Current Issue : October-December
Volume : 2021
Issue Number : 4
Articles : 5 Articles
Background: Asthma is a common respiratory disorder; some data were present on the correlation between
increased levels of trace elements and the risk of asthma development. It was aimed to evaluate the levels of 13
selected blood and tooth elements (magnesium, phosphorus, calcium, chromium, manganese, iron, copper, zinc,
strontium, molybdenum, cadmium, lead, mercury) in a well-controlled asthma group and the control group.
Methods: During the study period, 17 asthma patients and 26 age and gender-matched healthy children donated
shed deciduous teeth having neither decay nor filling and enrolled for the study. The element levels in blood and
teeth matrixes were analyzed with inductively coupled plasma mass spectrometry. Differences in blood and tooth
elements in groups were evaluated with generalized linear models after adjusting confounding factors.
Results: After adjusting the child’s “z scores of body mass index for age”, history of iron deficiency anemia, and status
of parental smoking, the generalized linear model revealed significantly lower tooth magnesium levels, lower blood
zinc levels, and lower blood zinc/copper ratio in the asthma group than the control group (p = 0.042, p = 0.034,
p = 0.002, respectively). Other studied elements for tooth and blood matrixes were similar in groups.
Conclusion: Our study revealed some differences in tooth and blood element levels in the asthma group. Further
studies on zinc and magnesium levels of severe asthma cases are necessary for the interpretation of the results....
Background: Pneumothorax is one complication of transbronchial biopsy (TBB) using endobronchial ultrasonography
with a guide sheath (EBUS-GS-TBB). We sought to clarify the risk factors for pneumothorax after EBUS-GS-TBB
under fluoroscopic guidance.
Methods: We retrospectively reviewed data from 916 patients who underwent EBUS-GS-TBB at Fujita Health University
Hospital. We evaluated the following risk factors for pneumothorax after EBUS-GS-TBB: patient characteristics
(sex, age, and pulmonary comorbidities); lesion data (location, size, existence of ground-glass opacities [GGOs], pleural
involvement, computed tomography [CT] bronchus sign, visibility on fluoroscopy, and EBUS findings); final diagnosis;
years of bronchoscopist experience; and guide sheath size. Univariate and multivariate logistic regression analyses
Results: Among the 916 patients, 30 (3.28%) presented with pneumothorax. With a univariate analysis, factors that
independently predisposed to pneumothorax included lesions containing GGOs, lesions in sagittal lung segments
on fluoroscopy, lesions that were not visible on fluoroscopy, and infectious lesions. A univariate analysis also showed
that lesions in the right upper lobe or left upper division, as well as malignant lesions, were less likely to lead to
pneumothorax. Age, underlying pulmonary disease, CT bronchus sign, EBUS findings, bronchoscopist experience, and
guide sheath size did not influence the incidence of pneumothorax. A multivariate analysis revealed that only lesions
containing GGOs (odds ratio [OR] 6.47; 95% confidence interval [CI] 2.13–19.6, P = 0.001) and lesions in lung segments
with a sagittal orientation on fluoroscopy (OR 2.47; 95% CI 1.09–5.58, P = 0.029) were significant risk factors for EBUSGS-
Conclusions: EBUS-GS-TBB of lesions containing GGOs or lesions located in sagittal lung segments on fluoroscopy
correlate with a higher pneumothorax risk....
Background: Idiopathic pulmonary hemosiderosis (IPH) encompasses a rare and agnogenic group of diffuse alveolar
capillary hemorrhagic diseases. Corticosteroid treatment is the globally preferred therapeutic strategy for IPH; however,
it can cause immunodeficiency. Nocardia infection often occurs in immunocompromised patients and primarily
involves the pleura and lungs. Herein, we describe a case of pediatric pulmonary Nocardia infection after the corticosteroid
treatment of IPH.
