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1.
Odontoestomatol ; 24(39): 1-19, 2022.
Article in Spanish | LILACS, BNUY, BNUY-Odon | ID: biblio-1370330

ABSTRACT

La enfermedad por coronavirus es una infección respiratoria causada por el virus SARS-CoV 2, el cual genera una cascada de eventos sistémicos, afectando diferentes órganos y tejidos. El entendimiento de la fisiopatología del COVID-19 es indispensable no solo al momento de brindar tratamiento a los pacientes, sino que también para comprender las causas de las complicaciones que presentan un número importante de pacientes recuperados. El objetivo de este trabajo es presentar una revisión actualizada de los efectos de la infección en diferentes órganos y sistemas principales que sea de utilidad como material de referencia para profesionales y estudiantes de la salud. Para ello se realizó una búsqueda bibliográfica en los portales PubMED, Scielo, Google Scholar, Cochrane y Springer Link, así como en las bases de repositorios científicos pre-publicación bioRxiv ("bioarchives") y medRxiv ("med-archives") y sobre un total de cerca de 200 mil artículos, se seleccionaron 100 artículos para esta revisión en base a su relevancia o sugerencias de parte de profesionales especializados.


Coronavirus disease is a respiratory infection caused by the SARS-CoV-2 virus, which causes a cascade of systemic events, affecting various organs and tissues. Understanding the pathophysiology of COVID-19 is essential to treat patients and understand the causes of the complications in a significant number of recovered patients. This article presents a review of the effects of infection on various organs and systems that will be useful as reference material for healthcare professionals and medical students. To this end, a literature search was conducted in PubMED, Scielo, Google Scholar, Cochrane, and Springer Link portals, as well as in the pre-publication scientific repositories bioRxiv ("bioarchives") and medRxiv ("med-archives") databases. From about 200,000 papers, 100 articles were selected for this review based on their relevance or suggestions from experts in the field.


A doença coronavírus é uma infecção respiratória causada pelo vírus SARS-CoV-2, que gera uma cascata de eventos sistêmicos, afetando diferentes órgãos e tecidos. Compreender a fisiopatologia da COVID-19 é essencial não apenas no tratamento de pacientes, mas também para compreender as causas das complicações que um número significativo de pacientes recuperados apresenta. O objetivo deste trabalho é apresentar uma revisão atualizada dos efeitos da infecção em diferentes órgãos e principais sistemas que seja útil como material de referência para profissionais de saúde e estudantes. Para isso, foi realizada uma pesquisa bibliográfica nos portais PubMED, Scielo, Google Scholar, Cochrane e Springer Link, bem como nos repositórios científicos de pré-publicação bioRxiv ("bioarquivos") e medRxiv ("arquivos med"). Num total de cerca de 200 mil artigos, 100 artigos foram selecionados para esta revisão por sua relevância ou sugestões de profissionais especializados.


Subject(s)
Humans , COVID-19/physiopathology , Pulmonary Alveoli/physiopathology , Cardiovascular Diseases/physiopathology , Central Nervous System Diseases/physiopathology , Digestive System Diseases/physiopathology , Endocrine System Diseases/physiopathology , SARS-CoV-2/metabolism , COVID-19/epidemiology , Mouth Diseases/physiopathology
2.
Int. j. morphol ; 38(6): 1779-1785, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134511

ABSTRACT

SUMMARY: The Bactrian camel, which is native to China and Mongolia, is large in size and is an even-toed ungulate species. The double humps on the Bactrian camel back differentiate it from the dromedary camel, which has a single hump. This species has adapted to unsuitable conditions (lack of food and water) in the Gobi Desert and is advanced in unique anatomical and physiological characteristics during a prolonged evolution period. Several studies have been conducted on the anatomical features of the Bactrian camel, but none have given attention to the alveolar capillaries of the Bactrian camel lung. Therefore, the current study aims to explore the architecture of the alveolar capillary in the Bactrian camel lung and further explain the mechanism of blood flow in its lung. The current study extracted and examined the architecture of the alveolar capillary in the lung of the Bactrian camel (Camelus bactrianus) and further explained the mechanism of blood flow by performing lung casting and replica scanning electron microscopy methods. The reports showed that the resources of the alveolar-capillary originated from the capillaries of the subpleural space or interlobular septulum, sometimes originating from the precapillary arterioles or directly from the terminal arterioles. The alveolar capillaries anastomosed and formed a single layer of dense, basket-like network surrounding the alveolus. The mash diameter of the alveolar-capillary network was larger than that of the capillary, and the appearance of the mash was oval and elliptical. Many of the collapsed alveolar-capillary networks were found in the alveolar microvascular architecture in the lung of the Bactrian camel. The study found that, due to many collapsed alveoli in the Bactrian camel lung, the disproportional pressure between the pulmonary alveoli induced less imbalance of blood flow in the alveolar capillary, which affected the gas exchange efficiency. Therefore, the function of the anastomosing capillary branch was likely to regulate the blood flow between the alveolar-capillary network.


