Vol 9, No 4 (2018)

Original Research
Comparative study of the effects of mesenchymal stem cells with different delivery methods in an experimental model of lung fibrosis
Averyanov A.V., Konoplyannikov A.G., Zabozlaev F.G., Sotnikova A.G., Danilevskaya O.V., Konoplyannikov M.A., Tatarsky A.R.

Background: Transplantation of mesenchymal stem cells (MSCs) is one of the most promising directions in the treatment of idiopathic pulmonary fibrosis. In experimental small animal studies, intravenous and endobronchial (installation) techniques are used for the cell preparation delivery, while in humans inhalation of drugs is the simplest and most available method.

Aim: The aim of the study was to determine the optimal type of a nebulizer for viability of MSCs during nebulization, followed by a comparison of the effects of inhalation and intravenous delivery methods in a standard model of bleomycin pulmonary fibrosis in rabbits.

Methods: At the first stage, the survival of MSCs was assessed ex vivo after 10 minutes of compressor, ultrasound and mesh nebulization. Subsequently we used a nebulizer, which showed the best result in the cells, viability. At the next stage аfter bronchoscopic installation of bleomycin, 5 rabbits received intravenous transplantation of 2×106 allogeneic BMMSCs, other 5 rabbits — 2×107 MSCs inhaled via a compressor nebulizer; the control healthy and bleomycin groups included 5 animals each.

Results: The highest degree of viability of MSC was maintained after passing via the compressor nebulizer (72%), a significantly lower survival rate was observed in ultrasonic nebulization (20%) and no live cells were detected after mesh nebulization. Both groups treated with MSC had a significantly lower fibrosis index on the Ashcroft morphometric scale than the control group of bleomycin fibrosis. Collagen expression in the lung tissue was significantly higher in all the groups with bleomycin injury, but in animals which underwent MSC inhalation, it was significantly different (0.51 point) from the bleomycin group without treatment (2.1 points). The level of neutrophils in the BAL fluid was significantly lower in animals which received the intravenous MSC therapy. The levels of TNF-α and TGF-β1 in the BAL fluids tended to decrease in the treatment groups, but did not differ significantly from control.

Conclusions: The highest survival rate of MSCs is observed when using a compressor nebulizer, which apparently should be considered as the best way for delivering cells to the respiratory tract. Both inhalation and intravenous administration of MSCs cause similar effects of inhibiting the development of bleomycin-induced pulmonary fibrosis, which indicates the possibility of using both ways of cell delivery without loss of effectiveness.

Journal of Clinical Practice. 2018;9(4):4-14
In vivo endomicroscopic features of distal airways in chronic bronchitis and chronic obstructive pulmonary disease
Danilevskaya O.V., Averyanov A.V.

Relevance: Probe-based confocal laser endomicroscopy (CLE) of distal airways is a unique technology that allows real-time visualization of structures containing natural fluorophores, which are emitted by exposure to laser radiation with a wavelength of 488 nm, in vivo. To date, the endomicroscopic features of the distal respiratory tract have not been adequately studied in lung diseases, including chronic obstructive pulmonary disease and chronic bronchitis.

The goal of the present study is to describe the endomicroscopic signs of the distal parts of the respiratory system in chronic inflammatory lung diseases such as chronic obstructive pulmonary disease and chronic bronchitis.

Methods: A total of 21 patients with emphysematous and bronchitic phenotypes of chronic obstructive pulmonary disease and chronic bronchitis were examined. All the patients have undergone CLE of distal airways or alveoloscopy during bronchoscopy. The most pathognomonic changes were evaluated on the obtained endomicroscopic images.

Results: For each studied nosological form of chronic inflammatory lung diseases, by careful morphometric analysis of a significant number of informative images, the most specific endomicroscopic changes were identified with the release of CLE patterns.

Conclusions: CLE of distal airways in patients with chronic inflammatory lung diseases allows visualizing changes in the elastic framework of the acini, as well as identifying pathological intraluminal contents, which can be attributed to valuable additional tools in a row of diagnostic methods of respiratory medicine.

Journal of Clinical Practice. 2018;9(4):15-24
The dynamics of some health indicators in adult patients with cystic fibrosis, observed in the research institute of pulmonology in 2003-2018
Krasovskiy S.A., Amelina E.L., Gorinova U.V., Chernyak A.V., Afanasjeva M.V., Krilova N.A., Shumkova G.L., Zonenko O.G., Tatarskiy A.R.

Background: Evaluation of the main clinical and functional indicators and their relationship with the treatment and diagnostic care at different time periods can contribute to the development of further effective medical strategies and globally lead to improved care for cystic fibrosis patients.

Aim: An assessment of the dynamics of some clinical and functional indicators in adult CF patients, who have been observed ed Research Institute of Pulmonology during the last 15 years(2003–2018).

Methods: The comparative analysis was performed on the data of adult patients with cystic fibrosis, observed at 31.12.2003 and at the end of October of 2018. The group of patients in 2003 consists of 80 and in 2018 — of 667 patients. The comparative analysis between the groups was carried out according to the following indicators: age, survival, lung function, nutritional status, proportion of infection with pathogenic microflora, identification of mutations in the cystic fibrosis gene and diagnosis in adult patients.

