 años de edad, nacido en Ambato-Ecuador, con ingreso en noviembre del 2017, en emergencias del Hospital de Especialidades Carlos Andrade Marín, con presencia de tos con hemoptisis leve, febrícula, astenia, pérdida de peso e hiporexia de dos semanas de evolución. Se realizó múltiples exámenes, tras observar infiltrados pulmonares intersticiales, con elevación de inmunoglobulina G en suero, negativas para malignidad; se sospechó de enfermedad relacionada a inmunoglobulina G4. Se ampliaron los estudios para descartar otras patologías más prevalentes y cuyo diferencial es primordial. Se inició tratamiento con prednisona y micofenolato con buena respuesta clínica; durante dos años. DISCUSIÓN. La evidencia científica registró que el hallazgo más importante en la enfermedad relacionada con inmunoglobulina G4 fue un aumento de sus niveles séricos. La recurrencia de la enfermedad en un órgano afectado o la aparición de un nuevo órgano involucrado pudo conducir al diagnóstico en el caso presentado. CONCLUSIÓN. La enfermedad relacionada con inmunoglobulina G4 al ser una patología heterogénea, inmunomediada, al simular otras afecciones puede retrasar el diagnóstico; se debe tener una alta sospecha clínica, si al excluir otros procesos infecciosos, autoinmunes y/o eoplásicos, hay evidencia de patología fibroesclerosante multiorgánica sin causa establecida.

INTRODUCTION. IgG4-related disease is a multiorgan fibroinflammatory pathology of unknown origin that mimics malignant, infectious, and inflammatory disorders. The criteria of the American College of Rheumatology and the European League against Rheumatism 2019 are useful for the differential diagnosis of this disease when there is no evidence of immunoglobulin G4 in blood. CLINICAL CASE. 45-year-old male patient, born in Ambato-Ecuador, with admission in November 2017, in the emergency room of the Hospital de Especialidades Carlos Andrade Marín, with the presence of cough with mild hemoptysis, fever, asthenia, weight loss and hyporexia of two weeks of evolution. Multiple tests were performed, after observing interstitial pulmonary infiltrates, with elevated serum immunoglobulin G, negative for malignancy; immunoglobulin G4-related disease was suspected. Studies were extended to rule out other more prevalent pathologies whose differential is paramount. Treatment with prednisone and mycophenolate was started with good clinical response; for two years. DISCUSSION. The scientific evidence recorded that the most important finding in immunoglobulin G4-related disease was an increase in its serum levels. Recurrence of the disease in an affected organ or the appearance of a new involved organ could have led to the diagnosis in the presented case. CONCLUSION. Immunoglobulin G4-related disease, being a heterogeneous, immune-mediated pathology, by simulating other conditions may delay diagnosis; a high clinical suspicion should be maintained if, when other infectious, autoimmune and/or neoplastic processes are excluded, there is evidence of multiorgan fibrosclerosing pathology without established cause.

Atresia bronquial / Bronchial atresia

Introducción: La atresia bronquial es una patología poco frecuente, generalmente asintomática e incidental en las imágenes del tórax. La aproximación diagnóstica de esta entidad se puede hacer por radiografía y broncoscopia, donde se identifican algunos aspectos claves en el diagnóstico diferencial. De acuerdo las manifestaciones clínicas y posibles complicaciones el tratamiento puede ser desde conservador hasta quirúrgico con resección lobar o segmentaria. Objetivo: Presentar las características de un caso con atresia bronquial. Presentación de caso: Se presenta un caso de atresia bronquial en una paciente de 19 años de edad cuyo tratamiento definitivo fue bilobectomía media-inferior derecha. Conclusiones: La atresia bronquial es una entidad infrecuente que puede cursar de manera asintomática y ser detectada por un hallazgo radiológico en pacientes adultos de manera incidental. El diagnóstico se puede confirmar por broncoscopia y el tratamiento casi siempre es quirúrgico(AU)