RESUMEN: El camello bactriano, es originario de China y Mongolia, es de gran tamaño y es una especie de ungulado de dedos pares. Las dobles jorobas del lomo del camello bactriano lo diferencian del dromedario, que tiene una sola joroba. Esta especie se ha adaptado a condiciones inadecuadas (falta de alimento y agua) en el desierto de Gobi y ha avanzado en características anatómicas y fisiológicas únicas durante un período de evolución prolongado. Se han realizado varios estudios sobre las características anatómicas del camello bactriano, pero ninguno ha prestado atención a los capilares alveolares del pulmón de este animal. Por lo tanto, el presente estudio tuvo como objetivo principal explorar la arquitectura del capilar alveolar en el pulmón del camello bactriano y explicar el mecanismo del flujo sanguíneo. A partir de nuestro trabajo se examinó la arquitectura del capilar alveolar en el pulmón del camello bactriano (Camelus bactrianus) mediante la realización de métodos de microscopía electrónica de barrido y escaneo pulmonar. Los informes mostraron que los recursos del alvéolo-capilar se originaban en los capilares del espacio subpleural o del tabique interlobulillar y a veces se originaban en las arteriolas precapilares o directamente en las arteriolas terminales. Los capilares alveolares se anastomosaban y formaban una densa red de capa única en forma de cesta que rodeaba el alvéolo. El diámetro del macerado de la red alveolar-capilar era mayor que el del capilar y el aspecto del macerado era ovalado y elíptico. Muchas de las redes alvéolo-capilares colapsadas se encontraron en la arquitectura microvascular alveolar en el pulmón del camello bactriano. El estudio encontró que, muchos alvéolos colapsados en el pulmón del camello bactriano, la presión desproporcionada entre los alvéolos pulmonares inducía un menor desequilibrio del flujo sanguíneo en el capilar alveolar, lo que afectaba la eficiencia del intercambio de gases. Por lo tanto, la función de la rama capilar anastomosante probablemente regularía el flujo sanguíneo entre la red alveolar-capilar.


Subject(s)
Animals , Pulmonary Alveoli/blood supply , Pulmonary Alveoli/ultrastructure , Capillaries/anatomy & histology , Capillaries/ultrastructure , Camelus/anatomy & histology , Lung/blood supply , Lung/ultrastructure , Microscopy, Electron, Scanning
4.
Int. j. morphol ; 37(3): 953-958, Sept. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1012380

ABSTRACT

La correcta utilización de los términos morfológicos está estandarizada por las terminologías, una de ellas es la Terminologia Histologica (TH). Éstas sugieren la exclusión de los epónimos. Pese a esto, existen estructuras que continúan en esta condición. Específicamente, "Poros de Kohn, Canales de Martin y Canales de Lambert" son términos que componen la ventilación colateral (VC) y son ejemplo de esta situación. Así, el objetivo del presente estudio fue identificar en TH los términos asociados a la VC a fin de proponer denominaciones siguiendo las recomendaciones de la Federación Internacional de Programas de Terminologías Anatómicas (FIPAT). Se buscaron los términos relacionados a la VC en TH, posteriormente, se efectuó el mismo ejercicio en textos de histología, además de esto, en base de datos MedLine a través de su buscador PudMed con el siguiente algoritmo: (lung) AND (alveoli pulmonary) AND (airway) AND (collateral) AND (ventilation). En TH se encontró el término Porus septalis (H3. 05.02.0.00036) para referirse al término Poros de Kohn, en seis textos de histología se menciona el término Poros de Kohn, en 21 artículos revisados se menciona la VC, de estos, en diez se utiliza el epónimo Poro de Kohn, para referirse a los poros septales, el epónimo Canales de Lambert fue utilizado en seis artículos y el epónimo Canales de Martin, apareció en cinco artículos. A partir de la información encontrada, su desarrollo histórico, sumado a los lineamientos de la FIPAT, proponemos complementar e incluir en TH los términos Porus septalis alveolaris para los poros de Kohn, Ductus bronchiolaris alveolaris para los Canales de Lambert y Ductus interbronquiolaris para los canales de Martin, respectivamente.


The correct use of morphological terms is standardized by the Terminologies, one of them is the Histological Terminology (HT) For these Terminologies, the exclusion of eponyms is recommended. Despite this, there are structures that remain as eponyms. Three in particular: Pores of Kohn, Martin Channels and Lambert Channels are terms that make up collateral ventilation (CV) and are an example of this. Thus, the objective of the present study was to identify in the HT the terms associated with the CV in order to propose denominations following the recommendations of the Federative International Programme on Anatomical Terminologies (FIPAT). The terms related to CV in the TH were researched, and subsequently, the same exercise was carried out in histology texts. The MedLine database was also used through its PudMed search engine with the following algorithm: (lung) AND (alveoli pulmonary) AND (airway) AND (collateral) AND (ventilation). In HT the term Porus Septalis" (H3.05.0.0.036) was found to refer to the term "Pores of Kohn, in six histology texts the term Pores of Kohn is mentioned, in 21 reviewed articles the CV is mentioned, of these, in ten the eponymous Pores of Kohn is used, to refer to the Septal Pores, the eponymous Lambert Channels was used in six articles and the eponymous Martin Channels appeared in five articles. From the information found, its historical development, added to the guidelines of the FIPAT, we propose complementing and including in the HT the terms "Porus septalis alveolaris" for pores of Kohn, "Ductus bronchiolaris alveolaris" for the Lambert Channels and "Ductus interbronquiolaris" for the Martin Channels, respectively.


