Tubular microfibers have recently attracted extensive interest for applications in tissue engineering.However,the fabrication of tubular fibers with intricate hierarchical structures remains a major challenge.Here,we ...Tubular microfibers have recently attracted extensive interest for applications in tissue engineering.However,the fabrication of tubular fibers with intricate hierarchical structures remains a major challenge.Here,we present a novel one-step microfluidic spinning method to generate bio-inspired screwed conduits(BSCs).Based on the microfluidic rope-coiling effect,a viscous hydrogel precursor is first curved into a helix stream in the channel,and then consecutively packed as a hollow structured stream and gelated into a screwed conduit(SC)via ionic and covalent crosslinking.By taking advantage of the excellent fluid-controlling ability of microfluidics,various tubes with diverse structures are fabricated via simple control over fluid velocities and multiple microfluidic device designs.The perfusability and permeability results,as well as the encapsulation and culture of human umbilical vein endothelial cells(HUVECs),human pulmonary alveolar epithelial cells(HPAs),and myogenic cells(C2C12),demonstrate that these SCs have good perfusability and permeability and the ability to induce the formation of functional biostructures.These features support the uniqueness and potential applications of these BSCs as biomimetic blood vessels and bronchiole tissues in combination with tissue microstructures,with likely application possibilities in biomedical engineering.展开更多
Gas exchange in human lungs is established by several flow mechanisms. In the present study, the features of gas displacement in the distal bronchioles of a human lung are investigated by both numerical calculation an...Gas exchange in human lungs is established by several flow mechanisms. In the present study, the features of gas displacement in the distal bronchioles of a human lung are investigated by both numerical calculation and experimental observation with particle image velocimetry. The effect of respiration frequency is considered, such as high frequency oscillatory ventilation. By comparing the obtained results, it has been found that the redistribution of gas is attributed to irreversible flow, which is remarkable in higher frequencies oscillation with even lower tidal volumes. Owing to the continuous driving, a time-averaged net flow was induced and intensified by the oscillation. Thus, the gas in the centre region penetrated the deeper region and the outer gas was evacuated to the upper region. Consequently, this streaming contributes to prompt gas replacement. Furthermore, we analysed the effect of the respiration wave form to consider the flow acceleration. From this inspection, it was found that the enhanced inertial force tends to encourage the irreversible flow.展开更多
BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,pa...BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.展开更多
Introduction: Lower respiratory infections in general, and acute bronchiolitis in particular, represent a major cause of morbidity in children in Niger. The aim of this study was to investigate the epidemiological, di...Introduction: Lower respiratory infections in general, and acute bronchiolitis in particular, represent a major cause of morbidity in children in Niger. The aim of this study was to investigate the epidemiological, diagnostic and therapeutic features of acute bronchiolitis in infants in the Pediatrics A department of the National Hospital in Zinder. Patients and Methods: This was a descriptive, cross-sectional study with prospective data collection conducted from April 1 to May 31, 2024. All infants aged 0 to 24 months hospitalized with acute bronchiolitis in the pediatric ward A of Zinder National Hospital were included in the study. Epidemiological, diagnostic and therapeutic aspects were the characteristics studied. Data analysis was performed using Epi info 7 software. Results: During the study period, acute bronchiolitis accounted for 51% of hospitalizations, and infants aged 3 - 11 months were the most affected (52.90%). The sex ratio was 1.6. The average age of patients was 10.40 ± 6.91 months, with extremes of 1 and 24 months. 98.50% of patients came from urban areas, and the socioeconomic level of families was average in 47.49% of cases. Mixed breastfeeding was practiced in 59.63% of cases. Average hospital admission time was 4.22 days. The main clinical signs were cough (43.18%), rhinorrhea (70.85%), ronchi (35.33%), crepitating rales (26.54%), sibilant rales (24.11%), signs of struggle (14.02%) and polypnea (70.85%). Paraclinical findings included chest distension, hyperleukocytosis and anemia, with 47.48%, 55.14% and 78.31% respectively. Therapeutically, nebulization was used in 93.08% of cases, respiratory physiotherapy (41.34%), corticosteroid therapy (34.08%), antibiotic therapy (21.50%), oxygen therapy (20.11%) and antipyretics (4.68%) were prescribed. Progression was favorable in 93.08% of patients, with a case-fatality rate of 1.12%. Conclusion: With its high frequency, acute bronchiolitis is a public health problem. Boys were the most affected by the condition, and the predominant age group was 3 to 11 months. Management was essentially based on nebulization and physiotherapy.展开更多
BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.T...BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.CONCLUSION Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline posttransplant.Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.展开更多
BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complicat...BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complications such as myocarditis,which may present with life-threatening symptoms if not promptly recognized.CASE SUMMARY We describe the case of a 26-day-old male neonate who presented with respiratory distress,poor feeding,and irritability.Initial evaluation revealed an RSV infection confirmed via nasopharyngeal swab.As the clinical course progressed,the infant developed cardiac arrhythmias,elevated cardiac enzymes,and echocardiographic findings consistent with myocarditis.Management included mechanical ventilation,corticosteroid therapy,L-carnitine,and vitamin D supplementation.The patient responded well to treatment and was successfully extubated and discharged in stable condition after nine days of hospitalization.CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of RSV-associated myocarditis in neonates.展开更多
Oscillatory flow facilitates gas exchange in human respiration system. In the present study, both numerical calculation and PIV (Particle Image Velocimetry) measurement indicate that, under the application of HFOV (Hi...Oscillatory flow facilitates gas exchange in human respiration system. In the present study, both numerical calculation and PIV (Particle Image Velocimetry) measurement indicate that, under the application of HFOV (High Frequency Oscillatory Ventilation), apparent steady streaming is caused and augmented in distal airways by the continuous oscillation, i.e., the core air moves downwards and the peripheral air evacuates upwards within bronchioles. The net flow of steady streaming serves to overcome the lack of tidal volume in HFOV and delivers fresh air into deeper lung region. Also, numerical calculations reveal that the intensity of steady streaming is mainly influenced by the geometry of airways with provided oscillatory frequency and tidal volume, and it rises with Re and Wo up to a Re of about 124 and Wo of about 5. Steady streaming is considered as an important factor for the ventilation efficiency of HFOV.展开更多
Extraintestinal manifestations occur commonly in inflammatory bowel diseases(IBD). Pulmonary manifestations(PM) of IBD may be divided in airway disorders, interstitial lung disorders, serositis, pulmonary vasculitis, ...Extraintestinal manifestations occur commonly in inflammatory bowel diseases(IBD). Pulmonary manifestations(PM) of IBD may be divided in airway disorders, interstitial lung disorders, serositis, pulmonary vasculitis, necrobiotic nodules, drug-induced lung disease, thromboembolic lung disease and enteropulmonary fistulas. Pulmonary involvement may often be asymptomatic and detected solely on the basis of abnormal screening tests. The common embryonic origin of the intestine and the lungs from the primitive foregut, the co-existence of mucosa associated lymphoid tissue in both organs, autoimmunity, smoking and bacterial translocation from the colon to the lungs may all be involved in the pathogenesis of PM in IBD. PM are mainly detected by pulmonary function tests and highresolution computed tomography. This review will focus on the involvement of the airways in the context of IBD, especially stenoses of the large airways, tracheo-bronchitis, bronchiectasis, bronchitis, mucoid impaction, bronchial granulomas, bronchiolitis, bronchiolitis obliterans syndrome and the co-existence of IBD with asthma, chronic obstructive pulmonary disease, sarcoidosis and a1-antitrypsin deficiency.展开更多
Lung transplantation is one of the highest risk solid organ transplant modalities. Recent studies have demonstrated a relationship between gastroesophageal reflux disease(GERD) and lung transplant outcomes, including ...Lung transplantation is one of the highest risk solid organ transplant modalities. Recent studies have demonstrated a relationship between gastroesophageal reflux disease(GERD) and lung transplant outcomes, including acute and chronic rejection. The aim of this review is to discuss the pathophysiology, evaluation, and management of GERD in lung transplantation, as informed by the most recent publications in the field. The pathophysiology of reflux-induced lung injury includes the effects of aspiration and local immunomodulation in the development of pulmonary decline and histologic rejection, as reflective of allograft injury. Modalities of reflux and esophageal assessment, including ambulatory p H testing, impedance, and esophageal manometry, are discussed, as well as timing of these evaluations relative to transplantation. Finally, antireflux treatments are reviewed, including medical acid suppression and surgical fundoplication, as well as the safety, efficacy, and timing of such treatments relative to transplantation. Our review of the data supports an association between GERD and allograft injury, encouraging a strategy of early diagnosis and aggressive reflux management in lung transplant recipients to improve transplant outcomes. Further studies are needed to explore additional objective measures of reflux and aspiration, better compare medical and surgical antireflux treatment options, extend followup times to capture longer-term clinical outcomes, and investigate newer interventions including minimally invasive surgery and advanced endoscopic techniques.展开更多
BACKGROUND Bronchiolitis is a common lower respiratory tract infection in infants and young children.Severe cases may be accompanied by obvious dyspnea and oxygen saturation decline.AIM To summarize the clinical featu...BACKGROUND Bronchiolitis is a common lower respiratory tract infection in infants and young children.Severe cases may be accompanied by obvious dyspnea and oxygen saturation decline.AIM To summarize the clinical features,standard diagnosis,and treatment of bronchi-olitis.METHODS This is a retrospective analysis of 114 pediatric patients(74 males,40 females)who were first diagnosed as having bronchioles at the Department of Pediatrics of Tongling Maternal and Child Health Hospital from January 2019 to December 2019.The clinical features,imaging features,treatment,and other clinical data were recorded and analyzed.RESULTS The age of onset of the disease was mainly from 1 mo to 6 mo(75.4%),and the time to hospital visit was mostly from the 2nd day to the 4th day of the course of the disease(75.4%).Lung imaging examination