For preterm infants, bronchopulmonary dysplasia (BPD) is usually caused by abnormal lung development due to various factors during prenatal and postnatal process. One of the reasons for death and bad prognosis of pret...For preterm infants, bronchopulmonary dysplasia (BPD) is usually caused by abnormal lung development due to various factors during prenatal and postnatal process. One of the reasons for death and bad prognosis of preterm infants is to have BPD. Up to now, there are no unified strategies or drugs to treat BPD. In clinical, many intervention treatments have been applied to achieve BPD therapy, mainly including preterm protection, protective ventilation strategies, and delivery of corticosteroids, pulmonary vasodilators, and antioxidants. This review summarizes the current advances in BPD protection and treatment, and notes that gut microbiota and mesenchymal stem cells (MSCs) can be the promising strategy for protecting and treating BPD in the future.展开更多
Bronchopulmonary dysplasia(BPD),also known as neonatal chronic lung disease,is a common respiratory disease in preterm infants.Preterm infants with BPD often exhibit changes in gut and lung microbiota.In recent years,...Bronchopulmonary dysplasia(BPD),also known as neonatal chronic lung disease,is a common respiratory disease in preterm infants.Preterm infants with BPD often exhibit changes in gut and lung microbiota.In recent years,with the development of high-throughput sequencing technology,more and more mechanisms of the gut-lung axis have been confirmed,helping to explore new directions for the treatment of BPD using microecological agents.This paper reviews the roles of gut microbiota,lung microbiota,and the gut-lung axis in the pathogenesis of BPD in preterm infants,providing new research avenues for the prevention and treatment of BPD.展开更多
There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of ...There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.展开更多
Allergic bronchopulmonary aspergillosis(ABPA) is a complex hypersensitivity syndrome triggered against antigens of Aspergillus fumigatus,a fungus that most commonly colonizes the airways of patients with bronchial ast...Allergic bronchopulmonary aspergillosis(ABPA) is a complex hypersensitivity syndrome triggered against antigens of Aspergillus fumigatus,a fungus that most commonly colonizes the airways of patients with bronchial asthma and cystic fibrosis.It presents clinically with refractory asthma,hemoptysis and systemic manifestations including fever,malaise and weight loss.Radiologically,it presents with central bronchiectasis and recurrent episodes of mucus plugging.The mucus plugs in ABPA are generally hypodense but in up to 20% of patients the mucus can be hyperdense on computed tomography.This paper reviews the literature on the clinical significance of hyperattenuated mucus in patients with ABPA.展开更多
AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospe...AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.展开更多
The probability of a radiologist interpreting a disease correctly is not only influenced by their training and experience but also on the knowledge of a particular entity.This editorial reviews certain myths and reali...The probability of a radiologist interpreting a disease correctly is not only influenced by their training and experience but also on the knowledge of a particular entity.This editorial reviews certain myths and realities associated with radiological manifestations of allergic bronchopulmonary aspergillosis(ABPA).ABPA is a hypersensitivity disorder against the antigens of Aspergillus fumigatus.Although commonly manifesting with central bronchiectasis(CB),the disorder can present without any abnormalities on high-resolution computed tomography(HRCT) of the chest,so-called serologic ABPA(ABPA-S).HRCT of the chest should not be used in screening or in the initial diagnostic work up of asthmatics,as asthma without ABPA can manifest with findings of CB.High-attenuation mucus(HAM) is the pathognomonic sign of ABPA and is very helpful in the diagnosis of ABPA complicating asthma and cystic fibrosis.Instead of classifying ABPA based on the presence and absence of CB into ABPA-CB and ABPA-S respectively,ABPA should be classif ied as ABPA-S,ABPACB and ABPA-CB-HAM.The classif ication scheme based on HAM not only identifies an immunologically severe disease but also predicts a patient with increased risk of recurrent relapses.展开更多
There is controversy regarding the roles of Ureaplasma urealyticum （U. urealyticum） colo- nization in the development of hronchopulmonary dysplasia （BPD）. This study explored the association between U. urealyticum...There is controversy regarding the roles of Ureaplasma urealyticum （U. urealyticum） colo- nization in the development of hronchopulmonary dysplasia （BPD）. This study explored the association between U. urealyticum and bronchopulmonary dysplasia at 36 weeks post-menstrual age （BPD36）. Studies published before December 31, 2013 were searched from Medline, Embase, Ovid, Web of Sci- ence, and Cochrane databases, with the terms ＂Ureaplasma urealyticum＂, ＂chronic lung disease＂, or ＂BPD36＂ used, and English language as a limit. The association between U. urealyticum colonization and BPD36 was analyzed with RevMan 4.2.10 software, using the odds ratio （OR） and relative risk （RR） for dichotomous variables. Out of the enrolled 81 studies, 11 investigated the BPD36 in total 1193 in- fants. Pooled studies showed no association between U. urealyticum colonization and subsequent de- velopment of BPD36, with the OR and RR being 1.03 （95% CI=0.78-1.37; P=-0.84） and 1.01 （95% CI= 0.88-1.16, P=-0.84）, respectively. These findings indicated no association between U. urealyticum colo- nization and the development of BPD36.展开更多
Summary： This study aimed to investigate the association between surfactant protein B （SP-B） pol- ymorphisms and bronchopulmonary dysplasia （BPD） in Chinese Han infants. We performed a case- control study includi...Summary： This study aimed to investigate the association between surfactant protein B （SP-B） pol- ymorphisms and bronchopulmonary dysplasia （BPD） in Chinese Han infants. We performed a case- control study including 86 infants with BPD and 156 matched controls. Genotyping was performed by sequence specific primer-polymerase chain reaction （PCR） and haplotypes were reconstructed by the fastPHASE software. The results showed that significant differences were detected in the geno- type distribution of C/A-18 and intron 4 polymorphisms of SP-B gene between cases and controls. No significant differences were detected in fhe genotype distribution of C/T1580 or A/G9306 be- tween the two groups. Haplotype analysis revealed that the frequency of A-del-C-A haplotype was higher in case group （0.12 to 0.05, P=0.003）, whereas the frequency of C-inv-C-A haplotype was higher in control group （0.19 to 0.05, P=0.000）. In addition, a significant difference was observed in the frequency of C-inv-T-A haplotype between the two groups. It was concluded that the polymor- phisms of SP-B intron 4 and C/A-18 could be associated with BPD in Chinese Han infants, and the del allele of intron 4 and A allele of C/A-18 might be used as markers of susceptibility in the disease. Haplotype analysis indicated that the gene-gene interactions would play an important part in deter- mining susceptibility to BPD.展开更多
BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an allergic reaction to Aspergillus species that aggravates bronchial asthma.Previous studies demonstrated the glucocorticoid-sparing effect of dupilumab in p...BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an allergic reaction to Aspergillus species that aggravates bronchial asthma.Previous studies demonstrated the glucocorticoid-sparing effect of dupilumab in patients with ABPA.There is no report of complete withdrawal of glucocorticoids after dupilumab.CASE SUMMARY The patient was a 54-year-old woman with bronchial asthma treated with inhaled corticosteroids and a long-acting beta-2 agonist.She consulted our institution for productive cough and fever in March 2017.Chest computed tomography scan revealed mucoid impaction,and the bronchial lavage fluid culture was positive for Aspergillus fumigatus.The diagnosis was ABPA.The patient was treated with oral glucocorticoids from April 2017 to November 2017.In January 2019,she had bronchial asthma exacerbation,and a chest computed tomography scan showed recurrent mucoid impaction.She was treated with oral glucocorticoids and itraconazole.In February 2020,during tapering of oral glucocorticoid,she had the third episode of bronchial asthma exacerbation and a mucoid impaction.The patient was treated with dupilumab in addition to oral glucocorticoid and itraconazole.The clinical response improved,and oral glucocorticoid was discontinued in June 2020.CONCLUSION This is the first case of ABPA in which complete withdrawal of glucocorticoid was possible after treatment with dupilumab.展开更多
BACKGROUND An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis(ABPA).As ABPA is an allergic respiratory d...BACKGROUND An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis(ABPA).As ABPA is an allergic respiratory disease,immunoglobulin E and peripheral-blood eosinophilia have been used as diagnostic indicators.However,eosinophilia in bronchoalveolar lavage fluid(BALF)has not been considered in the diagnostic criteria for ABPA.CASE SUMMARY We present a case of ABPA in which the eosinophil count in peripheral blood was not increased,whereas the eosinophil percentage in BALF reached 60%.After antifungal and hormone therapy,imaging revealed very good resolution of lung infiltration.CONCLUSION The value of the eosinophil count in BALF for the diagnosis of ABPA is worthy of the clinician's attention,especially when the patient’s clinical features lack specificity and the diagnostic parameters are negative.展开更多
BACKGROUND Concomitant allergic fungal rhinosinusitis(AFRS)and allergic bronchopulmonary aspergillosis(ABPA)are extremely rare,with no more than 20 cases reported in the English literature.CASE SUMMARY A 52-year-old f...BACKGROUND Concomitant allergic fungal rhinosinusitis(AFRS)and allergic bronchopulmonary aspergillosis(ABPA)are extremely rare,with no more than 20 cases reported in the English literature.CASE SUMMARY A 52-year-old female patient complained of right-sided nasal obstruction,rhinorrhea,sneezing,epistaxis,and hyposmia for a period of around 5 mo.Nasal examination detected paleness and edema of the nasal mucous membrane and a polyp in the right middle meatus.A computed tomography(CT)scan of the sinuses revealed a ground-glass opacity filling the right maxillary and ethmoid sinuses,along with bone absorption in the medial wall of the right maxillary sinus.Magnetic resonance images were obtained with T1-weighted,T2-weighted,and gadolinium-enhanced T1-weighted sequences.A well-defined mass,located in the right maxillary and ethmoid sinuses and displaying obvious hypointense features,was observed on both T1-and T2-weighted images,with peripheral enhancement on gadolinium-enhanced T1-weighted images.The patient also has a 20-year history of cough and dyspnea.Chest CT revealed columned and cystiform bronchiectasis in the bilateral bronchus,surrounded by a large number of spotted and funicular high-density lesions.The level of serum total IgE was>5000 kU/L.Serum IgE levels related to house dust and aspergillus showed a positive result,with the values being 3.5 kU/L and 1.2 kU/L.We performed functional endoscopic sinus surgery under local anesthesia.After surgery,topical glucocorticoids and saline irrigation were applied in the nasal cavity until the present time.An oral glucocorticoid(methylprednisolone 16 mg/d)and antifungal agent(itraconazole 200 mg/d)were also used for a period of 4 wk.Montelukast was prescribed at 10 mg/d until the present time.An endoscopic examination showed that the patient was recovering well at 3 mo after surgery.CONCLUSION Since different specialists treat ABPA and AFRS,their coexistence may be overlooked.AFRS accompanied by ABPA requires surgical therapy combined with medical control to improve the symptoms.展开更多
BACKGROUND Congenital cystic adenomatoid malformation(CCAM)and bronchopulmonary sequestration(BPS)are the most common lung diseases in fetuses.There are differences in the prognosis and treatment of CCAM and BPS,and t...BACKGROUND Congenital cystic adenomatoid malformation(CCAM)and bronchopulmonary sequestration(BPS)are the most common lung diseases in fetuses.There are differences in the prognosis and treatment of CCAM and BPS,and the clinical diagnosis and treatment plan is usually prepared prior to birth.Therefore,it is quite necessary to make a clear diagnosis before delivery.CCAM and BPS have similar imaging features,and the differentiation mainly relies on the difference in supply vessels.However,it is hard to distinguish them due to invisible supplying vessels on some images.AIM To explore the application value of magnetic resonance imaging(MRI)in the differential diagnosis of fetal CCAM and BPS.METHODS Data analysis for 32 fetuses with CCAM and 14 with BPS diagnosed by prenatal MRI at Huzhou Maternal and Child Health Care Hospital and Anhui Provincial Children’s Hospital from January 2017 to January 2020 was performed to observe the source blood vessels of lesions and their direction.Pathological confirmation was completed through CT examination and/or operations after birth.RESULTS After birth,31 cases after birth were confirmed to be CCAM,and 15 were confirmed to be BPS.The CCAM group consisted of 21 macrocystic cases and 10 microcystic cases.In 18 cases,blood vessels were visible in lesions.Blood supply of the pulmonary artery could be traced in eight cases,and in 10 cases,only vessels running from the midline to the lateral down direction were observed.No lesions were found in four macrocystic cases and one microcystic case with CCAM through CT after birth;two were misdiagnosed by MRI,and three were misdiagnosed by prenatal ultrasonography.The BPS group consisted of 12 intralobar cases and three extralobar cases.Blood vessels were visible in lesions of nine cases,in four of which,the systemic circulation blood supply could be traced,and in five of which,only vessels running from the midline to the lateral up direction were observed.Three were misdiagnosed by MRI,and four were misdiagnosed by prenatal ultrasonography.CONCLUSION CCAM and BPS can be clearly diagnosed based on the origin of blood vessels,and correct diagnosis can be made according to the difference in the direction of the blood vessels,but it is hard distinguish microcystic CCAM and BPS without supplying vessels.In some CCAM cases,mainly the macrocystic ones,the lesions may disappear after birth.展开更多