Subject(s)
Humans , Pulmonary Alveoli/anatomy & histology , Bronchi/anatomy & histology , Terminology as Topic , Pulmonary Ventilation , Eponyms
6.
Article in Chinese | WPRIM | ID: wpr-775076

ABSTRACT

Diffuse alveolar hemorrhage (DAH) is a clinical syndrome with major clinical manifestations of hemoptysis, anemia, and diffuse infiltration in the lung. DAH has a high mortality rate in the acute stage and is a life-threatening emergency in clinical practice. Compared with adult DHA, childhood DHA tends to have a specific spectrum of underlying diseases. It has long been believed that idiopathic pulmonary hemosiderosis (IPH) is the main cause of childhood DAH; however, with the increase in reports of childhood DAH cases, the etiology spectrum of childhood DAH is expanding. The treatment and prognosis of DAH with different etiologies are different. This review article gives a general outline of childhood DAH, with focuses on DAH caused by IPH, systemic lupus erythematosus, anti-neutrophil cytoplasmic antibody-related vasculitis, COPA syndrome, or IgA vasculitis.


Subject(s)
Antibodies, Antineutrophil Cytoplasmic , Child , Hemorrhage , Humans , Lung Diseases , Pulmonary Alveoli , Vasculitis
7.
Article in Chinese | WPRIM | ID: wpr-774179

ABSTRACT

The inhalation and deposition of particles in human pulmonary acinus region can cause lung diseases. Numerical simulation of the deposition of inhaled particles in the pulmonary acinus region has offered an effective gateway to the prevention and clinical treatment of these diseases. Based on some important affecting factors such as pulmonary acinar models, model motion, breathing patterns, particulate characteristics, lung diseases and ages, the present research results of numerical simulation in human pulmonary acinus region were summarized and analyzed, and the future development directions were put forward in this paper, providing new insights into the further research and application of the numerical simulation in the pulmonary acinus region.


Subject(s)
Aerosols , Computer Simulation , Humans , Lung , Physiology , Models, Biological , Particle Size , Pulmonary Alveoli , Physiology
8.
Acta cir. bras ; 33(10): 896-903, Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-973463

ABSTRACT

Abstract Purpose: To investigate the apoptotic mechanisms in rabbits with blast-induced acute lung injury (ALI). Methods: A total of 40 rabbits were randomly divided into a blank control group (A, n=10) and an experimental group (EXP, n=30). Explosion-induced chest-ALI models were prepared and sampled at different time points (4, 12, and 24h after modeling, T1-T3) to test the lung dry weight/wet weight ratio (W/D) and arterial oxygen pressure (PaO2), apoptosis of lung tissue by the TUNEL assay, and Caspase-3, Bax, and Bcl-2 levels by immunohistochemical analysis. Furthermore, lung tissue was sampled to observe pathological morphology by microscopy. Results: Under a light microscope, Group EXP exhibited obvious edema in the pulmonary interstitial substance and alveoli, a large number of red blood cells, inflammatory cells, and serous exudation in the alveolar cavity, as well as thickening of the pulmonary interstitial fluid. Compared to Group A, the W/D ratio was significantly increased in Group EXP (P<0.01), while PaO2 was significantly reduced (P<0.01). The apoptosis index was significantly increased (P<0.01), and caspase-3 and Bax/Bcl-2 levels were increased (P<0.01). Conclusion: Apoptosis plays an important role in the occurrence and development of acute lung injury in rabbits by participating in lung injury and promoting the progression of ALI.


Subject(s)
Animals , Male , Female , Rabbits , Blast Injuries/physiopathology , Apoptosis/physiology , Acute Lung Injury/physiopathology , Pulmonary Alveoli/pathology , Blast Injuries/pathology , Blast Injuries/blood , Random Allocation , Proto-Oncogene Proteins c-bcl-2/blood , Disease Models, Animal , bcl-2-Associated X Protein/blood , Caspase 3/blood , Acute Lung Injury/pathology , Acute Lung Injury/blood
9.
Medicina (Ribeiräo Preto) ; 51(3): 211-216, jul.-set. 2018.
Article in Portuguese | LILACS | ID: biblio-979801

ABSTRACT

A poliangiite microscópica (PAM) é uma vasculite necrosante sistêmica pauci-imune associada ao anticorpo anticitoplasma de neutrófilos (ANCA) com preferência de pequenos vasos. Relato do caso: Relatamos o caso de uma paciente do sexo feminino, 54 anos, que apresentou quadro de poliartrite migratória em punhos, joelhos e tornozelos associada à rigidez matinal progressiva, com histórico de "rash" malar, fotossensibilidade e alopecia. Progrediu ao longo do ano de 2017 com deterioração da função renal e hemorragia pulmonar, necessitando de cuidados intensivos. A biópsia renal sugeriu padrão compatível com glomerulonefrite pauci-imune e o diagnóstico de poliangiite microscópica foi aventado. Realizou pulsoterapia com metilprednisolona e ciclofosfamida, além de plasmaférese, recebendo alta após estabilização do quadro clínico. Importância do problema: O presente caso ilustra uma complicação incomum e de elevada morbimortalidade da PAM. A negatividade do ANCA dificultou o diagnóstico, sendo necessária a realização de biópsia renal com confirmação diagnóstica. A síndrome pulmão-rim apresenta evolução potencialmente fatal se não instituído precocemente o tratamento. (AU)