showed increase in lung texture,fuzzy(93.8%).The main treatment was atomization therapy:Budesonide combined with terbutaline(45.6%)and budesonide combined with salbutamol(38.5%).The average hospitalization time was 7.1±2.4 d,and the overall cure rate was 94.7%.In patients without bacterial infection,the use of antibiotics significantly prolonged the length of hospital stay(7.8±2.5 d vs 5.7±1.8 d)and improved the cure rate(98.3%vs 87.9%,P<0.05).CONCLUSION Infants with bronchiolitis are mainly male and tend to have a good prognosis.However,the unneeded use of antibiotics may prolong the length of hospital stay significantly,which imposes the burden both on the patients and hospital system.CONCLUSION Bronchiolitis is a common acute respiratory infectious disease in infants and young children.It mainly affects male children and the age onset is between 1 to 6 mo.The standard use of antibiotics should be emphasized in view of the prolonged average length of hospital stay between the antibiotic treatment group and the non-antibiotic treatment group.When the course of disease is more than 7 d or the treatment effect is poor,active anti-infective treatment is needed to improve the long-term prognosis.Very few children have recurrent cough and wheezing symptoms within 1 year,which may be related to the risk of later asthma attack.FOOTNOTES Author contributions:Shi C and Wu MH contributed to study conception and design,and provision of study materials or patients;Shi C contributed to administrative support;Zuo A,Yang MM,and Jiang RR contributed to data collection and assembly;Shi C contributed to data analysis and interpretation,and manuscript writing;all authors contributed to the final approval of the manuscript.Institutional review board statement:The study was conducted in accordance with the Declaration of Helsinki(as revised in 2013).The study was approved by Institutional Review Board of Tongling Maternal and Child Health Hospital.展开更多
AIM To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis,its association with risk factors,disease severity and thromboembolic complications.METHODS A retrospectiv...AIM To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis,its association with risk factors,disease severity and thromboembolic complications.METHODS A retrospective observational medical chart review of 305 infants aged two years or less hospitalized for bronchiolitis.Clinical outcomes included disease severity,duration of hospital stay,admission to pediatric intensive care unit,or death.They also included complications of thrombocytosis,including thromboembolic complications such as cerebrovascular accident,acute coronary syndrome,deep venous thrombosis,pulmonary embolus,mesenteric thrombosis and arterial thrombosis and also hemorrhagic complications such as bleeding(spontaneous hemorrhage in the skin,mucous membranes,gastrointestinal,respiratory,or genitourinary tracts).RESULTS The median age was 4.7 mo and 179 were males(59%).Respiratory syncytial virus was isolated in 268(84%),adenovirus in 23(7%) and influenza virus A or B in 13(4%).Thrombocytosis(platelet count > 500 × 109/L) occurred in 88(29%;95%CI:24%-34%),more commonly in younger infants with the platelet count declining with age.There was no significant association with the duration of illness,temperature on admission,white blood cell count,serum C-reactive protein concentration,length of hospital stay or admission to the intensive care unit.No death,thrombotic or hemorrhagic events occurred.CONCLUSION Thrombocytosis is common in children under two years of age admitted with bronchiolitis.It is not associated with disease severity or thromboembolic complications.展开更多
BACKGROUND Cryptogenic organizing pneumonia(COP),formerly known as bronchiolitis obliterans organizing pneumonia,is an extremely rare disease in pregnancy.In this case,we report on COP diagnosed in recurrent pneumonia...BACKGROUND Cryptogenic organizing pneumonia(COP),formerly known as bronchiolitis obliterans organizing pneumonia,is an extremely rare disease in pregnancy.In this case,we report on COP diagnosed in recurrent pneumonia that does not respond to antibiotics in pregnant woman.CASE SUMMARY A 35-year-old woman with no prior lung disease presented with concerns of chest pain with cough,sputum,dyspnea,and mild fever at 11 wk’gestation.She was diagnosed with community-acquired pneumonia and treated with antibiotics;her symptoms improved temporarily.Four weeks after discharge,she was readmitted with aggravated symptoms.Chest computed tomography demonstrated multifocal patchy airspace consolidation and ground-glass opacities at the basal segments of the right lower lobe,at the lateral basal segment of the lower lobe,and at the lingular segment of the left upper lobe.Bronchoalveolar lavage revealed an increased lymphocyte count and a decreased CD4/CD8 ratio.Prednisolone(0.5 mg/kg/d)was administered for 10 d after the second admission.Dyspnea improved after 3 d of steroid treatment and other symptoms improved on the 5th day of steroid administration.Post-delivery transbronchial lung biopsy further revealed the presence of granulation tissue with fibroblasts in smallbronchiole lumens.CONCLUSION This case suggests that it is important to differentiate COP from atypical pneumonia in the deteriorated condition despite antibiotic treatment.展开更多
In last decade,dengue has emerged as one of the most important vector born disease.With increasing cases,uncommon presentations and complications are now commonly recognized.Here,we report two cases of rare pattern of...In last decade,dengue has emerged as one of the most important vector born disease.With increasing cases,uncommon presentations and complications are now commonly recognized.Here,we report two cases of rare pattern of respiratory involvement in dengue:acute respiratory distress syndrome and bronchiolitis with respiratory failure.展开更多