Background: Bronchopulmonary dysplasia (BPD) continues to be an important problem in neonates especially premature infants despite improved facilities of care, monitoring and treatment. Pulmonary hypertension (PH) is ...Background: Bronchopulmonary dysplasia (BPD) continues to be an important problem in neonates especially premature infants despite improved facilities of care, monitoring and treatment. Pulmonary hypertension (PH) is a major complicating factor and key cause of mortality in this population. Altered vascular and alveolar growth particularly in canalicular and early saccular stages of lung development following mechanical ventilation and oxygen therapy result in arrest of the lung development leading to BPD with PH. Early recognition of PH in infants with these risk factors is important for optimal management. We tested the hypothesis that asymmetric dimethylarginine, would be greater in infants with bronchopulmonary dysplasia associated pulmonary hypertension than in infants with BPD alone. The Aim: The aim of the current study was to measure the Asymmetric dimethylarginine (ADMA) levels, arginine levels & the plasma arginine-to-ADMA ratio in newborn infants with broncho-pulmonary dysplasia, to evaluate echocardiographic parameters among neonates with bronchopulmonary dysplasia, to correlate between plasma ADMA & arginine-to-ADMA ratio and echocardiographic (ECHO) parameters in those patients and to compare full term & preterm neonates with bronchopulmonary dysplasia as regard to plasma ADMA level. Methods: A case-control study was carried out of ninety (90) newborns selected from those admitted to Neonatal Intensive Care Unit at Maternity & Children Hospital and Alzhraa University hospital during the period from October 2015 to March 2018. Neonates were divided into 2 groups: Patient with BPD with PH (cases group): It included 45 neonates with BPD & PH, 35 preterm neonates and 10 full term neonates. Patient with BPD only (Control group): It included 45 neonates with BPD without PH. These 45 neonates were divided as 22 preterm neonates and 23 full term neonates. Laboratory work was done in Alzhraa University hospital. Asymmetric dimethylarginine (ADMA) levels & arginine levels were measured using competitive enzyme linked immune-assay (ELISA). Results: Patients with both BPD and PH had greater plasma levels of ADMA than patients with BPD alone (P value 0.000). ADMA level > 186 ng/dl can predict development of PH in patient with BPD with sensitivity 100% and specify 100%. Preterm neonates with BPD had greater level of ADMA than full term neonates (P value 0.002). There was no statically significance difference between level of ADMA if withdrawn before or after 28 days of age (range of age at time of sampling in our study was 23 - 40 days) (P value 0.878), even ADMA level increased above the cut point early in the disease before we screened some cases by ECHO. There was no statically significance difference between level of arginine in cases and control groups with P value 0.530. The plasma arginine-to-ADMA ratio was lower in cases than in controls suggesting a greater likelihood of inhibition of nitric oxide production in patients with both BPD and PH than in patients with BPD alone (P value 0.000). ADMA level can predict severity of pulmonary hypertension in patient with BPD, as it was positively correlated with the grade of pulmonary hypertension (P value 0.006). ADMA level is higher in neonates with BPD and PH who died than those who survived;it can predict death in neonates with BPD &PH at cut off point > 643 ng/dl. Conclusion: ADMA increased in newborn infants with BPD, who developed PH. ADMA may have diagnostic and prognostic values. ADMA level was higher in preterm neonates than full term neonates and its level was correlated positively with severity of PH. ADMA levels were significant higher in infants with BPD with PH who died later than those who survived. There was no statically significance difference between levels of ADMA, whether it was drawn before or after 28 days of age (range 23 - 40 days). Echocardiographic screening and ADMA measurement could help in prevention of PH, diagnosis and early treatment of newborn infants suffering from BPD.展开更多
BACKGROUND Pulmonary hypertension(PH)is a severe complication of bronchopulmonary dysplasia(BPD)in premature neonates and is closely related to prognosis.However,there is no effective and safe treatment for PH due to ...BACKGROUND Pulmonary hypertension(PH)is a severe complication of bronchopulmonary dysplasia(BPD)in premature neonates and is closely related to prognosis.However,there is no effective and safe treatment for PH due to BPD in infants.Successful treatment for cases of BPD-associated PH with Tadalafil combined with bosentan is rare.This case may make a significant contribution to the literature because PH is difficult to manage as a serious complication of BPD in preterm infants.Mortality is high,especially when it is complicated by heart failure.CASE SUMMARY An extremely premature neonate with a gestational age of 26+5 wk and birth weight of 0.83 kg was diagnosed with BPD associated with PH;oral sildenafil did not improve the PH.The infant experienced sudden cardiac arrest and serious heart failure with severe PH.After a series of treatments,including cardiopulmonary resuscitation,mechanical ventilation,and inhaled nitric oxide(iNO),the respiratory and circulatory status improved but the pulmonary artery pressure remained high.Then oral sildenafil was replaced with oral tadalafil and bosentan;pulmonary artery pressure improved,and the infant recovered at our hospital.After 2 years of follow-up,she is in good condition,without any cardiovascular complications.CONCLUSION INO can effectively improve the respiratory and circulatory status of infants with PH associated with premature BPD.B-type natriuretic peptide should be routinely measured during hospitalization to evaluate the risk and prognosis of BPD-associated PH in preterm infants.Tadalafil combined with bosentan for the treatment of PH associated with premature BPD was better than sildenafil in this case.Further studies are needed to explore the efficacy and safety of different vasodilators in the treatment of PH associated with premature BPD.展开更多
BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an immune-related pulmonary disease caused by sensitization of airway by Aspergillus fumigatus.The disease manifests as bronchial asthma and recurring pulmona...BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an immune-related pulmonary disease caused by sensitization of airway by Aspergillus fumigatus.The disease manifests as bronchial asthma and recurring pulmonary shadows,which may be associated with bronchiectasis.The diagnosis of ABPA mainly depends on serological,immunological,and imaging findings.Pathological examination is not necessary but may be required in atypical cases to exclude pulmonary tuberculosis,tumor,and other diseases through lung biopsy.CASE SUMMARY An 18-year-old man presented with recurrent wheezing,cough,and peripheral blood eosinophilia.Chest computed tomography showed pulmonary infiltration.There was a significant increase in eosinophils in bronchoalveolar lavage fluid.There was no history of residing in a parasite-endemic area or any evidence of parasitic infection.Pathologic examination of bronchoalveolar lavage fluid excluded fungal and mycobacterial infections.The patient was receiving medication for comorbid diseases,but there was no temporal correlation between medication use and clinical manifestations,which excluded drug-induced etiology.Histopathological examination of lung biopsy specimen showed no signs of eosinophilic granulomatosis with polyangiitis,IgG4-related diseases,or tumors.The diagnosis of ABPA was considered based on the history of asthma and the significant increase in serum Aspergillus fumigatus-specific immunoglobulin(Ig)E.Eosinophil-related diseases were excluded through pathological biopsy,which showed typical pathological manifestations of ABPA.CONCLUSION The possibility of ABPA should be considered in patients with poorly controlled asthma,especially those with eosinophilia,lung infiltration shadows,or bronchiectasis.Screening for serum IgE,Aspergillus fumigatus-specific IgE and IgG,and alveolar lavage can help avoid misdiagnosis.展开更多