Microscopic polyangiitis (MPA) is a pauci-immune systemic necrotizing vasculitis associated with neutrophil anti-cytoplasmic antibody (ANCA) with a preference for small vessels. Case report: We report the case of a 54-year-old woman, who presented migratory polyarthritis in wrists, knees and ankles associated with progressive morning stiffness, with history of malar "rash", photosensitivity and alopecia. It progressed throughout the year of 2017 with deterioration of renal function and pulmonary hemorrhage, requiring intensive care. Renal biopsy suggested a pattern compatible with pauci-immune glomerulonephritis and the diagnosis of microscopic polyangiitis was suggested. She underwent pulse therapy with methylprednisolone and cyclophosphamide, in addition to plasmapheresis, being discharged from hospital after stabilization of the clinical condition. Importance of the issue: The present case reveals an uncommon and high morbimortality complication of MPA. The negativity of the ANCA made diagnosis difficult, and a renal biopsy was necessary to confirm diagnosis. Lung-kidney syndrome is potentially fatal if the treatment is not instituted early. (AU)


Subject(s)
Humans , Female , Middle Aged , Pulmonary Alveoli , Microscopic Polyangiitis , Glomerulonephritis , Hemorrhage , Hemothorax
10.
Rev. méd. hondur ; 86(1/2): 34-36, ene-. jul. 2018. ilus
Article in Spanish | LILACS | ID: biblio-1007329

ABSTRACT

Antecedentes: La microlitiasis es una afección pulmonar poco frecuente, caracterizada por acumulo de fosfatos de calcio en el interior de los alveolos pulmonares, originando cuerpos nodulares conocidos como microlitos, siendo esta su principal caracterís-tica. Destacando la poca relación Clínico Radiológica, dada su escasa documentación y relativamente poco estudio, es difícil su diag-nóstico y frecuentemente es confundida con otras entidades patológicas. Caso Clínico: Femenina de 38 años, hipertensa controlada con atenolol 100 mg vía oral día, exposición al humo de leña, con 6 meses de tos intermitente, seca, disnea y sibilancias nocturnas, se le practicó una tomografía que en la ventana mediastial se aprecia corazón de tamaño normal con algunas adenomegalias de pocos milímetros para órticos y peri traqueales no sospechosos y en la ventana pulmonar hay llenado alveolar homogéneo difuso bilateral, con engrosamiento nodular centro lobular y septal con calciicaciones inas de la pleura. La biopsia trasbronquial reporta espacios al-veolares con presencia de concentraciones laminares en piel de cebolla basóilos intra alveolares compatible con microlitiasis alveolar. Discusión: Identiicar estas particularidades nos permitiría realizar un abordaje temprano para evitar complicaciones iniciales de esta enfermedad, aunque no se conoce un tratamiento curativo...(AU)


Subject(s)
Humans , Female , Adult , Pulmonary Alveoli , Calcinosis/complications , Calcium Phosphates , Genetic Diseases, Inborn , Lung Diseases
11.
INSPILIP ; 2(1): 1-16, ene.-jun. 2018.
Article in Spanish | LILACS | ID: biblio-987255

ABSTRACT

El edema pulmonar no cardiogénico es una entidad fisiopatológica caracterizada por una lesión generalizada de los capilares pulmonares que provoca un aumento de su permeabilidad a los líquidos, proteínas y otros elementos formes de la sangre, ocasionando un constante flujo de líquidos desde la circulación pulmonar hacia el espacio intersticial y los alvéolos, resultando el edema pulmonar no cardiogénico. El objetivo de este estudio es considerar la incidencia de esta entidad en los casos de muertes súbitas, por medio del estudio histopatológico y caracterizar los factores predisponentes relacionados a esta patología. Todas las muestras fueron sometidas a procedimientos técnicos para estudio histopatológico para confirmar o descartar el diagnóstico macroscópico emitido en la necropsia. Para este estudio se analizaron 518 informes de estudio histopatológico correspondientes a los años 2013, 2014, 2015 y 2016, las cuales 119 correspondieron a edema pulmonar no cardiogénico, siendo el 22,97 % de estos 119 informes de estudio histopatológico se analizaron e interpretaron de acuerdo con los factores predisponentes teniendo como hallazgo importante 39,49 % al síndrome metabólico; 21,84 % a la intoxicación alcohólica; 14,28 % a la intoxicación medicamentosa, entre otros. De esto concluimos que es importante realizar el estudio histopatológico a los casos de muerte súbita sin diagnóstico, puesto que algunas pueden ser encasilladas en un síndrome metabólico o intoxicaciones que ameritan investigación para determinar la causa de muerte.


