• Title/Summary/Keyword: Acute Lung injury

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A Case of Activated Charcoal Aspiration Treated by Early and Repeated Bronchoalveolar Lavage (기관지내시경을 통해 치료한 활성탄 흡인 1예)

  • Lee, Han-Min;Park, Jae-Seok;Kim, Jae-Yun;Lee, Ji-Yeon;Ahn, Byung-Kyu;Gil, Hyo-Wook;Choi, Jae-Sung
    • Tuberculosis and Respiratory Diseases
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    • v.72 no.2
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    • pp.177-181
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    • 2012
  • Activated charcoal is an inert substance and it is used in standard therapy in patients with acute intoxication. Charcoal has some side effects such as pulmonary aspiration, gastrointestinal complications, and electrolyte abnormalities. Although aspiration of charcoal is a rare complication, it can cause fatal sequelae. We report a 69-year old man who developed acute respiratory failure associated with charcoal aspiration after management of glyphosate poisoning. The patient was drowsy and suffered severe vomiting during transport to our hospital. On arrival, acute respiratory failure was observed due to charcoal aspiration, but the clinical state was improved with repeated bronchoscopy with a bronchoalveolar lavage (BAL). We presumed that the aspirated charcoal was an important factor in evoking a lung injury. Early bronchoscopy with a BAL might be an effective method for eliminating charcoal from the lung, especially in the case of a large amount of aspiration, and be helpful in decreasing respiratory failure due to charcoal aspiration.

Effects of an Herbal Medicine, Gagam-daewhang mangcho-tang, and its Components on Cerulein-induced Acute Pancreatitis in Mice (加減大黃芒硝湯및 그 구성약재가 Cerulein으로 유도된 생쥐의 急性 膵臟炎에 미치는 影響)

  • Yu, Ju-yeon;Yu, Keun-jeong;Shin, Yong-jeen;Lee, Un-jung
    • The Journal of Internal Korean Medicine
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    • v.36 no.2
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    • pp.105-121
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    • 2015
  • Objectives: This study investigated the effects of Gagam-daewhang mangcho-tang (GDM) and its components on cerulein-induced acute pancreatitis (AP) in mice Methods: The AP mouse model was induced by intra-peritoneal injection of cerulein (50 μg/kg) at hourly intervals for 6 times. The experimental drug was administrated intraperitoneally 1 hour prior to the first injection of cerulein. Mice were sacrificed at 6 hours after the last injection of cerulein. Blood samples were taken to determine serum amylase level. The pancreas and lungs were rapidly removed for histochemical examination and myeloperoxidase (MPO) assays. Results: Administration of modified GDM significantly reduced the ratio of pancreas/body weight, level of serum amylase, neutrophil infiltration, and histological damage of the pancreas and lung. In a test of the components of GDM, the Salvia miltiorrhiza (SM) group showed a significant suppression of the severity of AP. In an experiment testing the concentration of SM, the 150 mg/kg SM group showed significant attenuation of the severity of AP. Conclusions: Modified GDM and a SM water extract could attenuate AP and AP-associated lung injury via suppression of digestive enzyme secretion and MPO activity.

Icariin attenuates the severity of cerulein-induced acute pancreatitis by inhibiting p38 activation in mice

  • Dong-Uk Kim;Gi-Sang Bae;Myoung-Jin Kim;Ji-Won Choi;Dong-Gu Kim;Ho-Joon Song;Sung-Joo Park
    • International Journal of Molecular Medicine
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    • v.44 no.4
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    • pp.1563-1573
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    • 2019
  • Acute pancreatitis (AP) is an inflammatory disease of the pancreas. Icariin (ICA), a flavonoid glycoside, has been reported to have several pharmacological effects; however, the anti-inflammatory effects of ICA against AP require further study. Therefore, we aimed to investigate the effect of ICA on cerulein-induced AP. In the present study, AP was induced by intraperitoneally administering a supramaximal concentration of cerulein (50 ㎍/kg/h) for 6 h. ICA was also administered intraperitoneally, and mice were sacrificed 6 h after the final cerulein injection. Blood samples were collected to determine serum amylase and lipase levels. The pancreas and lung were rapidly removed for histological examination, and the analysis of myeloperoxidase activity. In addition, reverse transcription-quantitative polymerase chain reaction was conducted to analyze the expression of inflammatory cytokines in pancreatic tissues. Our results revealed that the administration of ICA prevented an increase in the pancreas weight/body weight ratio of mice and serum digestive enzyme levels. ICA treatment also inhibited cerulein-induced histological injury and neutrophil infiltration of the pancreas and lung. In addition, ICA suppressed the production of pro-inflammatory cytokines, including interleukin (IL)-1β, IL-6 and tumor necrosis factor-α in the pancreas. Furthermore, ICA administration was observed to inhibit p38 activation during cerulein-induced AP. Inhibition of p38 activation resulted in alleviated pancreatitis. Collectively, our results suggested that ICA exhibits anti-inflammatory effects in cerulein-induced AP via the inhibition of p38.