[Objectives]To explore the use of Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch on the basis of comprehensive treatment,compare it with the combined aerosol inhalation of terbutaline,ipratropium bro...[Objectives]To explore the use of Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch on the basis of comprehensive treatment,compare it with the combined aerosol inhalation of terbutaline,ipratropium bromide and budesonide which are commonly used in clinic,and observe the curative effect in the treatment of acute bronchiolitis and the effect on serum IL-4 and IL-8.[Methods]80 children with acute bronchiolitis were randomly divided into observation group(n=40)and control group(n=40),and both groups were given routine comprehensive treatment.The observation group was treated with Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch and budesonide,while the control group was treated with combined aerosol inhalation of terbutaline,ipratropium bromide and budesonide.The curative effect of the two groups was observed;the remission duration of cough,wheezing,dyspnea and nocturnal wheezing,and the disappearance time of wheezing rales and moist rales were observed in the two groups;the treatment course of intravenous infusion of methylprednisolone sodium succinate,oxygen inhalation time,sputum suction times and hospitalization time were observed in the two groups;the changes of serum IL-4 and IL-8 were observed before and after treatment in the two groups;the adverse drug reactions were observed.[Results](i)The total effective rate of the two groups was 100%(P>0.05),but the cure rate of the observation group(72.5%)was significantly higher than that of the control group(42.5%)(P<0.01).(ii)The disappearance time of cough,wheezing rales and moist rales and hospitalization time in the observation group were significantly shorter than those in the control group(P<0.01),the remission duration of nocturnal wheezing in the observation group was shorter than that in the control group(P<0.05),and the remission duration of wheezing and dyspnea in the control group was slightly longer than that in the control group(P>0.05).(iii)There was no significant difference(P>0.05)in serum IL-4 and serum IL-8 between the two groups before and after treatment.After treatment,the levels of serum IL-4 and IL-8 in the observation group and the control group were significantly lower than those before treatment in the observation group and the control group.[Conclusions]On the basis of comprehensive treatment,the use of Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch in the treatment of acute bronchiolitis could reduce the effect of nocturnal wheezing on sleep,reduce the levels of serum IL-4 and IL-8,and significantly improve adverse symptoms.展开更多
BACKGROUND Tidal breathing flow-volume(TBFV)analysis provides important information about lung mechanics in infants.AIM To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute...BACKGROUND Tidal breathing flow-volume(TBFV)analysis provides important information about lung mechanics in infants.AIM To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis.METHODS In this cross-sectional study,TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge.The ratio of time to peak expiratory flow to total expiratory time(tPEF/tE)at baseline and after the administration of 400 mcg salbutamol was evaluated.RESULTS A total of 56 infants(35 boys),aged 7.4±2.8 mo,were included.Of them,12.5%were exposed to tobacco smoke and 41.1%were breastfed less than 2 mo.There were no differences in baseline TBFV measurements between the breastfeeding groups;however,those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation(12%±10.4%vs 0.9%±7.1%;P<0.001).Moreover,there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding(P<0.001).In multivariate regression analysis,infants who breastfed less(regression coefficient-0.335,P=0.010)or were exposed to cigarette smoke(regression coefficient 0.353,P=0.007)showed a greater change in tPEF/tE after bronchodilation,independent of sex,prematurity,and family history of asthma or atopy.CONCLUSION Infants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke,have TBFV measurements indicative of obstructive lung disease.展开更多
Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respira...Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance.展开更多
Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment ...Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.展开更多
基金supported by the National Key Research and Development Program of China(2020YFA0710800)the Key Program of National Natural Science Foundation of China(81930043and 82330055)the National Natural Science Foundation of China(82101184).
文摘Tubular microfibers have recently attracted extensive interest for applications in tissue engineering.However,the fabrication of tubular fibers with intricate hierarchical structures remains a major challenge.Here,we present a novel one-step microfluidic spinning method to generate bio-inspired screwed conduits(BSCs).Based on the microfluidic rope-coiling effect,a viscous hydrogel precursor is first curved into a helix stream in the channel,and then consecutively packed as a hollow structured stream and gelated into a screwed conduit(SC)via ionic and covalent crosslinking.By taking advantage of the excellent fluid-controlling ability of microfluidics,various tubes with diverse structures are fabricated via simple control over fluid velocities and multiple microfluidic device designs.The perfusability and permeability results,as well as the encapsulation and culture of human umbilical vein endothelial cells(HUVECs),human pulmonary alveolar epithelial cells(HPAs),and myogenic cells(C2C12),demonstrate that these SCs have good perfusability and permeability and the ability to induce the formation of functional biostructures.These features support the uniqueness and potential applications of these BSCs as biomimetic blood vessels and bronchiole tissues in combination with tissue microstructures,with likely application possibilities in biomedical engineering.
