Comparative Evaluation of Vibratory Physiotherapy Methods in the Early Period after Cardiac Surgery

Postoperative respiratory complications in patients undergoing cardiac surgery occur in 20‒30% cases, and the most of them can be associated with ineffective cough and bronchial mucus evacuation.The objective. Comparative assessment of effectiveness and safety of methods for stimulating the evacuation of bronchial secretions using oscillatory PEP-therapy (Acapella Duet), oscillatory chest compression insufflator-aspirator “Comfort Cough Plus”, and the traditional method of manual chest percussion in the early period after cardiac surgery.Subjects and Methods. The prospective study included 120 cardiac surgery patients. They were divided into 3 groups (40 in each), depending on the type of the applied respiratory procedure. Distribution into groups was carried out by random selection. All procedures were performed 10‒12 hours after tracheal extubation. Before the procedure and 20 minutes after it, the efficiency of sputum discharge was assessed, gas exchange indices on room air breathing and maximum inspiratory lung capacity (MILC) were measured.Results. Ineffective bronchial mucus evacuating in the early period after tracheal extubation was observed in 86.7% of the patients. A single procedure of both PEP-therapy (Group 1) and mechanical cough stimulation (Group 2) led to improved sputum passage, as evidenced by an increase in the number of patients with productive cough by 4.25 times (p < 0.0009) and 5.3 times (p < 0.0007), respectively. In patients of Groups 1 and 2, an increase in MILC was observed (by 42.2% and 60.0%, respectively, p = 0.000001), the difference between the groups was statistically significant. In Control Group 3, with manual physiotherapy, the average increase in MILC was only 11.6%. Mechanical respiratory therapy procedures led to significant improvement in gas exchange variables, as evidenced by an increase in SpO2 in Groups 1 and 2 (p = 0.000009 and 0.000001, respectively) and a decrease in the proportion of patients with impaired oxygenating lung function (SpO2 below 92%) by 11 and 12 times, respectively (p < 0.01). The most significant changes were revealed in case of mechanical stimulation with aspirator-insufflator due to combination of two methods (oscillatory chest compression and lung inflation). In Control Group, no significant changes of gas exchange variables were observed.Conclusion: Mechanical vibratory methods for stimulating the bronchial secretion evacuation have significant advantages over classical manual chest massage in patients after cardiac surgery. Their positive effect on sputum passage, ventilatory parameters and gas exchange was noted, and the most pronounced effect was observed after oscillatory chest compression with insufflator-aspirator. The procedures were well tolerated and there were no complications associated with them.

Elevated tumor markers in a benign lung disease

Background This study aimed to determine the underlying pathophysiologic mechanism of elevated carbohydrate antigen 19-9 (CA19-9) in pulmonary sequestration (PS) patients. Materials and methods Four pulmonary sequestration patients, 12 pneumonia patients and 12 healthy adult volunteers were prospectively studied. Specimens from another 34 pulmonary sequestration patients were retrospectively analyzed. Serum CA19-9 levels of 4 patients were tested before and 1 week, 1 month and 3 months after surgery. The CA19-9 levels of 12 pneumonia patients and 12 healthy adult volunteers were tested as controls. The expression and localization of CA19-9 in diseased lesions and corresponding normal lung tissues were analyzed by Immunohistochemical (IHC). Hematoxylin–eosin (HE) staining was performed to observe the pathological changes in pulmonary sequestration tissues. Results Serum CA19-9 levels were significantly higher in the 4 patients (797.3 ± 316 IU/ml) than in the pneumonia patients (10.07 ± 5.01 IU/ml) and healthy volunteers (9.85 ± 4.12 IU/ml). In addition, serum CA19-9 levels decreased dramatically after the focus was removed. Positive staining of CA19-9 was found in 70% (24/34) of pulmonary sequestration tissues, and CA19-9 was mainly expressed in the bronchial mucus. In the 4 diseased lesions, deformed alveolar structure and inflammatory cell infiltration were observed, and the degree of damage was positively correlated with serum CA19-9 levels. Conclusions CA19-9 could be generated by abnormal columnar epithelia in pulmonary sequestration tissues and was transported into circulation after alveoli damage. CA19-9 could serve as an adjuvant diagnostic marker in pulmonary sequestration.

Artificial intelligence in CT for quantifying lung changes in the era of CFTR modulators