Background: Bronchopulmonary Dysplasia (BPD) is a chronic lung condition that primarily affects preterm infants. Genetic predispositions, environmental factors, prenatal, and postnatal risk factors have been associate...Background: Bronchopulmonary Dysplasia (BPD) is a chronic lung condition that primarily affects preterm infants. Genetic predispositions, environmental factors, prenatal, and postnatal risk factors have been associated with bronchopulmonary dysplasia. However, there is a lack of consensus regarding these factors. Purpose: To examine the available information on pathogenesis and summarize the points of agreement to generate concise information that can guide patient management and spur further research. Method: PubMed, Embase and Web of Science were used to search for studies that analyzed the risk factors associated with bronchopulmonary dysplasia between 2006 and 2022 with the key search terms “bronchopulmonary dysplasia, etiology, preterm birth, mechanical ventilation”. Results: This study found that the pathogenesis of bronchopulmonary dysplasia is multifactorial, involving close interactions among these major etiological factors and other minor risk factors. A combination of mechanical ventilation, intrauterine factors, inflammation, genetic predispositions, insufficient surfactants, docosahexaenoic acid, and nutrition, among other minor risk factors, was all required in one way or another to influence BPD development. Therefore, studies should continuously update and incorporate the emerging information to assist frontline healthcare workers and generate qualitative data for clinical trial design and further research. Conclusion: Bronchopulmonary Dysplasia is different from other respiratory illnesses, and the pathogenesis of bronchopulmonary is multifactorial.展开更多
To investigate bronchopulmonary dysplasia (BPD) and its treatment with dexamethasone (DEX) in premature infants with birth weight (BW) < 1500 g. We retrospectively reviewed the records of preterm infants admitted t...To investigate bronchopulmonary dysplasia (BPD) and its treatment with dexamethasone (DEX) in premature infants with birth weight (BW) < 1500 g. We retrospectively reviewed the records of preterm infants admitted to the Division of Neonatology, the Second Xiangya Hospital, Central South University between September 2011 and December 2014. Patients were excluded if they needed oxygen therapy but were lost to follow-up at ≤36 weeks post-menstrual age (PMA) or <56 days after birth, or they had severe congenital anomalies. The incidence of BPD was 18% (37/212). Gestational age (GA) was <32 weeks in all BPD patients. GA, BW, and Apgar scores were lower and hospitalization duration and pulmonary surfactant (PS) use were higher in the BPD group than in the non-BPD group (P < 0.05). Risk factors for BPD included neonatal respiratory distress syndrome, neonatal pneumonia, positive sputum culture, pulmonary hemorrhage, respiratory failure. Multivariate logistic regression revealed that GA (odds ratio [OR]: 0.479, P = 0.004) and neonatal respiratory distress syndrome (OR: 6.146, P = 0.043) were independent risk factors for BPD. DEX was administered to 26 patients after the diagnosis of BPD. After one and two weeks of DEX treatment, the oxygen requirement had significantly reduced compared to the week prior to treatment (P < 0.05), while during treatment, the weight gain rate and weight gain efficiency slower significantly than that during either of the two preceding weeks (P < 0.001). These results suggest that low GA was the most important risk factor for BPD, DEX reduced oxygen dependency but decreased weight gain.展开更多
<strong>Summary:</strong> A malignant tumour that develops from the bronchial epithelium and then invades the lungs. It ranks third after colorectal and breast cancer. In Mali, computed tomography (CT) is ...<strong>Summary:</strong> A malignant tumour that develops from the bronchial epithelium and then invades the lungs. It ranks third after colorectal and breast cancer. In Mali, computed tomography (CT) is the main imaging tool used at all stages of treatment. We had initiated this study with the objective of specifying the place of CT in the diagnosis of primary bronchopulmonary cancer at the hospital of Mali. <strong>Method: </strong>This is a prospective and descriptive study conducted by the Medical Imaging and Thoracic Surgery departments at Mali Hospital from March 2014 to February 2015. All the patients who have benefited from a CT scan and presenting at least one histologically confirmed bronchopulmonary tumor were included. <strong>Results: </strong>We were recruiting 60 patients with bronchopulmonary cancers out of 500 referred for a thoracic CT scan performed, a frequency of 12%. There was one male patient with a sex ratio of 4H/1F. The average age was 60 years. The history of smoking was 85%. The symptoms were dominated by general condition (63.33%), cough (25%) and haemoptysis (58.33%). CT scans were performed in all patients. The lesions were located more in the lower lobes (71%). The tumours were: heterogeneous tissue density (70%), spiculated contours (80%), and the histology was more non-small cell carcinoma. <strong>Conclusion: </strong>The incidence of bronchopulmonary cancer is very high and its prognosis is poor at an advanced stage. The evaluative role of CT and biopsy guidance has given it a place of choice in its management. The diagnosis of certainty remains histology.展开更多
Background Longer hospitalizations for preterm infants with bronchopulmonary dysplasia(BPD)delay developmental outcomes,increase the risk for hospital-acquired complications,and exert a substantial socioeconomic burde...Background Longer hospitalizations for preterm infants with bronchopulmonary dysplasia(BPD)delay developmental outcomes,increase the risk for hospital-acquired complications,and exert a substantial socioeconomic burden.This study aimed to identify factors associated with an extended length of stay(LOS)at different levels of severity of BPD.Methods A cohort study was conducted using the Korean Neonatal Network registry of very low birth weight infants with BPD between 2013 and 2017 through retrospective analysis.Results A total of 4263 infants were diagnosed with BPD.For mild BPD,infants requiring surgical treatment for patent ductus arteriosus needed a longer LOS[eadjustedβcoefficients(adjβ)1.041;95%confidence interval(CI):0.01–0.08]and hydrocephalus(eadjβ1.094;95%CI 0.01–0.17).In moderate BPD,infants administered steroids or with intraventricular hemorrhage required a longer LOS(eadjβ1.041;95%CI 0.00–0.07 and eadjβ1.271;95%CI 0.11–0.38,respectively).In severe BPD,infants with comorbidities required a longer LOS:pulmonary hypertension(eadjβ1.174;95%CI 0.09–0.23),administrated steroid for BPD(eadjβ1.116;95%CI 0.07–0.14),sepsis(eadjβ1.062;95%CI 0.01–0.11),patent ductus arteriosus requiring surgical ligation(eadjβ1.041;95%CI 0.00–0.08),and intraventricular hemorrhage(eadjβ1.016;95%CI 0.05–0.26).Additionally,the higher the clinical risk index score,the longer the LOS needed for infants in all groups.Conclusions The factors affecting LOS differed according to the severity of BPD.Individualized approaches to reducing LOS may be devised using knowledge of the various risk factors affecting LOS by BPD severity.展开更多
The treatment of infants with established bronchopulmonary dysplasia （BPD） remains a common,frustrating and expensive problem in neonatology, pediatric PlUlmonology, pediatric critical care and general pediatrics.