文摘Gas exchange in human lungs is established by several flow mechanisms. In the present study, the features of gas displacement in the distal bronchioles of a human lung are investigated by both numerical calculation and experimental observation with particle image velocimetry. The effect of respiration frequency is considered, such as high frequency oscillatory ventilation. By comparing the obtained results, it has been found that the redistribution of gas is attributed to irreversible flow, which is remarkable in higher frequencies oscillation with even lower tidal volumes. Owing to the continuous driving, a time-averaged net flow was induced and intensified by the oscillation. Thus, the gas in the centre region penetrated the deeper region and the outer gas was evacuated to the upper region. Consequently, this streaming contributes to prompt gas replacement. Furthermore, we analysed the effect of the respiration wave form to consider the flow acceleration. From this inspection, it was found that the enhanced inertial force tends to encourage the irreversible flow.
文摘BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.
文摘Introduction: Lower respiratory infections in general, and acute bronchiolitis in particular, represent a major cause of morbidity in children in Niger. The aim of this study was to investigate the epidemiological, diagnostic and therapeutic features of acute bronchiolitis in infants in the Pediatrics A department of the National Hospital in Zinder. Patients and Methods: This was a descriptive, cross-sectional study with prospective data collection conducted from April 1 to May 31, 2024. All infants aged 0 to 24 months hospitalized with acute bronchiolitis in the pediatric ward A of Zinder National Hospital were included in the study. Epidemiological, diagnostic and therapeutic aspects were the characteristics studied. Data analysis was performed using Epi info 7 software. Results: During the study period, acute bronchiolitis accounted for 51% of hospitalizations, and infants aged 3 - 11 months were the most affected (52.90%). The sex ratio was 1.6. The average age of patients was 10.40 ± 6.91 months, with extremes of 1 and 24 months. 98.50% of patients came from urban areas, and the socioeconomic level of families was average in 47.49% of cases. Mixed breastfeeding was practiced in 59.63% of cases. Average hospital admission time was 4.22 days. The main clinical signs were cough (43.18%), rhinorrhea (70.85%), ronchi (35.33%), crepitating rales (26.54%), sibilant rales (24.11%), signs of struggle (14.02%) and polypnea (70.85%). Paraclinical findings included chest distension, hyperleukocytosis and anemia, with 47.48%, 55.14% and 78.31% respectively. Therapeutically, nebulization was used in 93.08% of cases, respiratory physiotherapy (41.34%), corticosteroid therapy (34.08%), antibiotic therapy (21.50%), oxygen therapy (20.11%) and antipyretics (4.68%) were prescribed. Progression was favorable in 93.08% of patients, with a case-fatality rate of 1.12%. Conclusion: With its high frequency, acute bronchiolitis is a public health problem. Boys were the most affected by the condition, and the predominant age group was 3 to 11 months. Management was essentially based on nebulization and physiotherapy.
文摘BACKGROUND Gastroesophageal reflux disease has been shown to contribute to allograft injury and rejection outcomes in lung transplantation through a proposed mechanism of aspiration,inflammation,and allograft injury.The value of pre-transplant reflux testing in predicting reduction in pulmonary function after lung transplantation is unclear.We hypothesized that increased reflux burden on pre-transplant reflux testing is associated with pulmonary function decline following lung transplant.AIM To assess the relationship between pre-transplant measures of reflux and pulmonary function decline in lung transplant recipients.METHODS This was a retrospective cohort study of lung transplant recipients who underwent pre-transplant reflux testing with 24-hour pH-impedance off acid suppression at a tertiary center in 2007-2016.Patients with pre-transplant fundoplication were excluded.Time-to-event analysis was performed using Cox proportional hazards models to assess associations between reflux measures and reduction in forced expiratory volume in 1 second(FEV1)of≥20%post-transplant.Patients not meeting endpoint were censored at time of post-transplant fundoplication,last clinic visit,or death,whichever was earliest.RESULTS Seventy subjects(58%men,mean age:56 years)met the inclusion criteria.Interstitial lung disease represented the predominant pulmonary diagnosis(40%).Baseline demographics were similar between groups and were not associated with pulmonary decline.The clinical endpoint(≥20%FEV1 decline)was reached in 18 subjects(26%).In time-to-event univariate analysis,FEV1 decline was associated with increased acid exposure time(AET)[hazard ratio(HR)=3.49,P=0.03]and increased proximal acid reflux(HR=3.34,P=0.04)with confirmation on Kaplan-Meier analysis.Multivariate analysis showed persistent association between pulmonary decline and increased AET(HR=3.37,P=0.04)when controlling for potential confounders including age,body mass index,and sex.Subgroup analysis including only patients with FEV1 decline showed that all subjects with abnormal AET progressed to bronchiolitis obliterans syndrome.CONCLUSION Increased reflux burden on pre-transplant testing was associated with significant pulmonary function decline posttransplant.Pre-transplant reflux assessment may provide clinically relevant information in the prognostication and management of transplant recipients.