The Spectrum of CT Findings of COVID-19 Pneumonia: Acute Alveolar Insult and Organizing Pneumonia as Different Phases of Lung Injury and Repair (COVID-19 폐렴의 다양한 CT 영상 소견: 급성 폐포 손상과 기질화 폐렴)

  • Yun Su Kim;Ung Rae Kang;Young Hwan Kim
    • Journal of the Korean Society of Radiology
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    • v.82 no.2
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    • pp.359-370
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    • 2021
  • Purpose To analyze the findings and serial changes in chest CT lesions in 123 symptomatic patients with coronavirus disease 2019 (COVID-19). Materials and Methods From February 19 to April 7, 2020, a total of 123 confirmed COVID-19 patients (male, 44; female, 79; mean age, 59.2 ± 18.6) were enrolled in this retrospective study. A total of 234 CT scans were reviewed for the following patterns: acute alveolar insult (AAI) patterns: ground-glass opacity (GGO), crazy-paving appearance, mixed pattern, and consolidation; organizing pneumonia (OP) patterns: perilobular patterns, band opacity, curvilinear opacity, reversed halo opacity, and small nodular consolidation; resolving patterns: pure GGO, remnant curvilinear, small nodular consolidation, and serial changes of lung abnormalities. We compared the proportions of AAI pattern, OP pattern, or resolving pattern with time progression and analyzed the association between the patterns and disease severity using Pearson chi-square and Fisher's exact test. Results Predominant CT patterns were AAI pattern (87%) in the early hospital period group (0-10 days, after the onset of symptoms), OP pattern (45.7%) in the later hospital period group (after 10 days), and resolving pattern in discharge and follow-up group (47.2% and 84.8%, respectively). The difference in the proportions of predominant CT patterns with time progression was statistically significant (p < 0.001, Pearson's chi-square test). No statistically significant association was observed between the patterns and disease severity (p = 0.055, Fisher's exact test). No fibrous changes in the lesions were observed on follow-up CT scans. Conclusion The serial CT scans of COVID-19 patients showed the spectrum of COVID pneumonia CT manifestations as different phases of lung injury and repair.

The Effects of Nuclear Factor-κB Decoy Oligodeoxynucleotide on Lipopolysaccharide-Induced Direct Acute Lung Injury (리포다당질로 인한 직접성 급성폐손상에서 Nuclear Factor-κB Decoy Oligodeoxynucleotide의 효과)