文摘For preterm infants, bronchopulmonary dysplasia (BPD) is usually caused by abnormal lung development due to various factors during prenatal and postnatal process. One of the reasons for death and bad prognosis of preterm infants is to have BPD. Up to now, there are no unified strategies or drugs to treat BPD. In clinical, many intervention treatments have been applied to achieve BPD therapy, mainly including preterm protection, protective ventilation strategies, and delivery of corticosteroids, pulmonary vasodilators, and antioxidants. This review summarizes the current advances in BPD protection and treatment, and notes that gut microbiota and mesenchymal stem cells (MSCs) can be the promising strategy for protecting and treating BPD in the future.
文摘Bronchopulmonary dysplasia(BPD),also known as neonatal chronic lung disease,is a common respiratory disease in preterm infants.Preterm infants with BPD often exhibit changes in gut and lung microbiota.In recent years,with the development of high-throughput sequencing technology,more and more mechanisms of the gut-lung axis have been confirmed,helping to explore new directions for the treatment of BPD using microecological agents.This paper reviews the roles of gut microbiota,lung microbiota,and the gut-lung axis in the pathogenesis of BPD in preterm infants,providing new research avenues for the prevention and treatment of BPD.
文摘There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.
文摘Allergic bronchopulmonary aspergillosis(ABPA) is a complex hypersensitivity syndrome triggered against antigens of Aspergillus fumigatus,a fungus that most commonly colonizes the airways of patients with bronchial asthma and cystic fibrosis.It presents clinically with refractory asthma,hemoptysis and systemic manifestations including fever,malaise and weight loss.Radiologically,it presents with central bronchiectasis and recurrent episodes of mucus plugging.The mucus plugs in ABPA are generally hypodense but in up to 20% of patients the mucus can be hyperdense on computed tomography.This paper reviews the literature on the clinical significance of hyperattenuated mucus in patients with ABPA.
文摘AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-na?ve allergic bronchopulmonary aspergillosis (ABPA) patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-na?ve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm) in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB) was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.
文摘The probability of a radiologist interpreting a disease correctly is not only influenced by their training and experience but also on the knowledge of a particular entity.This editorial reviews certain myths and realities associated with radiological manifestations of allergic bronchopulmonary aspergillosis(ABPA).ABPA is a hypersensitivity disorder against the antigens of Aspergillus fumigatus.Although commonly manifesting with central bronchiectasis(CB),the disorder can present without any abnormalities on high-resolution computed tomography(HRCT) of the chest,so-called serologic ABPA(ABPA-S).HRCT of the chest should not be used in screening or in the initial diagnostic work up of asthmatics,as asthma without ABPA can manifest with findings of CB.High-attenuation mucus(HAM) is the pathognomonic sign of ABPA and is very helpful in the diagnosis of ABPA complicating asthma and cystic fibrosis.Instead of classifying ABPA based on the presence and absence of CB into ABPA-CB and ABPA-S respectively,ABPA should be classif ied as ABPA-S,ABPACB and ABPA-CB-HAM.The classif ication scheme based on HAM not only identifies an immunologically severe disease but also predicts a patient with increased risk of recurrent relapses.
基金supported by the National Natural Science Foundation of China(No.30772359)
文摘There is controversy regarding the roles of Ureaplasma urealyticum （U. urealyticum） colo- nization in the development of hronchopulmonary dysplasia （BPD）. This study explored the association between U. urealyticum and bronchopulmonary dysplasia at 36 weeks post-menstrual age （BPD36）. Studies published before December 31, 2013 were searched from Medline, Embase, Ovid, Web of Sci- ence, and Cochrane databases, with the terms ＂Ureaplasma urealyticum＂, ＂chronic lung disease＂, or ＂BPD36＂ used, and English language as a limit. The association between U. urealyticum colonization and BPD36 was analyzed with RevMan 4.2.10 software, using the odds ratio （OR） and relative risk （RR） for dichotomous variables. Out of the enrolled 81 studies, 11 investigated the BPD36 in total 1193 in- fants. Pooled studies showed no association between U. urealyticum colonization and subsequent de- velopment of BPD36, with the OR and RR being 1.03 （95% CI=0.78-1.37; P=-0.84） and 1.01 （95% CI= 0.88-1.16, P=-0.84）, respectively. These findings indicated no association between U. urealyticum colo- nization and the development of BPD36.
基金supported by grants from the National Natural Science Foundation of China (Nos. 30872795 and 81170001)
文摘Summary： This study aimed to investigate the association between surfactant protein B （SP-B） pol- ymorphisms and bronchopulmonary dysplasia （BPD） in Chinese Han infants. We performed a case- control study including 86 infants with BPD and 156 matched controls. Genotyping was performed by sequence specific primer-polymerase chain reaction （PCR） and haplotypes were reconstructed by the fastPHASE software. The results showed that significant differences were detected in the geno- type distribution of C/A-18 and intron 4 polymorphisms of SP-B gene between cases and controls. No significant differences were detected in fhe genotype distribution of C/T1580 or A/G9306 be- tween the two groups. Haplotype analysis revealed that the frequency of A-del-C-A haplotype was higher in case group （0.12 to 0.05, P=0.003）, whereas the frequency of C-inv-C-A haplotype was higher in control group （0.19 to 0.05, P=0.000）. In addition, a significant difference was observed in the frequency of C-inv-T-A haplotype between the two groups. It was concluded that the polymor- phisms of SP-B intron 4 and C/A-18 could be associated with BPD in Chinese Han infants, and the del allele of intron 4 and A allele of C/A-18 might be used as markers of susceptibility in the disease. Haplotype analysis indicated that the gene-gene interactions would play an important part in deter- mining susceptibility to BPD.