文摘BACKGROUND Respiratory syncytial virus(RSV)is a leading cause of lower respiratory tract infections in neonates.While typically associated with bronchiolitis and pneumonia,RSV can rarely cause extrapulmonary complications such as myocarditis,which may present with life-threatening symptoms if not promptly recognized.CASE SUMMARY We describe the case of a 26-day-old male neonate who presented with respiratory distress,poor feeding,and irritability.Initial evaluation revealed an RSV infection confirmed via nasopharyngeal swab.As the clinical course progressed,the infant developed cardiac arrhythmias,elevated cardiac enzymes,and echocardiographic findings consistent with myocarditis.Management included mechanical ventilation,corticosteroid therapy,L-carnitine,and vitamin D supplementation.The patient responded well to treatment and was successfully extubated and discharged in stable condition after nine days of hospitalization.CONCLUSION This case highlights the importance of early recognition and multidisciplinary management of RSV-associated myocarditis in neonates.
文摘Oscillatory flow facilitates gas exchange in human respiration system. In the present study, both numerical calculation and PIV (Particle Image Velocimetry) measurement indicate that, under the application of HFOV (High Frequency Oscillatory Ventilation), apparent steady streaming is caused and augmented in distal airways by the continuous oscillation, i.e., the core air moves downwards and the peripheral air evacuates upwards within bronchioles. The net flow of steady streaming serves to overcome the lack of tidal volume in HFOV and delivers fresh air into deeper lung region. Also, numerical calculations reveal that the intensity of steady streaming is mainly influenced by the geometry of airways with provided oscillatory frequency and tidal volume, and it rises with Re and Wo up to a Re of about 124 and Wo of about 5. Steady streaming is considered as an important factor for the ventilation efficiency of HFOV.
文摘Extraintestinal manifestations occur commonly in inflammatory bowel diseases(IBD). Pulmonary manifestations(PM) of IBD may be divided in airway disorders, interstitial lung disorders, serositis, pulmonary vasculitis, necrobiotic nodules, drug-induced lung disease, thromboembolic lung disease and enteropulmonary fistulas. Pulmonary involvement may often be asymptomatic and detected solely on the basis of abnormal screening tests. The common embryonic origin of the intestine and the lungs from the primitive foregut, the co-existence of mucosa associated lymphoid tissue in both organs, autoimmunity, smoking and bacterial translocation from the colon to the lungs may all be involved in the pathogenesis of PM in IBD. PM are mainly detected by pulmonary function tests and highresolution computed tomography. This review will focus on the involvement of the airways in the context of IBD, especially stenoses of the large airways, tracheo-bronchitis, bronchiectasis, bronchitis, mucoid impaction, bronchial granulomas, bronchiolitis, bronchiolitis obliterans syndrome and the co-existence of IBD with asthma, chronic obstructive pulmonary disease, sarcoidosis and a1-antitrypsin deficiency.
文摘Lung transplantation is one of the highest risk solid organ transplant modalities. Recent studies have demonstrated a relationship between gastroesophageal reflux disease(GERD) and lung transplant outcomes, including acute and chronic rejection. The aim of this review is to discuss the pathophysiology, evaluation, and management of GERD in lung transplantation, as informed by the most recent publications in the field. The pathophysiology of reflux-induced lung injury includes the effects of aspiration and local immunomodulation in the development of pulmonary decline and histologic rejection, as reflective of allograft injury. Modalities of reflux and esophageal assessment, including ambulatory p H testing, impedance, and esophageal manometry, are discussed, as well as timing of these evaluations relative to transplantation. Finally, antireflux treatments are reviewed, including medical acid suppression and surgical fundoplication, as well as the safety, efficacy, and timing of such treatments relative to transplantation. Our review of the data supports an association between GERD and allograft injury, encouraging a strategy of early diagnosis and aggressive reflux management in lung transplant recipients to improve transplant outcomes. Further studies are needed to explore additional objective measures of reflux and aspiration, better compare medical and surgical antireflux treatment options, extend followup times to capture longer-term clinical outcomes, and investigate newer interventions including minimally invasive surgery and advanced endoscopic techniques.