  • Kim, Je Hyeong;Yoon, Dae Wui;Jung, Ki Hwan;Kim, Hye Ok;Ha, Eun Sil;Lee, Kyoung Ju;Hur, Gyu Young;Lee, Sung Yong;Lee, Sang Yeub;Shin, Chol;Shim, Jae Jeong;In, Kwang Ho;Yoo, Se Hwa;Kang, Kyung Ho
    • Tuberculosis and Respiratory Diseases
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    • v.67 no.2
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    • pp.95-104
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    • 2009
  • Background: The pathophysiologic mechanisms of early acute lung injury (ALI) differ according to the type of primary insult. It is important to differentiate between direct and indirect pathophysiologic pathways, and this may influence the approach to treatment strategies. NF-$\kappa$B decoy oligodeoxynucleotide (ODN) is a useful tool for the blockade of the expression of NF-$\kappa$B-dependent proinflammatory mediators and has been reported to be effective in indirect ALI. The purpose of this study was to investigate the effect of NF-$\kappa$B decoy ODN in the lipopolysaccharide (LPS)-induced direct ALI model. Methods: Five-week-old specific pathogen-free male BALB/c mice were used for the experiment. In the preliminary studies, tumor necrosis factor (TNF)-$\alpha$, interleukine (IL)-6 and NF-$\kappa$B activity peaked at 6 hours after LPS administration. Myeloperoxidase (MPO) activity and ALI score were highest at 36 and 48 hours, respectively. Therefore, it was decided to measure each parameter at the time of its highest level. The study mice were randomly divided into three experimental groups: (1) control group which was administered 50 ${\mu}L$ of saline and treated with intratracheal administration of 200 ${\mu}L$ DW containing only hemagglutinating virus of Japan (HVJ) vector (n=24); (2) LPS group in which LPS-induced ALI mice were treated with intratracheal administration of 200 ${\mu}L$ DW containing only HVJ vector (n=24); (3) LPS+ODN group in which LPS-induced ALI mice were treated with intratracheal administration of 200 ${\mu}L$ DW containing 160 ${\mu}g$ of NF-$\kappa$B decoy ODN and HVJ vector (n=24). Each group was subdivided into four experimental subgroups: (1) tissue subgroup for histopathological examination for ALI at 48 hours (n=6); (2) 6-hour bronchoalveolar lavage (BAL) subgroup for measurement of TNF-$\alpha$ and IL-6 in BAL fluid (BALF) (n=6); (3) 36-hour BAL subgroup for MPO activity assays in BALF (n=6); and (4) tissue homogenate subgroup for measurement of NF-$\kappa$B activity in lung tissue homogenates at 6 hours (n=6). Results: NF-$\kappa$B decoy ODN treatment significantly decreased NF-$\kappa$B activity in lung tissues. However, it failed to improve the parameters of LPS-induced direct ALI, including the concentrations of tumor necrosis factor-$\alpha$ and interleukin-6 in BALF, myeloperoxidase activity in BALF and histopathologic changes measured by the ALI score. Conclusion: NF-$\kappa$B decoy ODN, which has been proven to be effective in indirect models, had no effect in the direct ALI model.

Lung Injury Indices Depending on Tumor Necrosis Factor-$\alpha$ Level and Novel 35 kDa Protein Synthesis in Lipopolysaccharide-Treated Rat (내독소처치 흰쥐에서 Tumor Necrosis Factor-$\alpha$치 상승에 따른 폐손상 악화 및 35 kDa 단백질 합성)