文摘BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an allergic reaction to Aspergillus species that aggravates bronchial asthma.Previous studies demonstrated the glucocorticoid-sparing effect of dupilumab in patients with ABPA.There is no report of complete withdrawal of glucocorticoids after dupilumab.CASE SUMMARY The patient was a 54-year-old woman with bronchial asthma treated with inhaled corticosteroids and a long-acting beta-2 agonist.She consulted our institution for productive cough and fever in March 2017.Chest computed tomography scan revealed mucoid impaction,and the bronchial lavage fluid culture was positive for Aspergillus fumigatus.The diagnosis was ABPA.The patient was treated with oral glucocorticoids from April 2017 to November 2017.In January 2019,she had bronchial asthma exacerbation,and a chest computed tomography scan showed recurrent mucoid impaction.She was treated with oral glucocorticoids and itraconazole.In February 2020,during tapering of oral glucocorticoid,she had the third episode of bronchial asthma exacerbation and a mucoid impaction.The patient was treated with dupilumab in addition to oral glucocorticoid and itraconazole.The clinical response improved,and oral glucocorticoid was discontinued in June 2020.CONCLUSION This is the first case of ABPA in which complete withdrawal of glucocorticoid was possible after treatment with dupilumab.
基金Supported by Zhejiang Provincial Department of Education,No.Y202045102.
文摘BACKGROUND An immediate hypersensitive immune response to Aspergillus fumigatus antigens is one of the main characteristic features of allergic bronchopulmonary aspergillosis(ABPA).As ABPA is an allergic respiratory disease,immunoglobulin E and peripheral-blood eosinophilia have been used as diagnostic indicators.However,eosinophilia in bronchoalveolar lavage fluid(BALF)has not been considered in the diagnostic criteria for ABPA.CASE SUMMARY We present a case of ABPA in which the eosinophil count in peripheral blood was not increased,whereas the eosinophil percentage in BALF reached 60%.After antifungal and hormone therapy,imaging revealed very good resolution of lung infiltration.CONCLUSION The value of the eosinophil count in BALF for the diagnosis of ABPA is worthy of the clinician's attention,especially when the patient’s clinical features lack specificity and the diagnostic parameters are negative.
文摘BACKGROUND Concomitant allergic fungal rhinosinusitis(AFRS)and allergic bronchopulmonary aspergillosis(ABPA)are extremely rare,with no more than 20 cases reported in the English literature.CASE SUMMARY A 52-year-old female patient complained of right-sided nasal obstruction,rhinorrhea,sneezing,epistaxis,and hyposmia for a period of around 5 mo.Nasal examination detected paleness and edema of the nasal mucous membrane and a polyp in the right middle meatus.A computed tomography(CT)scan of the sinuses revealed a ground-glass opacity filling the right maxillary and ethmoid sinuses,along with bone absorption in the medial wall of the right maxillary sinus.Magnetic resonance images were obtained with T1-weighted,T2-weighted,and gadolinium-enhanced T1-weighted sequences.A well-defined mass,located in the right maxillary and ethmoid sinuses and displaying obvious hypointense features,was observed on both T1-and T2-weighted images,with peripheral enhancement on gadolinium-enhanced T1-weighted images.The patient also has a 20-year history of cough and dyspnea.Chest CT revealed columned and cystiform bronchiectasis in the bilateral bronchus,surrounded by a large number of spotted and funicular high-density lesions.The level of serum total IgE was>5000 kU/L.Serum IgE levels related to house dust and aspergillus showed a positive result,with the values being 3.5 kU/L and 1.2 kU/L.We performed functional endoscopic sinus surgery under local anesthesia.After surgery,topical glucocorticoids and saline irrigation were applied in the nasal cavity until the present time.An oral glucocorticoid(methylprednisolone 16 mg/d)and antifungal agent(itraconazole 200 mg/d)were also used for a period of 4 wk.Montelukast was prescribed at 10 mg/d until the present time.An endoscopic examination showed that the patient was recovering well at 3 mo after surgery.CONCLUSION Since different specialists treat ABPA and AFRS,their coexistence may be overlooked.AFRS accompanied by ABPA requires surgical therapy combined with medical control to improve the symptoms.
基金Supported by Huzhou Science and Technology Plan of Zhejiang Province,No.2018GYB75.
文摘BACKGROUND Congenital cystic adenomatoid malformation(CCAM)and bronchopulmonary sequestration(BPS)are the most common lung diseases in fetuses.There are differences in the prognosis and treatment of CCAM and BPS,and the clinical diagnosis and treatment plan is usually prepared prior to birth.Therefore,it is quite necessary to make a clear diagnosis before delivery.CCAM and BPS have similar imaging features,and the differentiation mainly relies on the difference in supply vessels.However,it is hard to distinguish them due to invisible supplying vessels on some images.AIM To explore the application value of magnetic resonance imaging(MRI)in the differential diagnosis of fetal CCAM and BPS.METHODS Data analysis for 32 fetuses with CCAM and 14 with BPS diagnosed by prenatal MRI at Huzhou Maternal and Child Health Care Hospital and Anhui Provincial Children’s Hospital from January 2017 to January 2020 was performed to observe the source blood vessels of lesions and their direction.Pathological confirmation was completed through CT examination and/or operations after birth.RESULTS After birth,31 cases after birth were confirmed to be CCAM,and 15 were confirmed to be BPS.The CCAM group consisted of 21 macrocystic cases and 10 microcystic cases.In 18 cases,blood vessels were visible in lesions.Blood supply of the pulmonary artery could be traced in eight cases,and in 10 cases,only vessels running from the midline to the lateral down direction were observed.No lesions were found in four macrocystic cases and one microcystic case with CCAM through CT after birth;two were misdiagnosed by MRI,and three were misdiagnosed by prenatal ultrasonography.The BPS group consisted of 12 intralobar cases and three extralobar cases.Blood vessels were visible in lesions of nine cases,in four of which,the systemic circulation blood supply could be traced,and in five of which,only vessels running from the midline to the lateral up direction were observed.Three were misdiagnosed by MRI,and four were misdiagnosed by prenatal ultrasonography.CONCLUSION CCAM and BPS can be clearly diagnosed based on the origin of blood vessels,and correct diagnosis can be made according to the difference in the direction of the blood vessels,but it is hard distinguish microcystic CCAM and BPS without supplying vessels.In some CCAM cases,mainly the macrocystic ones,the lesions may disappear after birth.