RationaleChest computed tomography (CT) remains the imaging standard for demonstrating cystic fibrosis airway structural disease in vivo. However, visual scorings as an outcome measure are time-consuming, require training, and lack high reproducibility.ObjectiveTo validate a fully automated artificial intelligence-driven scoring of cystic fibrosis lung disease severity.MethodsData were retrospectively collected in three cystic fibrosis reference centers, between 2008 and 2020, in 184 patients 4 to 54-years-old. An algorithm using three two-dimensional convolutional neural networks was trained with 78 patients’ CTs (23 530 CT slices) for the semantic labeling of bronchiectasis, peribronchial thickening, bronchial mucus, bronchiolar mucus, and collapse/consolidation. 36 patients’ CTs (11 435 CT slices) were used for testing versus ground-truth labels. The method's clinical validity was assessed in an independent group of 70 patients with or without lumacaftor/ivacaftor treatment (n=10 and 60, respectively) with repeat examinations. Similarity and reproducibility were assessed using Dice coefficient, correlations using Spearman test, and paired comparisons using Wilcoxon rank test.Measurement and main resultsThe overall pixelwise similarity of artificial intelligence-driven versus ground-truth labels was good (Dice coefficient=0.71). All artificial intelligence-driven volumetric quantifications had moderate to very good correlations to a visual imaging scoring (p<0.001) and fair to good correlations to FEV1% at pulmonary function test (p<0.001). Significant decreases in peribronchial thickening (p=0.005), bronchial mucus (p=0.005), bronchiolar mucus (p=0.007) volumes were measured in patients with lumacaftor/ivacaftor. Conversely, bronchiectasis (p=0.002) and peribronchial thickening (p=0.008) volumes increased in patients without lumacaftor/ivacaftor. The reproducibility was almost perfect (Dice>0.99).ConclusionArtificial intelligence allows a fully automated volumetric quantification of cystic fibrosis-related modifications over an entire lung. The novel scoring system could provide a robust disease outcome in the era of effective CFTR modulator therapy.

Vinpocetine alleviates lung inflammation via macrophage inflammatory protein-1β inhibition in an ovalbumin-induced allergic asthma model

Asthma is a well-known bronchial disease that causes bronchial inflammation, narrowing of the bronchial tubes, and bronchial mucus secretion, leading to bronchial blockade. In this study, we investigated the association between phosphodiesterase (PDE), specifically PDE1, and asthma using 3-isobutyl-1-methylxanthine (IBMX; a non-specific PDE inhibitor) and vinpocetine (Vinp; a PDE1 inhibitor). Balb/c mice were randomized to five treatment groups: control, ovalbumin (OVA), OVA + IBMX, OVA + Vinp, and OVA + dexamethasone (Dex). All mice were sensitized and challenged with OVA, except for the control group. IBMX, Vinp, or Dex was intraperitoneally administered 1 h before the challenge. Vinp treatment significantly inhibited the increase in airway hyper-responsiveness (P<0.001) and reduced the number of inflammatory cells, particularly eosinophils, in the lungs (P<0.01). It also ameliorated the damage to the bronchi and alveoli and decreased the OVA-specific IgE levels in serum, an indicator of allergic inflammation increased by OVA (P<0.05). Furthermore, the increase in interleukin-13, a known Th2 cytokine, was significantly decreased by Vinp (P<0.05), and Vinp regulated the release and mRNA expression of macrophage inflammatory protein-1β (MIP-1β) increased by OVA (P<0.05). Taken together, these results suggest that PDE1 is associated with allergic lung inflammation induced by OVA. Thus, PDE1 inhibitors can be a promising therapeutic target for the treatment of asthma.

Pathogistological changes in the lungs of Felis silvestris catus when infected with Aelurostrongylus abstrusus

Aelurostrongylus abstrusus is a parasite that belongs to Nematoda type, Metastrongyloidea superfamily, Angiostrongylidae family, Aelurostrongylus genus and is known as feline helminth, whose intermediate hosts are slugs and snails and reservoir hosts are mice and birds. In cats, Aelurostrongylus abstrusus parasitizes in bronchioles and alveoli, causing specific inflammatory changes in the lower respiratory tract and enables the development of such clinical signs as cough, shortness of breath as well as mucous-purulent discharge from the nasal cavity, when complicated by bacterial infections. Females of parasite lay eggs, which the larvae of L1 hatch from. Subsequently, these larvae cough with bronchial mucus and are swallowed by an animal. They pass through the digestive channel without changes and together with the faeces are released into the environment. The first stage larvae actively penetrate into the body of the slugs, fade twice and are becoming invasive. Duration of larvae development from the stage L1 to L3 depends on the biological cycle of intermediate hosts – slugs and snails. Cats are becoming infected by eating slugs or snails with invasive larvae of the third stage (L3), which are transmitted from the digestive channel of the definitive host (cat) with blood flow to the lungs. Usually, the pathogen has low pathogenicity and invasions are primarily detected after animal’s death, during pathoanatomical dissection. Acute clinical signs of the disease have not been described much up to date. The article presents the results of pathomorphological examination of the cat's lungs infected by Aelurostrongylus abstrusus. The severity of pathomorphological changes of the cat’s pulmonary tissue depends on the intensity of the invasion. When dissected, the lungs appear unevenly coloured, dark red with light and slightly denser areas, where focal parasitic nodules are clearly distinct, surrounded by pink halo and different in size but mostly round, dense consistency. Main morphological characteristic of Aelurostrongylus abstrusus infection is the presence of numerous eggs and L1 larvae in the alveoli but also in the bronchi. Helminth eggs accumulated in the alveolar lumps, surrounded by a thin shell; a severe cellular reaction from lymphocytes, macrophages and histiocytes occurred around this shell. An inflammatory reaction resulted in the thickening of the interstitial tissue with a strong vascular response, characterized by fraying and edema of the vessel walls. The results of pathomorphological researches have shown that the main changes were localized in the lungs and bronchial tubes with diffuse damage of the pulmonary tissue parenchyma and development of croupous pneumonia.