  • Choi, Young-Mee;Kim, Young-Kyoon;Kwon, Soon-Seog;Kim, Kwan-Hyoung;Moon, Hwa-Sik;Song, Jeong-Sup;Park, Sung-Hak
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1236-1251
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    • 1998
  • Background : TNF-$\alpha$ appears to be a central mediator of the host response to sepsis. While TNF-$\alpha$ is mainly considered a proinflammatory cytokine, it can also act as a direct cytotoxic cytokine. However, there are not so many studies about the relationship bet ween TNF-$\alpha$ level and lung injury severity in ALI, particularly regarding the case of ALI caused by direct lung injury such as diffuse pulmonary infection. Recently, a natural defense mechanism, known as the stress response or the heat shock response, has been reported in cellular or tissue injury reaction. There are a number of reports examining the protective role of pre-induced heat stress proteins on subsequent LPS-induced TNF-$\alpha$ release from monocyte or macrophage and also on subsequent LPS-induced ALI in animals. However it is not well established whether the stress protein synthesis such as HSP can be induced from rat alveolar macrophages by in vitro or in vivo LPS stimulation. Methods : We measured the level of TNF-$\alpha$, the percentage of inflammatory cells in bronchoalveolar lavage fluid, protein synthesis in alveolar macrophages isolated from rats at 1, 2, 3, 4, 6, 12, and 24 hours after intratracheal LPS instillation. We performed histologic examination and also obtained histologic lung injury index score in lungs from other rats at 1, 2, 3, 4, 6, 12, 24 h after intratracheal LPS instillation. Isolated non-stimulated macrophages were incubated for 2 h with different concentration of LPS (0, 1, 10, 100 ng/ml, 1, or 10 ${\mu}g/ml$). Other non-stimulated macrophages were exposed at $43^{\circ}C$ for 15 min, then returned to at $37^{\circ}C$ in 5% CO2-95% for 1 hour, and then incubated for 2 h with LPS (0, 1, 10, 100ng/ml, 1, or 10 ${\mu}g/ml$). Results : TNF-$\alpha$ levels began to increase significantly at 1 h, reached a peak at 3 h (P<0.0001), began to decrease at 6 h, and returned to control level at 12 h after LPS instillation. The percentage of inflammatory cells (neutrophils and alveolar macrophages) began to change significantly at 2 h, reached a peak at 6 h, began to recover but still showed significant change at 12 h, and showed insignificant change at 24 h after LPS instillation compared with the normal control. After LPS instillation, the score of histologic lung injury index reached a maximum value at 6 h and remained steady for 24 hours. 35 kDa protein band was newly synthesized in alveolar macrophage from 1 hour on for 24 hours after LPS instillation. Inducible heat stress protein 72 was not found in any alveolar macrophages obtained from rats after LPS instillation. TNF-$\alpha$ levels in supernatants of LPS-stimulated macro phages were significantly higher than those of non-stimulated macrophages(p<0.05). Following LPS stimulation, TNF-$\alpha$ levels in supernatants were significantly lower after heat treatment than in those without heat treatment (p<0.05). The inducible heat stress protein 72 was not found at any concentrations of LPS stimulation. Whereas the 35 kDa protein band was exclusively found at dose of LPS of 10 ${\mu}g/ml$. Conclusion : TNF-$\alpha$ has a direct or indirect close relationship with lung injury severity in acute lung injury or acute respiratory distress syndrome. In vivo and in vitro LPS stimulation dose not induce heat stress protein 72 in alveolar macrophages. It is likely that 35 kDa protein, synthesized by alveolar macrophage after LPS instillation, does not have a defense role in acute lung injury.

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Effect of the Inhibition of $PLA_2$ on the Oxidative Stress in the Lungs of Glutathione Depleted Rats Given Endotoxin Intratracheally (Glutathione이 고갈된 흰쥐에서 내독소에 의해 유도된 급성 폐손상시 $PLA_2$ 억제가 산소기 형성에 미치는 영향)

  • Cho, Hyun-Gug;Moon, Hye-Jung;Park, Won-Hark;Kim, Te-Oan;Lee, Young-Man
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.2
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    • pp.246-259
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    • 2000
  • Background: As one of the etiologies of acute respiratory distress syndrome(ARDS), sepsis is one of the morbid causes of this cryptogenic malady. Even though many documents on the role of endotoxin(ETX) in the pathogenesis of ARDS have been issued, still the underlying mechanism associated with oxidative stress and activation of $PLA_2$ has been controversial. In the present study, the role of phospholipase $A_2(PLA_2)$ in the neutrophilic respiratory burst, which is presumed to cause acute lung injury during sepsis, was probed. Method: In glutathione-depleted Sprague-Dawley rats, lung leak, infiltration of neutrophils, $PLA_2$ activity and lipid peroxidation in the lung were measured after intratracheal instillation of endotoxin(delete). In addition, gamma glutamyl transferase(GGT) activity and the amount of pulmonary surfactant were measured. Morphologically, the changes in ultrastructure and cytochemical demonstration of oxidants were presented to confirm the neutrophilic oxidative stress and to elucidate the effects of $PLA_2$ activation on(delete) oxidative stress. Results: Instillation of ETX to glutathione-depleted rats intensified lung leak and lipid peroxidation when compared with non-glutathione depleted rats treated with the endotoxin. Moreover, oxidative stress was confirmed by the assay of GGT and malondialdehyde. Functionally, the depletion of glutathione altered the secretion of pulmonary surfactant from alveolar type II cells. Ultrastructurally and cytochemicaliy, oxidative stress was also confirmed after treatment of with ETX and diethylmaleate(DEM). Conclusion: The endotoxin-induced acute lung injury was mediated by oxidative stress, which in turn was provoked by the neutrophilic respiratory burst. The activation of $PLA_2$ in the lung seems to playa pivotal role in the oxidative stress of the lung.