文摘BACKGROUND Bronchiolitis is a common lower respiratory tract infection in infants and young children.Severe cases may be accompanied by obvious dyspnea and oxygen saturation decline.AIM To summarize the clinical features,standard diagnosis,and treatment of bronchi-olitis.METHODS This is a retrospective analysis of 114 pediatric patients(74 males,40 females)who were first diagnosed as having bronchioles at the Department of Pediatrics of Tongling Maternal and Child Health Hospital from January 2019 to December 2019.The clinical features,imaging features,treatment,and other clinical data were recorded and analyzed.RESULTS The age of onset of the disease was mainly from 1 mo to 6 mo(75.4%),and the time to hospital visit was mostly from the 2nd day to the 4th day of the course of the disease(75.4%).Lung imaging examination showed increase in lung texture,fuzzy(93.8%).The main treatment was atomization therapy:Budesonide combined with terbutaline(45.6%)and budesonide combined with salbutamol(38.5%).The average hospitalization time was 7.1±2.4 d,and the overall cure rate was 94.7%.In patients without bacterial infection,the use of antibiotics significantly prolonged the length of hospital stay(7.8±2.5 d vs 5.7±1.8 d)and improved the cure rate(98.3%vs 87.9%,P<0.05).CONCLUSION Infants with bronchiolitis are mainly male and tend to have a good prognosis.However,the unneeded use of antibiotics may prolong the length of hospital stay significantly,which imposes the burden both on the patients and hospital system.CONCLUSION Bronchiolitis is a common acute respiratory infectious disease in infants and young children.It mainly affects male children and the age onset is between 1 to 6 mo.The standard use of antibiotics should be emphasized in view of the prolonged average length of hospital stay between the antibiotic treatment group and the non-antibiotic treatment group.When the course of disease is more than 7 d or the treatment effect is poor,active anti-infective treatment is needed to improve the long-term prognosis.Very few children have recurrent cough and wheezing symptoms within 1 year,which may be related to the risk of later asthma attack.FOOTNOTES Author contributions:Shi C and Wu MH contributed to study conception and design,and provision of study materials or patients;Shi C contributed to administrative support;Zuo A,Yang MM,and Jiang RR contributed to data collection and assembly;Shi C contributed to data analysis and interpretation,and manuscript writing;all authors contributed to the final approval of the manuscript.Institutional review board statement:The study was conducted in accordance with the Declaration of Helsinki(as revised in 2013).The study was approved by Institutional Review Board of Tongling Maternal and Child Health Hospital.
文摘AIM To determine the true prevalence of thrombocytosis in children less than 2 years of age with bronchiolitis,its association with risk factors,disease severity and thromboembolic complications.METHODS A retrospective observational medical chart review of 305 infants aged two years or less hospitalized for bronchiolitis.Clinical outcomes included disease severity,duration of hospital stay,admission to pediatric intensive care unit,or death.They also included complications of thrombocytosis,including thromboembolic complications such as cerebrovascular accident,acute coronary syndrome,deep venous thrombosis,pulmonary embolus,mesenteric thrombosis and arterial thrombosis and also hemorrhagic complications such as bleeding(spontaneous hemorrhage in the skin,mucous membranes,gastrointestinal,respiratory,or genitourinary tracts).RESULTS The median age was 4.7 mo and 179 were males(59%).Respiratory syncytial virus was isolated in 268(84%),adenovirus in 23(7%) and influenza virus A or B in 13(4%).Thrombocytosis(platelet count > 500 × 109/L) occurred in 88(29%;95%CI:24%-34%),more commonly in younger infants with the platelet count declining with age.There was no significant association with the duration of illness,temperature on admission,white blood cell count,serum C-reactive protein concentration,length of hospital stay or admission to the intensive care unit.No death,thrombotic or hemorrhagic events occurred.CONCLUSION Thrombocytosis is common in children under two years of age admitted with bronchiolitis.It is not associated with disease severity or thromboembolic complications.
文摘BACKGROUND Cryptogenic organizing pneumonia(COP),formerly known as bronchiolitis obliterans organizing pneumonia,is an extremely rare disease in pregnancy.In this case,we report on COP diagnosed in recurrent pneumonia that does not respond to antibiotics in pregnant woman.CASE SUMMARY A 35-year-old woman with no prior lung disease presented with concerns of chest pain with cough,sputum,dyspnea,and mild fever at 11 wk’gestation.She was diagnosed with community-acquired pneumonia and treated with antibiotics;her symptoms improved temporarily.Four weeks after discharge,she was readmitted with aggravated symptoms.Chest computed tomography demonstrated multifocal patchy airspace consolidation and ground-glass opacities at the basal segments of the right lower lobe,at the lateral basal segment of the lower lobe,and at the lingular segment of the left upper lobe.Bronchoalveolar lavage revealed an increased lymphocyte count and a decreased CD4/CD8 ratio.Prednisolone(0.5 mg/kg/d)was administered for 10 d after the second admission.Dyspnea improved after 3 d of steroid treatment and other symptoms improved on the 5th day of steroid administration.Post-delivery transbronchial lung biopsy further revealed the presence of granulation tissue with fibroblasts in smallbronchiole lumens.CONCLUSION This case suggests that it is important to differentiate COP from atypical pneumonia in the deteriorated condition despite antibiotic treatment.
文摘In last decade,dengue has emerged as one of the most important vector born disease.With increasing cases,uncommon presentations and complications are now commonly recognized.Here,we report two cases of rare pattern of respiratory involvement in dengue:acute respiratory distress syndrome and bronchiolitis with respiratory failure.