Introduction: Bronchial atresia is a rare disease, generally asymptomatic and incidental in chest images. The diagnostic approach of this entity can be done by radiography and bronchoscopy, some key aspects are identified in the differential diagnosis. According to the clinical manifestations and possible complications, the treatment can range from conservative to surgical with lobar or segmental resection. Objective: To describe a case of bronchial atresia. Case report: A case of bronchial atresia is reported in a 19-year-old patient whose definitive treatment was a right-lower-middle bilobectomy. Conclusions: Bronchial atresia is a rare entity that can occur asymptomatically and be detected incidentally by a radiological finding in adult patients. The diagnosis can be confirmed by bronchoscopy, and treatment is almost always surgical(AU)

Small bronchiolar histopathological changes related to prolonged diabetes / Pequeños cambios histopatológicos bronquiolares relacionados con la diabetes prolongada

SUMMARY: Diabetes mellitus increases the risk of developing chronic obstructive pulmonary disease (COPD). The small bronchiole is a prominent site of airflow obstruction that causes increased airway resistance in patients with the COPD. Therefore, the histological and ultrastructural changes in small bronchioles in streptozotocin (STZ)-induced chronic diabetes were determined. Twenty-four weeks after STZ induction, rats were sacrificed, and the right and left lungs were collected for examination by light and electron microscopy. The alterations to the small bronchioles were the same in both lungs of these diabetic rats. The bronchiolar epithelial cells, both ciliated and secretory club cells, showed pyknotic nuclei and damaged cytoplasmic organelles. Increased thickening of the bronchiolar wall occurred in diabetic rats due to smooth muscle layer thickening, inflammatory cell infiltration, and increased numbers of myofibroblasts with collagen deposition.These results indicated that chronic diabetes caused extreme damage to small bronchioles, which may lead to chronic small airway obstruction and ultimately increase the likelihood of COPD progression. This basic knowledge provides a better understanding of the progression of pathogenesis in the small airways of patients with prolonged diabetes.

RESUMEN: La diabetes mellitus aumenta el riesgo de desarrollar enfermedad pulmonar obstructiva crónica (EPOC). El bronquiolo es un sitio prominente de obstrucción del flujo de aire que causa una mayor resistencia de las vías respiratorias en pacientes con EPOC. Por lo tanto, se determinaron los cambios histológicos y ultraestructurales en los bronquiolos en la diabetes crónica inducida por estreptozotocina (STZ). 24 semanas después de la inducción de STZ, se sacrificaron las ratas y se analizaron los pulmones derecho e izquierdo por microscopía óptica y electrónica. Las alteraciones de los pequeños bronquiolos fueron las mismas en ambos pulmones de estas ratas diabéticas. Las células epiteliales bronquiolares, tanto ciliadas como secretoras, mostraban núcleos picnóticos y orgánelos citoplasmáticos dañados. Se produjo un aumento del engrosamiento de la pared bronquiolar en ratas diabéticas debido al engrosamiento de la capa de músculo liso, infiltración de células inflamatorias y un mayor número de miofibroblastos con colágeno. Estos resultados indicaron que la diabetes crónica causaba daño extremo a los pequeños bronquiolos, lo que puede conducir a una obstrucción crónica de las vías respiratorias pequeñas y además aumentar la probabilidad de progresión de la EPOC. Esta información proporcionará un mejor conocimiento de la patogénesis en las vías respiratorias pequeñas de los pacientes con diabetes prolongada.

Exosomes Derived from Hydroquinone-transformed Human Bronchial Epithelial Cells Inhibited Recipient Cell Apoptosis by transferring miR-221 / 生物医学与环境科学（英文）