文摘Background: Bronchopulmonary dysplasia (BPD) continues to be an important problem in neonates especially premature infants despite improved facilities of care, monitoring and treatment. Pulmonary hypertension (PH) is a major complicating factor and key cause of mortality in this population. Altered vascular and alveolar growth particularly in canalicular and early saccular stages of lung development following mechanical ventilation and oxygen therapy result in arrest of the lung development leading to BPD with PH. Early recognition of PH in infants with these risk factors is important for optimal management. We tested the hypothesis that asymmetric dimethylarginine, would be greater in infants with bronchopulmonary dysplasia associated pulmonary hypertension than in infants with BPD alone. The Aim: The aim of the current study was to measure the Asymmetric dimethylarginine (ADMA) levels, arginine levels & the plasma arginine-to-ADMA ratio in newborn infants with broncho-pulmonary dysplasia, to evaluate echocardiographic parameters among neonates with bronchopulmonary dysplasia, to correlate between plasma ADMA & arginine-to-ADMA ratio and echocardiographic (ECHO) parameters in those patients and to compare full term & preterm neonates with bronchopulmonary dysplasia as regard to plasma ADMA level. Methods: A case-control study was carried out of ninety (90) newborns selected from those admitted to Neonatal Intensive Care Unit at Maternity & Children Hospital and Alzhraa University hospital during the period from October 2015 to March 2018. Neonates were divided into 2 groups: Patient with BPD with PH (cases group): It included 45 neonates with BPD & PH, 35 preterm neonates and 10 full term neonates. Patient with BPD only (Control group): It included 45 neonates with BPD without PH. These 45 neonates were divided as 22 preterm neonates and 23 full term neonates. Laboratory work was done in Alzhraa University hospital. Asymmetric dimethylarginine (ADMA) levels & arginine levels were measured using competitive enzyme linked immune-assay (ELISA). Results: Patients with both BPD and PH had greater plasma levels of ADMA than patients with BPD alone (P value 0.000). ADMA level > 186 ng/dl can predict development of PH in patient with BPD with sensitivity 100% and specify 100%. Preterm neonates with BPD had greater level of ADMA than full term neonates (P value 0.002). There was no statically significance difference between level of ADMA if withdrawn before or after 28 days of age (range of age at time of sampling in our study was 23 - 40 days) (P value 0.878), even ADMA level increased above the cut point early in the disease before we screened some cases by ECHO. There was no statically significance difference between level of arginine in cases and control groups with P value 0.530. The plasma arginine-to-ADMA ratio was lower in cases than in controls suggesting a greater likelihood of inhibition of nitric oxide production in patients with both BPD and PH than in patients with BPD alone (P value 0.000). ADMA level can predict severity of pulmonary hypertension in patient with BPD, as it was positively correlated with the grade of pulmonary hypertension (P value 0.006). ADMA level is higher in neonates with BPD and PH who died than those who survived;it can predict death in neonates with BPD &PH at cut off point > 643 ng/dl. Conclusion: ADMA increased in newborn infants with BPD, who developed PH. ADMA may have diagnostic and prognostic values. ADMA level was higher in preterm neonates than full term neonates and its level was correlated positively with severity of PH. ADMA levels were significant higher in infants with BPD with PH who died later than those who survived. There was no statically significance difference between levels of ADMA, whether it was drawn before or after 28 days of age (range 23 - 40 days). Echocardiographic screening and ADMA measurement could help in prevention of PH, diagnosis and early treatment of newborn infants suffering from BPD.
基金Supported by The Clinical Research Fund of West China Second University Hospital,Sichuan University,No.KL109(to Li J),No.KL014(to Yang XY),and No.KL075(to Shi J).
文摘BACKGROUND Pulmonary hypertension(PH)is a severe complication of bronchopulmonary dysplasia(BPD)in premature neonates and is closely related to prognosis.However,there is no effective and safe treatment for PH due to BPD in infants.Successful treatment for cases of BPD-associated PH with Tadalafil combined with bosentan is rare.This case may make a significant contribution to the literature because PH is difficult to manage as a serious complication of BPD in preterm infants.Mortality is high,especially when it is complicated by heart failure.CASE SUMMARY An extremely premature neonate with a gestational age of 26+5 wk and birth weight of 0.83 kg was diagnosed with BPD associated with PH;oral sildenafil did not improve the PH.The infant experienced sudden cardiac arrest and serious heart failure with severe PH.After a series of treatments,including cardiopulmonary resuscitation,mechanical ventilation,and inhaled nitric oxide(iNO),the respiratory and circulatory status improved but the pulmonary artery pressure remained high.Then oral sildenafil was replaced with oral tadalafil and bosentan;pulmonary artery pressure improved,and the infant recovered at our hospital.After 2 years of follow-up,she is in good condition,without any cardiovascular complications.CONCLUSION INO can effectively improve the respiratory and circulatory status of infants with PH associated with premature BPD.B-type natriuretic peptide should be routinely measured during hospitalization to evaluate the risk and prognosis of BPD-associated PH in preterm infants.Tadalafil combined with bosentan for the treatment of PH associated with premature BPD was better than sildenafil in this case.Further studies are needed to explore the efficacy and safety of different vasodilators in the treatment of PH associated with premature BPD.
基金Supported by the National Natural Science Foundation of China,No.81900641the Research Funding of Peking University,No.BMU2021MX020,No.BMU2022MX008.
文摘BACKGROUND Allergic bronchopulmonary aspergillosis(ABPA)is an immune-related pulmonary disease caused by sensitization of airway by Aspergillus fumigatus.The disease manifests as bronchial asthma and recurring pulmonary shadows,which may be associated with bronchiectasis.The diagnosis of ABPA mainly depends on serological,immunological,and imaging findings.Pathological examination is not necessary but may be required in atypical cases to exclude pulmonary tuberculosis,tumor,and other diseases through lung biopsy.CASE SUMMARY An 18-year-old man presented with recurrent wheezing,cough,and peripheral blood eosinophilia.Chest computed tomography showed pulmonary infiltration.There was a significant increase in eosinophils in bronchoalveolar lavage fluid.There was no history of residing in a parasite-endemic area or any evidence of parasitic infection.Pathologic examination of bronchoalveolar lavage fluid excluded fungal and mycobacterial infections.The patient was receiving medication for comorbid diseases,but there was no temporal correlation between medication use and clinical manifestations,which excluded drug-induced etiology.Histopathological examination of lung biopsy specimen showed no signs of eosinophilic granulomatosis with polyangiitis,IgG4-related diseases,or tumors.The diagnosis of ABPA was considered based on the history of asthma and the significant increase in serum Aspergillus fumigatus-specific immunoglobulin(Ig)E.Eosinophil-related diseases were excluded through pathological biopsy,which showed typical pathological manifestations of ABPA.CONCLUSION The possibility of ABPA should be considered in patients with poorly controlled asthma,especially those with eosinophilia,lung infiltration shadows,or bronchiectasis.Screening for serum IgE,Aspergillus fumigatus-specific IgE and IgG,and alveolar lavage can help avoid misdiagnosis.