Non-cardiogenic pulmonary edema is a pathophysiological entity characterized by a generalized lesion of the pulmonary capillaries that causes an increase of its permeability to the fluids, proteins and other form elements of the blood, causing a constant flow of liquids from the pulmonary circulation towards the interstitial space and alveoli, resulting in non-cardiogenic pulmonary edema. The aim of this study is to consider the incidence of this entity in cases of sudden deaths, through the histopathological study and to characterize the predisposing factors related to this pathology. All samples were subjected to technical procedures for histopathological study to confirm or rule out the macroscopic diagnosis emitted at necropsy. For this study, 518 histopathological reports corresponding to the years 2013, 2014, 2015 and 2016 were analyzed, of which 119 corresponded to non-cardiogenic pulmonary edema, with 22.97% of these 119 histopathological reports being analyzed and interpreted according to to the predisposing factors having as important finding 39.49% to the metabolic syndrome; 21.84% to alcoholic intoxication; 14.28% to drug intoxication among others. From this we conclude that it is important to carry out the histopathological study to cases of sudden death without diagnosis since some may be pigeonholed in a metabolic syndrome or poisonings that warrant investigation to determine the cause of death.


Subject(s)
Humans , Pulmonary Edema/pathology , Blood , Body Fluid Compartments , Proteins , Pulmonary Alveoli , Biopsy , Metabolic Syndrome
12.
Rev. bras. ter. intensiva ; 30(2): 208-218, abr.-jun. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959328

ABSTRACT

RESUMEN La mecánica del sistema respiratorio depende de las características del pulmón, la caja torácica y su interacción. En pacientes con síndrome de distrés respiratorio agudo bajo ventilación mecánica el monitoreo de la presión meseta en la vía aérea es fundamental debido a su valor pronóstico y su capacidad de reflejar el estrés pulmonar. Sin embargo, su validez puede verse afectada por cambios en las características mecánicas de la caja torácica, y además, no otorga información para la correcta titulación de presión positiva al final de la espiración en función de restablecer el volumen pulmonar. La influencia que la caja torácica ejerce sobre la mecánica del sistema respiratorio en síndrome de distrés respiratorio agudo no ha sido completamente descripta y es probable que haya sido sobredimensionada pudiendo conducir a toma de decisiones erróneas. Ante la insuflación con presión positiva al final de la espiración, la carga impuesta por la caja torácica es despreciable. En condiciones dinámicas, desplazar esta estructura demanda un cambio de presión cuya magnitud se relaciona con sus características mecánicas, dicha carga se mantiene constante independientemente del volumen a partir del cual es insuflada. Por lo que cambios en la presión en la vía aérea reflejan modificaciones en las condiciones mecánicas del pulmón. El monitoreo avanzado podría reservarse para pacientes con incremento de la presión intra-abdominal en los que no pueda implementarse una estrategia de ventilación mecánica protectora. Las estimaciones de reclutamiento alveolar basadas en la mecánica del sistema respiratorio podrían ser reflejo del diferente comportamiento de la caja torácica a la insuflación y no verdadero reclutamiento alveolar.


ABSTRACT The respiratory system mechanics depend on the characteristics of the lung and chest wall and their interaction. In patients with acute respiratory distress syndrome under mechanical ventilation, the monitoring of airway plateau pressure is fundamental given its prognostic value and its capacity to assess pulmonary stress. However, its validity can be affected by changes in mechanical characteristics of the chest wall, and it provides no data to correctly titrate positive end-expiratory pressure by restoring lung volume. The chest wall effect on respiratory mechanics in acute respiratory distress syndrome has not been completely described, and it has likely been overestimated, which may lead to erroneous decision making. The load imposed by the chest wall is negligible when the respiratory system is insufflated with positive end-expiratory pressure. Under dynamic conditions, moving this structure demands a pressure change whose magnitude is related to its mechanical characteristics, and this load remains constant regardless of the volume from which it is insufflated. Thus, changes in airway pressure reflect changes in the lung mechanical conditions. Advanced monitoring could be reserved for patients with increased intra-abdominal pressure in whom a protective mechanical ventilation strategy cannot be implemented. The estimates of alveolar recruitment based on respiratory system mechanics could reflect differences in chest wall response to insufflation and not actual alveolar recruitment.


Subject(s)
Humans , Respiration, Artificial/methods , Respiratory Distress Syndrome/surgery , Respiratory Distress Syndrome/therapy , Respiratory Mechanics/physiology , Prognosis , Pulmonary Alveoli/metabolism , Respiratory Distress Syndrome/physiopathology , Tidal Volume/physiology , Positive-Pressure Respiration , Thoracic Wall/metabolism , Monitoring, Physiologic/methods
13.
Frontiers of Medicine ; (4): 330-333, 2018.
Article in English | WPRIM | ID: wpr-772759

ABSTRACT

We observed a rare case of invasive mucinous adenocarcinoma (IMA) with a lepidic-predominant pattern accompanied by pulmonary tuberculosis. An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital. T-SPOT test result was 212 pg/ml (reference value of negative is < 14 pg/ml), Mycobacterium tuberculosis culture was positive, and tuberculin skin test (PPD) was negative (skin induration < 5 mm). The patient was treated with several courses of antibiotics and anti-tuberculosis treatments. Repeated chest CT scans showed disease progression. Bronchoscopy yielded negative results. PET-CT scans showed negative results. A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls. IMA with a lepidic-predominant pattern was diagnosed after invasiveness was found after experimental treatments. Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common; however, the present case of IMA having a lepidic-predominant pattern and coexisting with active tuberculosis has not been reported yet.