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The Effects of Moxifloxacin in Endotoxin-induced Acute Lung Injury (내독소로 유도된 급성폐손상에서 Moxifloxacin의 효과)

  • Baek, Jong Hyun;Lee, Jang Hoon;Lee, Jung Cheul;Lee, Dong Hyup;Moon, Yong Suk;Lee, Young Man
    • Journal of Chest Surgery
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    • v.42 no.1
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    • pp.1-8
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    • 2009
  • Background: The pathophysiology of acute respiratory distress syndrome with sepsis is acute lung injury (ALI) that's' caused by endotoxin (LPS). We evaluate effects of moxifloxacin on LPS-induced ALI in a rat model. Material and Method: The rats were divided into 3 groups as the control group (C), the LPS insult group (L), and the LPS+moxifloxacin treated group (L-M). ALI was induced by endotracheal instillation of E.coli LPS, then moxifloxacin was given in 30 minutes. Five hours later, we checked the lung weight/body weight ratio(the L/BW ratio), the protein & neutrophils in the bronchoalveolar lavage fluid (BALF), the myeloperoxidase (MPO) activity & the malondialdehyde (MDA) content, the expressions of cytosolic and secretory phospholipase $A_2$ (c, $sPLA_2$), and the morphology of the lung with using a light microscope. Result: The L/BW ratio, the protein content and the neutrophil count in the BALF, and the MPO activity and the MDA content in lung were significantly increased in group L compared to group C, and these factors were markedly decreased in group L-M compare to group L. The $cPLA_2$ expression and the $sPLA_2$ expression were increased in group L and the $cPLA_2$ expression was decreased in group L-M. Yet the $sPLA_2$ expression was not changed in group L-M. Morphologically, many inflammatory findings were observed in group L, but not in group L-M. Conclusion: Many of the inflammatory changes of ALI that were caused by LPS insult were ameliorated by moxifloxacin treatment.

Lagerstroemia ovalifolia Exerts Anti-Inflammatory Effects in Mice of LPS-Induced ALI via Downregulating of MAPK and NF-κB Activation

  • Min, Jae-Hong;Kim, Seong-Man;Park, JI-Won;Kwon, Nam Hoon;Goo, Soo Hyeon;Ngatinem, Ngatinem;Ningsih, Sri;Paik, Jin-Hyub;Choi, Sangho;Oh, Sei-Ryang;Han, Sang-Bae;Ahn, Kyung-Seop;Lee, Jae-Won
    • Journal of Microbiology and Biotechnology
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    • v.31 no.11
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    • pp.1501-1507
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    • 2021
  • Lagerstroemia ovalifolia Teijsm. & Binn. (LO) (crape myrtle) has reportedly been used as traditional herbal medicine (THM) in Java, Indonesia. Our previous study revealed that the LO leaf extract (LOLE) exerted anti-inflammatory effects on lipopolysaccharide (LPS)-stimulated RAW264.7 macrophages. Based on this finding, the current study aimed to evaluate the protective effects of LOLE in a mouse model of LPS-induced acute lung injury (ALI). The results showed that treatment with LPS enhanced the inflammatory cell influx into the lungs and increased the number of macrophages and the secretion of the inflammatory cytokines in the bronchoalveolar lavage fluid (BALF) of mice. However, these effects were notably abrogated with LOLE pretreatment. Furthermore, the increase of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and monocyte chemoattractant protein-1 (MCP-1) expression in the lung tissues of mice with ALI was also reversed by LOLE. In addition, LOLE significantly suppressed the LPS-induced activation of the MAPK/NF-κB signaling pathway and led to heme oxygenase-1 (HO-1) induction in the lungs. Additionally, in vitro experiments showed that LOLE enhanced the expression of HO-1 in RAW264.7 macrophages. The aforementioned findings collectively indicate that LOLE exerts an ameliorative effect on inflammatory response in the airway of ALI mice.

Early Surgical Stabilization of Ribs for Severe Multiple Rib Fractures (중증 다발성 늑골골절에 대한 조기 수술적 늑골고정술)

  • Hwang, Jung-Joo;Kim, Young-Jin;Ryu, Han-Young;Cho, Hyun-Min
    • Journal of Trauma and Injury
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    • v.24 no.1
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    • pp.12-17
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    • 2011
  • Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.