Objective@#Although benzene is a confirmed environmental carcinogen, the mechanism of its carcinogenicity remains largely unclear. The suggested oncogene, miR-221, is elevated and plays important roles in various tumors, but its role in benzene-induced carcinogenesis remains unknown.@*Methods@#In the present study, we constructed hydroquinone (HQ, a representative metabolite of benzene with biological activity)-transformed malignant cell line (16HBE-t) and analyzed the level of miR-221 in it with qRT-PCR. Exosomes from 16HBE-t cells incubated with or without an miR-221 inhibitor were isolated by ultracentrifugation, characterized by transmission electron microscopy and laser scanning confocal microscope, and then transfected into 16HBE cells. The effects of exosomal miR-221 on apoptosis induced by HQ in recipient cells were determined using flow cytometry.@*Results@#The amount of miR-221 in 16HBE-t was significantly increased compared with controls. When recipient cells ingested exosomes derived from 16HBE-t, miR-221 was increased, and apoptosis induced by HQ was inhibited. Blocking miR-221 in 16HBE-t using an inhibitor did not significantly alter miR-221 or apoptosis in recipient cells.@*Conclusion@#Exosomal miR-221 secreted by 16HBE-t inhibits apoptosis induced by HQ in normal recipient cells.

Assessment of Benchmark Dose in BEAS-2B Cells by Evaluating the Cell Relative Viability with Particulates in Motorcycle Exhaust / 生物医学与环境科学（英文）

Objective@#This study aimed to use an air-liquid interface (ALI) exposure system to simulate the inhalation exposure of motorcycle exhaust particulates (MEPs) and then investigate the benchmark dose (BMD) of MEPs by evaluating cell relative viability (CRV) in lung epithelial BEAS-2B cells.@*Methods@#The MEPs dose was characterized by measuring the number concentration (NC), surface area concentration (SAC), and mass concentration (MC). BEAS-2B cells were exposed to MEPs at different concentrations @*Results@#Our results reveal that BMD of NC and SAC were estimated by the best-fitting Hill model, while MC was estimated by Polynomial model. The BMDL for CRV following ALI exposure to MEPs were as follows: 364.2#/cm @*Conclusion@#These results indicate that MEPs exposure

Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To study the safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children.@*METHODS@#A total of 118 children who planned to undergo fiberoptic bronchoscopy from September 2018 to February 2021 were enrolled. They were divided into a control group (@*RESULTS@#Compared with the control group, the observation group had significantly decreased MAP at T@*CONCLUSIONS@#Dexmedetomidine hydrochloride combined with midazolam is a safe and effective way to administer general anesthesia for fiberoptic bronchoscopy in children, which can ensure stable vital signs during examination, reduce intraoperative adverse reactions and postoperative agitation, shorten examination time, and increase amnesic effect.

Effects of bronchial thermoplasty and cryoablation on airway smooth muscle / 中华医学杂志(英文版)

BACKGROUND@#The effectiveness of bronchial thermoplasty (BT) has been reported in patients with severe asthma. This study compared the effects of BT and cryoballoon ablation (CBA) therapy on the airway smooth muscle (ASM).@*METHODS@#Eight healthy male beagle dogs were included in this experiment. In the preliminary experiment, one dog received BT treatment for both lower lobe bronchus, another dog received CBA treatment for 7 s on the upper and lower lobe of right bronchus, and 30 s on the left upper and lower lobe. The treatments were performed twice at an interval of 1 month. In subsequent experiments, the right lower lobe bronchus was treated with BT, and the left lower lobe bronchus was treated with CBA. The effects of treatment were observed after 1 (n = 3) month and 6 months (n = 3). Hematoxylin-eosin staining, Masson trichrome staining, and immunohistochemical staining were used to compare the effects of BT and CBA therapy on the ASM thickness, collagen fibers synthesis, and M3 receptor expression after treatment. One-way analysis of variance with Dunnett post hoc test was used to analyze the differences among groups.@*RESULTS@#In the preliminary experiment, the ASM ablation effect of 30-s CBA was equivalent to that of 7-s CBA (ASM thickness: 30.52 ± 7.75 μm vs. 17.57 ± 15.20 μm, P = 0.128), but the bronchial mucociliary epithelium did not recover, and large numbers of inflammatory cells had infiltrated the mucosal epithelium at 1-month post-CBA with 30-s freezing. Therefore, we chose 7 s as the CBA treatment time in our follow-up experiments. Compared with the control group (35.81 ± 11.02 μm), BT group and CBA group (13.41 ± 4.40 μm and 4.81 ± 4.44 μm, respectively) had significantly decreased ASM thickness after 1 month (P < 0.001). Furthermore, the ASM thickness was significantly lower in the 1-month post-CBA group than in the 1-month post-BT group (P = 0.015). There was no significant difference in ASM thickness between the BT and CBA groups after six months (9.92 ± 4.42 μm vs. 7.41 ± 7.20 μm, P = 0.540). Compared with the control group (0.161 ± 0.013), the average optical density of the ASM M3 receptor was significantly decreased in 6-month post-BT, 1-month post-CBA, and 6-month post-CBA groups (0.070 ± 0.022, 0.072 ± 0.012, 0.074 ± 0.008, respectively; all P < 0.001). There was no significant difference in the average optical density of ASM M3 receptor between the BT and CBA therapy groups after six months (P = 0.613).@*CONCLUSIONS@#CBA therapy effectively ablates the ASM, and its ablation effect is equivalent to that of BT with a shorter onset time. A neural mechanism is involved in both BT and CBA therapy.