Subject(s)
Adenocarcinoma, Mucinous , Diagnosis , Pathology , Aged, 80 and over , Antibiotics, Antitubercular , Therapeutic Uses , Disease Progression , Humans , Lung Neoplasms , Diagnosis , Pathology , Male , Mycobacterium tuberculosis , Positron Emission Tomography Computed Tomography , Pulmonary Alveoli , Pathology , Tuberculosis, Pulmonary , Diagnosis , Drug Therapy
14.
Protein & Cell ; (12): 267-282, 2018.
Article in English | WPRIM | ID: wpr-757999

ABSTRACT

Irreversible destruction of bronchi and alveoli can lead to multiple incurable lung diseases. Identifying lung stem/progenitor cells with regenerative capacity and utilizing them to reconstruct functional tissue is one of the biggest hopes to reverse the damage and cure such diseases. Here we showed that a rare population of SOX9 basal cells (BCs) located at airway epithelium rugae can regenerate adult human lung. Human SOX9 BCs can be readily isolated by bronchoscopic brushing and indefinitely expanded in feeder-free condition. Expanded human SOX9 BCs can give rise to alveolar and bronchiolar epithelium after being transplanted into injured mouse lung, with air-blood exchange system reconstructed and recipient's lung function improved. Manipulation of lung microenvironment with Pirfenidone to suppress TGF-β signaling could further boost the transplantation efficiency. Moreover, we conducted the first autologous SOX9 BCs transplantation clinical trial in two bronchiectasis patients. Lung tissue repair and pulmonary function enhancement was observed in patients 3-12 months after cell transplantation. Altogether our current work indicated that functional adult human lung structure can be reconstituted by orthotopic transplantation of tissue-specific stem/progenitor cells, which could be translated into a mature regenerative therapeutic strategy in near future.


Subject(s)
Bronchiectasis , Genetics , Metabolism , Humans , Pulmonary Alveoli , Cell Biology , Metabolism , SOX9 Transcription Factor , Genetics , Metabolism , Stem Cell Transplantation , Methods , Stem Cells , Cell Biology , Metabolism
15.
Article in Chinese | WPRIM | ID: wpr-689617

ABSTRACT

<p><b>OBJECTIVE</b>To study the expression of SUMO-modified CCAAT enhancer binding protein α (C/EBPα) in preterm rat model of bronchopulmonary dysplasisa (BPD) induced by hyperoxia exposure and its role.</p><p><b>METHODS</b>Eighteen preterm rats were randomly divided into an air group and a hyperoxia group (n=9 each). The model of BPD was prepared in preterm rats exposed to hyperoxia. The rats from the two groups were sacrificed on postnatal days 4, 7 and 14 respectively (3 rats at each time) and lung tissues were harvested. Periodic acid-Schiff (PAS) staining was used to observe the differentiation of rat lung tissues. Ki67 expression was detected by immunohistochemistry. Western blot was used to measure the protein expression of small ubiquitin-related modifier-1(SUMO1) and C/EBPα. A co-immunoprecipitation assay was performed to measure the protein expression of SUMO-modified C/EBPα.</p><p><b>RESULTS</b>Compared with the air group, the hyperoxia group showed a decreased glycogen content in the lung tissue on postnatal day 4, and an increased content on postnatal days 7 and 14. Over the time of hyperoxia exposure, the hyperoxia group showed an increased expression of Ki67 in the lung tissue compared with the air group at all time points. Compared with the air group, the protein expression of C/EBPα increased on postnatal day 4 and decreased on postnatal days 7 and 14 in the hyperoxia group (P<0.05). The hyperoxia group had significantly upregulated expression of SUMO1 and SUMO-modified C/EBPα compared with the air group at all time points (P<0.05). In the hyperoxia group, the protein expression of SUMO-modified C/EBPα was positively correlated with the glycogen content (r=0.529, P<0.05) and the expression of Ki67 (r=0.671, P<0.05).</p><p><b>CONCLUSIONS</b>Hyperoxia may induce over-proliferation and differentiation disorders of alveolar epithelial cells in preterm rat model of BPD, possibly through an increased expression of SUMO-modified C/EBP&alpha.</p>


Subject(s)
Animals , Animals, Newborn , Bronchopulmonary Dysplasia , Metabolism , Pathology , CCAAT-Enhancer-Binding Protein-alpha , Metabolism , Cell Proliferation , Disease Models, Animal , Hyperoxia , Pathology , Ki-67 Antigen , Pulmonary Alveoli , Pathology , Rats , Rats, Sprague-Dawley , Sumoylation
16.
Rev. bras. ter. intensiva ; 29(3): 354-363, jul.-set. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-899521