文摘Background: Bronchopulmonary Dysplasia (BPD) is a chronic lung condition that primarily affects preterm infants. Genetic predispositions, environmental factors, prenatal, and postnatal risk factors have been associated with bronchopulmonary dysplasia. However, there is a lack of consensus regarding these factors. Purpose: To examine the available information on pathogenesis and summarize the points of agreement to generate concise information that can guide patient management and spur further research. Method: PubMed, Embase and Web of Science were used to search for studies that analyzed the risk factors associated with bronchopulmonary dysplasia between 2006 and 2022 with the key search terms “bronchopulmonary dysplasia, etiology, preterm birth, mechanical ventilation”. Results: This study found that the pathogenesis of bronchopulmonary dysplasia is multifactorial, involving close interactions among these major etiological factors and other minor risk factors. A combination of mechanical ventilation, intrauterine factors, inflammation, genetic predispositions, insufficient surfactants, docosahexaenoic acid, and nutrition, among other minor risk factors, was all required in one way or another to influence BPD development. Therefore, studies should continuously update and incorporate the emerging information to assist frontline healthcare workers and generate qualitative data for clinical trial design and further research. Conclusion: Bronchopulmonary Dysplasia is different from other respiratory illnesses, and the pathogenesis of bronchopulmonary is multifactorial.
文摘To investigate bronchopulmonary dysplasia (BPD) and its treatment with dexamethasone (DEX) in premature infants with birth weight (BW) < 1500 g. We retrospectively reviewed the records of preterm infants admitted to the Division of Neonatology, the Second Xiangya Hospital, Central South University between September 2011 and December 2014. Patients were excluded if they needed oxygen therapy but were lost to follow-up at ≤36 weeks post-menstrual age (PMA) or <56 days after birth, or they had severe congenital anomalies. The incidence of BPD was 18% (37/212). Gestational age (GA) was <32 weeks in all BPD patients. GA, BW, and Apgar scores were lower and hospitalization duration and pulmonary surfactant (PS) use were higher in the BPD group than in the non-BPD group (P < 0.05). Risk factors for BPD included neonatal respiratory distress syndrome, neonatal pneumonia, positive sputum culture, pulmonary hemorrhage, respiratory failure. Multivariate logistic regression revealed that GA (odds ratio [OR]: 0.479, P = 0.004) and neonatal respiratory distress syndrome (OR: 6.146, P = 0.043) were independent risk factors for BPD. DEX was administered to 26 patients after the diagnosis of BPD. After one and two weeks of DEX treatment, the oxygen requirement had significantly reduced compared to the week prior to treatment (P < 0.05), while during treatment, the weight gain rate and weight gain efficiency slower significantly than that during either of the two preceding weeks (P < 0.001). These results suggest that low GA was the most important risk factor for BPD, DEX reduced oxygen dependency but decreased weight gain.
文摘<strong>Summary:</strong> A malignant tumour that develops from the bronchial epithelium and then invades the lungs. It ranks third after colorectal and breast cancer. In Mali, computed tomography (CT) is the main imaging tool used at all stages of treatment. We had initiated this study with the objective of specifying the place of CT in the diagnosis of primary bronchopulmonary cancer at the hospital of Mali. <strong>Method: </strong>This is a prospective and descriptive study conducted by the Medical Imaging and Thoracic Surgery departments at Mali Hospital from March 2014 to February 2015. All the patients who have benefited from a CT scan and presenting at least one histologically confirmed bronchopulmonary tumor were included. <strong>Results: </strong>We were recruiting 60 patients with bronchopulmonary cancers out of 500 referred for a thoracic CT scan performed, a frequency of 12%. There was one male patient with a sex ratio of 4H/1F. The average age was 60 years. The history of smoking was 85%. The symptoms were dominated by general condition (63.33%), cough (25%) and haemoptysis (58.33%). CT scans were performed in all patients. The lesions were located more in the lower lobes (71%). The tumours were: heterogeneous tissue density (70%), spiculated contours (80%), and the histology was more non-small cell carcinoma. <strong>Conclusion: </strong>The incidence of bronchopulmonary cancer is very high and its prognosis is poor at an advanced stage. The evaluative role of CT and biopsy guidance has given it a place of choice in its management. The diagnosis of certainty remains histology.
基金supported by a research program funded by the Korea National Institute of Health(Grant Number 2022-ER0603-02#)supported by the Catholic Medical Center Research Foundation made in the program year of 2023The funder had no role in the study,including the design,data collection,analysis,interpretation of data,or writing of the manuscript.
文摘Background Longer hospitalizations for preterm infants with bronchopulmonary dysplasia(BPD)delay developmental outcomes,increase the risk for hospital-acquired complications,and exert a substantial socioeconomic burden.This study aimed to identify factors associated with an extended length of stay(LOS)at different levels of severity of BPD.Methods A cohort study was conducted using the Korean Neonatal Network registry of very low birth weight infants with BPD between 2013 and 2017 through retrospective analysis.Results A total of 4263 infants were diagnosed with BPD.For mild BPD,infants requiring surgical treatment for patent ductus arteriosus needed a longer LOS[eadjustedβcoefficients(adjβ)1.041;95%confidence interval(CI):0.01–0.08]and hydrocephalus(eadjβ1.094;95%CI 0.01–0.17).In moderate BPD,infants administered steroids or with intraventricular hemorrhage required a longer LOS(eadjβ1.041;95%CI 0.00–0.07 and eadjβ1.271;95%CI 0.11–0.38,respectively).In severe BPD,infants with comorbidities required a longer LOS:pulmonary hypertension(eadjβ1.174;95%CI 0.09–0.23),administrated steroid for BPD(eadjβ1.116;95%CI 0.07–0.14),sepsis(eadjβ1.062;95%CI 0.01–0.11),patent ductus arteriosus requiring surgical ligation(eadjβ1.041;95%CI 0.00–0.08),and intraventricular hemorrhage(eadjβ1.016;95%CI 0.05–0.26).Additionally,the higher the clinical risk index score,the longer the LOS needed for infants in all groups.Conclusions The factors affecting LOS differed according to the severity of BPD.Individualized approaches to reducing LOS may be devised using knowledge of the various risk factors affecting LOS by BPD severity.
文摘The treatment of infants with established bronchopulmonary dysplasia （BPD） remains a common,frustrating and expensive problem in neonatology, pediatric PlUlmonology, pediatric critical care and general pediatrics.