基金Supported by Scientific Research Project of the Department of Health of Guangxi Zhuang Autonomous Region(Z2015215)Development,Popularization and Application Project of Appropriate Medical and HealthTechnology in Guangxi(S2018015).
文摘[Objectives]To explore the use of Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch on the basis of comprehensive treatment,compare it with the combined aerosol inhalation of terbutaline,ipratropium bromide and budesonide which are commonly used in clinic,and observe the curative effect in the treatment of acute bronchiolitis and the effect on serum IL-4 and IL-8.[Methods]80 children with acute bronchiolitis were randomly divided into observation group(n=40)and control group(n=40),and both groups were given routine comprehensive treatment.The observation group was treated with Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch and budesonide,while the control group was treated with combined aerosol inhalation of terbutaline,ipratropium bromide and budesonide.The curative effect of the two groups was observed;the remission duration of cough,wheezing,dyspnea and nocturnal wheezing,and the disappearance time of wheezing rales and moist rales were observed in the two groups;the treatment course of intravenous infusion of methylprednisolone sodium succinate,oxygen inhalation time,sputum suction times and hospitalization time were observed in the two groups;the changes of serum IL-4 and IL-8 were observed before and after treatment in the two groups;the adverse drug reactions were observed.[Results](i)The total effective rate of the two groups was 100%(P>0.05),but the cure rate of the observation group(72.5%)was significantly higher than that of the control group(42.5%)(P<0.01).(ii)The disappearance time of cough,wheezing rales and moist rales and hospitalization time in the observation group were significantly shorter than those in the control group(P<0.01),the remission duration of nocturnal wheezing in the observation group was shorter than that in the control group(P<0.05),and the remission duration of wheezing and dyspnea in the control group was slightly longer than that in the control group(P>0.05).(iii)There was no significant difference(P>0.05)in serum IL-4 and serum IL-8 between the two groups before and after treatment.After treatment,the levels of serum IL-4 and IL-8 in the observation group and the control group were significantly lower than those before treatment in the observation group and the control group.[Conclusions]On the basis of comprehensive treatment,the use of Xiao’er Kechuanling Oral Liquid combined with Tulobuterol Patch in the treatment of acute bronchiolitis could reduce the effect of nocturnal wheezing on sleep,reduce the levels of serum IL-4 and IL-8,and significantly improve adverse symptoms.
文摘BACKGROUND Tidal breathing flow-volume(TBFV)analysis provides important information about lung mechanics in infants.AIM To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis.METHODS In this cross-sectional study,TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge.The ratio of time to peak expiratory flow to total expiratory time(tPEF/tE)at baseline and after the administration of 400 mcg salbutamol was evaluated.RESULTS A total of 56 infants(35 boys),aged 7.4±2.8 mo,were included.Of them,12.5%were exposed to tobacco smoke and 41.1%were breastfed less than 2 mo.There were no differences in baseline TBFV measurements between the breastfeeding groups;however,those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation(12%±10.4%vs 0.9%±7.1%;P<0.001).Moreover,there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding(P<0.001).In multivariate regression analysis,infants who breastfed less(regression coefficient-0.335,P=0.010)or were exposed to cigarette smoke(regression coefficient 0.353,P=0.007)showed a greater change in tPEF/tE after bronchodilation,independent of sex,prematurity,and family history of asthma or atopy.CONCLUSION Infants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke,have TBFV measurements indicative of obstructive lung disease.
文摘Acute viral bronchiolitis is a leading cause of admission to pediatric intensive care units, but research on the care of these critically ill infants has been limited. Pathology of viral bronchiolitis revealed respiratory obstruction due to intraluminal debris and edema of the airways and vasculature. This and clinical evidence suggest that airway clearance interventions such as hypertonic saline nebulizers and pulmonary toilet devices may be of benefit, particularly in situations of atelectasis associated with bronchiolitis. Research to distinguish an underlying asthma predisposition in wheezing infants with viral bronchiolitis may one day lead to guidance on when to trial bronchodilator therapy. Considering the paucity of critical care research in pediatric viral bronchiolitis, intensive care practitioners must substantially rely on individualization of therapies based on bedside clinical assessments. However, with the introduction of new diagnostic and respiratory technologies, our ability to support critically ill infants with acute viral bronchiolitis will continue to advance.
文摘Chronic lung allograft dysfunction(CLAD)following lung transplantation limits long-term survival considerably.The main reason for this is a lack of knowledge regarding the pathological condition and the establishment of treatment.The consensus statement from the International Society for Heart and Lung Transplantation on CLAD in 2019 classified CLAD into two main phenotypes:Bronchiolitis obliterans syndrome and restrictive allograft syndrome.Along with this clear classification,further exploration of the mechanisms and the development of appropriate prevention and treatment strategies for each phenotype are desired.In this review,we summarize the new definition of CLAD and update and summarize the existing knowledge on the underlying mechanisms of bronchiolitis obliterans syndrome and restrictive allograft syndrome,which have been elucidated from clinicopathological observations and animal experiments worldwide.