ABSTRACT

RESUMO A síndrome do desconforto respiratório agudo é um desafio para o intensivista. A característica principal desta doença aguda é o dano alveolar difuso, presente em cerca de metade dos pacientes com a síndrome. É claro que o suporte respiratório à síndrome do desconforto respiratório agudo tem melhorado gradualmente nas últimas décadas. É também evidente que todos estes procedimentos são benéficos, já que reduzem a lesão pulmonar e mantêm o paciente vivo. Isto deve ser interpretado como uma estratégia de ganho de tempo, até que o fator desencadeante ou de risco causal melhore, assim como a tempestade inflamatória diminua e o pulmão se cure. Por outro lado, todos - exceto dois tratamentos farmacológicos (bloqueadores neuromusculares e esteroides) - são incapazes de melhorar o desfecho da síndrome do desconforto respiratório agudo. A hipótese de que os resultados farmacológicos negativos podem ser explicados pela heterogeneidade histológica da síndrome do desconforto respiratório agudo tem sido apoiada pelas recentes demonstrações de que a síndrome com dano alveolar difuso tem característica clínico-patológica específica. O dano alveolar difuso é um diagnóstico patológico, e a biópsia pulmonar a céu aberto (a técnica mais comum para obtenção de tecido pulmonar) tem efeitos colaterais graves, sendo necessário que se desenvolvam biomarcadores substitutos para o dano alveolar difuso. O objetivo desta revisão é discutir três tópicos relacionados à síndrome do desconforto respiratório agudo: o relacionamento entre a síndrome do desconforto respiratório agudo e o dano alveolar difuso; como o dano alveolar difuso pode ser representado no quadro clínico; e como o enriquecimento pode melhorar os resultados de estudos clínicos farmacológicos realizados com pacientes com a síndrome e com dano alveolar difuso.


ABSTRACT Acute respiratory distress syndrome is a challenging entity for the intensivist. The pathological hallmark of the acute phase is diffuse alveolar damage, which is present in approximately half of living patients with acute respiratory distress syndrome. It is clear that respiratory support for acute respiratory distress syndrome has gradually been improving over recent decades. However, it is also evident that these procedures are beneficial, as they reduce lung injury and keep the patient alive. This could be interpreted as a time-gaining strategy until the trigger or causal or risk factor improves, the inflammatory storm decreases and the lung heals. However, all except two pharmacological treatments (neuromuscular blockers and steroids) were unable to improve the acute respiratory distress syndrome outcome. The hypothesis that pharmacological negative results may be explained by the histological heterogeneity of acute respiratory distress syndrome has been supported by the recent demonstration that acute respiratory distress syndrome with diffuse alveolar damage constitutes a specific clinical-pathological entity. Given that diffuse alveolar damage is a pathological diagnosis and that open lung biopsy (the most common technique to obtain lung tissue) has several side effects, it is necessary to develop surrogate biomarkers for diffuse alveolar damage. The aim of this narrative review is to address the following three topics related to acute respiratory distress syndrome: (a) the relationship between acute respiratory distress syndrome and diffuse alveolar damage, (b) how diffuse alveolar damage could be surrogated in the clinical setting and (c) how enrichment in diffuse alveolar damage may improve the results of pharmacological clinical trials tried out on patients with acute respiratory distress syndrome.


Subject(s)
Humans , Pulmonary Alveoli/pathology , Respiratory Distress Syndrome/therapy , Intensive Care Units , Respiratory Distress Syndrome/physiopathology , Biopsy/methods , Biomarkers/metabolism , Risk Factors , Critical Care/methods
17.
Rev. bras. ter. intensiva ; 29(2): 142-153, abr.-jun. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-899511

ABSTRACT

RESUMO Fundamentação: O estudo Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) é um ensaio clínico internacional, multicêntrico, randomizado, pragmático e controlado com ocultação da alocação que envolve 120 unidades de terapia intensiva no Brasil, Argentina, Colômbia, Espanha, Itália, Polônia, Portugal, Malásia e Uruguai, com o objetivo primário de determinar se o recrutamento alveolar gradual máximo associado com titulação da pressão positiva expiratória final, ajustada segundo a complacência estática do sistema respiratório (estratégia ART), é capaz de aumentar, quando comparada aos resultados do tratamento convencional (estratégia ARDSNet), a sobrevivência em 28 dias de pacientes com síndrome do desconforto respiratório agudo. Objetivo: Descrever o processo de gerenciamento dos dados e o plano de análise estatística em um ensaio clínico internacional. Métodos: O plano de análise estatística foi delineado pelo comitê executivo e revisado pelo comitê diretivo do ART. Foi oferecida uma visão geral do delineamento do estudo, com foco especial na descrição de desfechos primário (sobrevivência aos 28 dias) e secundários. Foram descritos o processo de gerenciamento dos dados, o comitê de monitoramento de dados, a análise interina e o cálculo do tamanho da amostra. Também foram registrados o plano de análise estatística para os desfechos primário e secundários, e os subgrupos de análise pré-especificados. Detalhes para apresentação dos resultados, inclusive modelos de tabelas para as características basais, adesão ao protocolo e efeito nos desfechos clínicos, foram fornecidos. Conclusão: Em acordo com as melhores práticas em ensaios clínicos, submetemos nossos planos de análise estatística e de gerenciamento de dados para publicação antes do fechamento da base de dados e início das análises. Antecipamos que este documento deve prevenir viés em análises e incrementar a utilidade dos resultados a serem relatados. Registro do estudo: Número no registro ClinicalTrials.gov NCT01374022.