Computed tomographic and radiologic anatomy of the lower respiratory tract in the red-foot tortoise (Chelonoidis carbonaria) / Anatomia radiológica e por tomografia computadorizada do trato respiratório inferior no jabuti-piranga (Chelonoidis carbonaria)

The diagnosis of several diseases in chelonians is a challenge in the veterinary clinic, because a detailed physical examination with auscultation and palpation is difficult due the presence of carapace and plastron. Imaging analysis such as radiography and computed tomography (CT) have been shown to be beneficial for diagnosis, prognosis and treatment in numerous animal species. Thus, this study aimed to identify and describe the structures of the lower respiratory tract in red-foot tortoises, by computed tomography, radiography and gross anatomy in twelve red-foot tortoises (Chelonoidis carbonaria), adults and of both sexes. The lower respiratory tract in these animals comprised the larynx, trachea, bronchi and the lungs. The presence of epiglottic cartilage was not observed in the animals studied. CT allowed the observation of the intrapulmonary part of the bronchi, which was accompanied by large intrapulmonary blood vessels. The lungs presented a reticulated parenchyma, without lobulations. Each lung had a small chamber located near the cranial and caudal poles. These structures were identified in CT and 3D CT reconstructions and these could suggest that these chambers could be non-respiratory structures, and could be comparable to the air sacs of birds. This study establishes normal CT anatomy of the lower respiratory tract of the red-foot tortoise; and may be used as a reference in the assessment of respiratory disorders in this tortoise.(AU)

O diagnóstico de diversas afecções em quelônios é um desafio para a clínica veterinária, já que um exame físico detalhado com auscultação e palpação é difícil devido à presença da carapaça e do plastrão. A radiografia e a tomografia computadorizada (TC) tem se mostrado benéficas para o diagnóstico, prognóstico e tratamento em muitas espécies animais. Assim, este estudo teve por objetivo identificar e descrever as estruturas do trato respiratório inferior no jabuti-piranga por meio da tomografia computadorizada, radiografia e anatomia em 12 jabutis-piranga (Chelonoidis carbonara), adultos e de ambos os sexos. Nos animais estudados, o trato respiratório inferior consistiu da laringe, traqueia, brônquios e os pulmões. A cartilagem epiglote não foi observada. A TC permitiu a observação da parte intrapulmonar dos brônquios, a qual estava acompanhada dos vasos sanguíneos intrapulmonares. Os pulmões possuíam um parênquima reticulado, sem lobações. Cada pulmão tinha uma pequena câmara localizada junto aos pólos cranial e caudal. Estas estruturas foram identificadas na TC e na reconstrução 3D a partir da TC e poderiam ser estruturas não-respiratórias, podendo ser comparadas aos sacos aéreos das aves. Este estudo identificou a anatomia normal por meio da TC do trato respiratório inferior do jabuti-piranga, o que pode ser usado como referência para diagnóstico de desordens respiratórias nesta espécie.(AU)