Case presentation: A 7-year-old girl presented with chief complaints of pale complexion persisting for 1 year and a
cough for 20 days. Abundant hemosiderin-laden macrophages were detected in the gastric juice, which supported
the diagnosis of IPH. Uninterrupted doses of corticosteroids were administered during the last hospitalization. After
nearly 2 months of corticosteroids therapy, the patient began to cough and produce a purulent sputum. Nextgeneration
sequencing of the bronchoalveolar lavage fluid revealed Nocardia abscessus (N. abscessus) DNA. Linezolid
was administered with good response, and the patient was discharged after 18 days of hospitalization. Her symptoms
and pulmonary lesions had recovered, and the IPH appeared to be well-controlled with low dose of corticosteroids in
Conclusions: Nocardia infection should be considered in the differential diagnoses for IPH patients receiving
corticosteroid therapy, especially in patients with poor response to conventional empirical antibiotic therapy. Nextgeneration
sequencing of bronchoalveolar lavage fluid may be used to quickly identify the Nocardia. Sulfonamides or
linezolid are effective for pediatric pulmonary Nocardia infection....
Background: Current interstitial lung disease (ILD) diagnostic guidelines assess criteria across clinical, radiologic and
pathologic domains. Significant interobserver variation in histopathologic evaluation has previously been shown but
the specific source of these discrepancies is poorly documented. We sought to document specific areas of difficulty
and develop improved criteria that would reduce overall interobserver variation.
Methods: Using an internet-based approach, we reviewed selected images of specific diagnostic features of ILD
histopathology and whole slide images of fibrotic ILD. After an initial round of review, we confirmed the presence of
interobserver variation among our group. We then developed refined criteria and reviewed a second set of cases.
Results: The initial round reproduced the existing literature on interobserver variation in diagnosis of ILD. Cases
which were pre-selected as inconsistent with usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF)
were confirmed as such by multi-observer review. Cases which were thought to be in the spectrum of chronic fibrotic
ILD for which UIP/IPF were in the differential showed marked variation in nearly all aspects of ILD evaluation including
extent of inflammation and extent and pattern of fibrosis. A proposed set of more explicit criteria had only modest
effects on this outcome. While we were only modestly successful in reducing interobserver variation, we did identify
specific reasons that current histopathologic criteria of fibrotic ILD are not well defined in practice.
Conclusions: Any additional classification scheme must address interobserver variation in histopathologic diagnosis
of fibrotic ILD order to remain clinically relevant. Improvements to tissue-based diagnostics may require substantial
resources such as larger datasets or novel technologies to improve reproducibility. Benchmarks should be established
for expected outcomes among clinically defined subgroups as a quality metric....
Background: Acute respiratory distress syndrome (ARDS) often requires controlled ventilation, yielding high
mechanical power and possibly further injury. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) can
be used as a bridge to recovery, however, if this fails the end result is destroyed lung parenchyma. This condition is
fatal and the only remaining alternative is lung transplantation. In the case study presented in this paper, lung transplantation
was not an option given the critically ill state and the presence of HLA antibodies. Airway pressure release
ventilation (APRV) may be valuable in ARDS, but APRV settings recommended in various patient and clinical studies
are inconsistent. The Time Controlled Adaptive Ventilation (TCAV™) method is the most studied technique to set and
adjust the APRV mode and uses an extended continuous positive airway pressure (CPAP) Phase in combination with a
very brief Release Phase. In addition, the TCAV™ method settings are personalized and adaptive based on changes in
lung pathophysiology. We used the TCAV™ method in a case of severe ARDS, which enabled us to open, stabilize and
slowly heal the severely damaged lung parenchyma.
Case presentation: A 43-year-old woman presented with Staphylococcus Aureus necrotizing pneumonia. Progressive
respiratory failure necessitated invasive mechanical ventilation and VV-ECMO. Mechanical ventilation (MV) was
ultimately discontinued because lung protective settings resulted in trivial tidal volumes. She was referred to our
academic transplant center for bilateral lung transplantation after the remaining infection had been cleared. We initiated
the TCAV™ method in order to stabilize the lung parenchyma and to promote tissue recovery. This strategy was
challenged by the presence of a large bronchopleural fistula, however, APRV enabled weaning from VV-ECMO and
mechanical ventilation. After two months, following nearly complete surgical closure of the remaining bronchopleural
fistulas, the patient was readmitted to ICU where she had early postoperative complications. Since other ventilation
modes resulted in significant atelectasis and hypercapnia, APRV was restarted. The patient was then again weaned
Conclusions: The TCAV™ method can be useful to wean challenging patients with severe ARDS and might contribute
to lung recovery. In this particular case, a lung transplantation was circumvented....
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