ABSTRACT Background: The Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) is an international multicenter randomized pragmatic controlled trial with allocation concealment involving 120 intensive care units in Brazil, Argentina, Colombia, Italy, Poland, Portugal, Malaysia, Spain, and Uruguay. The primary objective of ART is to determine whether maximum stepwise alveolar recruitment associated with PEEP titration, adjusted according to the static compliance of the respiratory system (ART strategy), is able to increase 28-day survival in patients with acute respiratory distress syndrome compared to conventional treatment (ARDSNet strategy). Objective: To describe the data management process and statistical analysis plan. Methods: The statistical analysis plan was designed by the trial executive committee and reviewed and approved by the trial steering committee. We provide an overview of the trial design with a special focus on describing the primary (28-day survival) and secondary outcomes. We describe our data management process, data monitoring committee, interim analyses, and sample size calculation. We describe our planned statistical analyses for primary and secondary outcomes as well as pre-specified subgroup analyses. We also provide details for presenting results, including mock tables for baseline characteristics, adherence to the protocol and effect on clinical outcomes. Conclusion: According to best trial practice, we report our statistical analysis plan and data management plan prior to locking the database and beginning analyses. We anticipate that this document will prevent analysis bias and enhance the utility of the reported results. Trial registration: ClinicalTrials.gov number, NCT01374022.


Subject(s)
Humans , Pulmonary Alveoli/metabolism , Respiratory Distress Syndrome/therapy , Positive-Pressure Respiration/methods , Research Design , Survival Rate , Data Interpretation, Statistical , Treatment Outcome , Intensive Care Units
18.
Acta méd. colomb ; 42(1): 64-67, ene.-mar. 2017. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-886340

ABSTRACT

Resumen Se presenta el caso de una paciente de 46 años de edad con cinco años de evolución de episodios intermitentes de hemoptisis cuyo diagnóstico final fue hemosiderosis pulmonar idiopática. Su presentación y características clínicas son comparadas con los otros casos reportados en la literatura.


Abstract The case of a 46-year-old patient with five years of evolution of intermittent episodes of hemoptysis whose final diagnosis was idiopathic pulmonary hemosiderosis is reported. Its presentation and clinical characteristics are compared with the other cases reported in the literature.


Subject(s)
Humans , Female , Middle Aged , Hemosiderosis , Pulmonary Alveoli , Hemoptysis , Lung Diseases
19.
Article in English | WPRIM | ID: wpr-110926

ABSTRACT

A 35-year-old man presented with progressive dyspnea and hemoptysis. His blood pressure was 230/140 mmHg and serum creatinine level was 20.13 mg/dL. Chest radiography and computed tomography revealed pulmonary hemorrhage. His renal function was low, thus emergent renal replacement therapy was required. Malignant hypertension and acute kidney injury were diagnosed, and antihypertensive therapy and hemodialysis started immediately. Renal biopsy was performed to examine the underlying disease. Typical pathological changes of malignant hypertension, fibrinoid necrosis of the afferent arterioles, and proliferative endoarteritis at the interlobular arteries were observed. His renal function improved gradually and pulmonary hemorrhage completely disappeared with administration of antihypertensive agents. Here, we report this rare case of malignant hypertension with pulmonary alveolar hemorrhage and speculate that the hemorrhage may be related to vascular injuries at the alveolar capillary level caused by malignant hypertension.


Subject(s)
Acute Kidney Injury , Adult , Antihypertensive Agents , Arteries , Arterioles , Biopsy , Blood Pressure , Capillaries , Creatinine , Dialysis , Dyspnea , Hemoptysis , Hemorrhage , Humans , Hypertension, Malignant , Necrosis , Pulmonary Alveoli , Radiography , Renal Dialysis , Renal Replacement Therapy , Thorax , Vascular System Injuries
20.
Article in Chinese | WPRIM | ID: wpr-300439

ABSTRACT

This article reports 4 girls with clinical manifestations of recurrent cough and anemia. The age of onset was less than 4 years, and three of them had shortness of breath. None of them had acute hemoptysis. All the girls had positive results of hemosiderin test for bronchoalveolar lavage fluid. As for imaging examination, 3 patients had ground-glass opacity, and 1 had interstitial change. Three girls were given the treatment for idiopathic pulmonary hemosiderosis and had no response. Selective bronchial arteriography was performed for the 4 girls and found bronchial artery to pulmonary circulation shunt (BPS). After they were diagnosed with BPS, they were given transcatheter embolization. The girls were followed up for half a year after surgery, and none of them was readmitted due to "cough and anemia". BPS manifests as abnormal shunt between the bronchial artery and the pulmonary artery/vein and has unknown causes. It is rare in children and should be considered for children who were thought to have idiopathic pulmonary hemosiderosis and had poor response to corticosteroid therapy.


Subject(s)
Anemia , Bronchial Arteries , Child , Child, Preschool , Embolization, Therapeutic , Female , Hemorrhage , Hemosiderosis , Humans , Lung Diseases , Pulmonary Alveoli , Pulmonary Circulation
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