Results: An increase in patient’s age, survival rate, the proportion of identified mutations in cystic fibrosis gene and infection of Burkholderia cepacia complex in the group of patients in 2018 was revealed. There were no differences in the state of lung function, nutritional status, the ratio of the living and dead patients and proportion of patients diagnosed in adulthood between groups.

Conclusion: The progress in the treatment through the introduction of modern methods and therapeutic programs leads to improved survival and an increase in the number of adult patients with cystic fibrosis.

Journal of Clinical Practice. 2018;9(4):25-32
Impulse оscillometry in the diagnosis of moderate airway obstruction
Savushkina O.I., Chernyak A.V., Kryukov E.V., Zaytsev A.A., Naumenko Z.K., Tatarsky A.R.

Background: Impulse oscillometry (IOS) is a non-invasive method for determining respiratory impedance and its parameters. IOS has certain advantages over traditional spirometry.

Aim: To assess the potential of IOS in the diagnosis of moderately severe airway obstruction.

Methods: We examined 53 patients divided in two groups. The first group consisted of 29 patients (26 males and 3 females aged 42 to 89 years) with moderately severe obstructive abnormalities; the second group included 24 patients (17 males and 7 females aged from 18 to 68 years) without ventilatory defects.

Results: Obstructive abnormalities were detected by IOS in 93% of patients in group 1, and the severity of obstruction was more pronounced compared to the results of spirometry in 37% of patients. In group 2, the IOS parameters were normal. There were significant differences in the lung function and IOS parameters between the first and second groups. There were significant correlations between airway resistance and IOS parameters in patients with moderately severe obstructive abnormalities.

Conclusion: Thus impulse oscillometry can be used in the clinical practice to diagnose disorders of respiratory mechanics in patients with moderately severe airway obstruction.

Journal of Clinical Practice. 2018;9(4):33-39
Microbiological features of bronchial asthma and chronic obstructive pulmonary disease during remission
Smirnova-Saprytskaya M.Y., Osipova G.L., Ospelnikova T.P., Danilina G.A., Zykov K.A.

Background: Bronchial asthma and chronic obstructive pulmonary disease are currently the fifth leading cause of death in the world. The combination of bronchial asthma and chronic obstructive pulmonary disease seems to be a unique disease resulting from the interaction of genetic, pathological and functional factors.

Aim: Study of clinical and functional parameters, bacterial spectrum in patients with combination of asthma and chronic obstructive pulmonary diseases bronchitis and non-bronchitis types.

Methods: Clinical and functional examination of 69 patients with obstructive respiratory diseases, of which 49 patients with asthma combined with chronic obstructive pulmonary disease of bronchitis and non-bronchitis types. The microbiological spectrum of nasal pharynx induced by sputum was studied.

Results: The following microorganisms were isolated: Staphylococcus (S. aureus, S. epidermidis), Neisseria subflava, Streptococcus (α-haemolyticus, β-haemolyticus), Streptococcus pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Branhamella catarrhalis, Enterococcus, Haemophilus influenzae, Candida albicans, Aspergillus spp., Actinomyces spp., Cladosporium, Penicillium, and others.

Conclusion: A more pronounced quantitative content and a more diverse microbial landscape leads to a more severe course of the disease asthma combined withchronic obstructive pulmonary disease especially of the bronchitis type.

Journal of Clinical Practice. 2018;9(4):40-46
The influence of etiological factors on immunoreactivity in patients with community-acquired pneumonia
Rvacheva A.V., Pustovalov A.A., Zykov K.A.

 The aim of this study was to uncover the characteristics of immunoreactivity in patients with community-acquired pneumonia, depending on the pathogen. The inflammatory process caused by various pathogens, has its own characteristics and affects the course of the disease. The study of the mechanisms of these complex interactions can improve the understanding of the processes occurring in community-acquired pneumonia, and, therefore, develop individual approaches to the therapy depending on the etiological factor.

Journal of Clinical Practice. 2018;9(4):47-54
Vocal cord dysfunction and asthma.
Osipova G.

Dysfunction of the vocal cords can be mistakenly diagnosed as asthma or combined with it.

Treatment of vocal dysfunction and asthma vary. Early diagnosis vocal cord dysfunction can prevent improper treatment and, therefore, minimize the rising costs of health care.

Journal of Clinical Practice. 2018;9(4):
Non-cystic fibrosis bronchiectasis: actual problem review and treatment prospects
Sinitsyn E.A., Zykov K.A.

This review introduces some actual data related to the etiology, epidemiology, pathogenesis of non-cystic fibrosis bronchiectasis, presents the nowaday tendencies of treatment methods development.

Journal of Clinical Practice. 2018;9(4):55-64
Inhalation beta-2-agonists in cardiorespiratory pathology: pro-or anti-inflammatory effects?
Nistor S.Y., Smolyakova E.V., Klimova A.A., Rvacheva A.V., Zykov K.A.

Currently, the increase in comorbid pathology, including patients with bronchoobstructive and cardiovascular diseases remains an urgent problem. Therefore, there is a need not only for new approaches in the tactics of management and treatment of patients with combined cardiorespiratory pathology, but also a more complete understanding of the impact of existing bronchodilator therapy on comorbid pathology and the pathophysiological changes taking place in order to create a new approach to the diagnosis and selection of effective and optimal treatment. The article provides a review of the literature on the impact of beta-2-agonists on pro- and anti-inflammatory mechanisms in patients with bronchial obstruction, including cardiovascular disease.

Journal of Clinical Practice. 2018;9(4):65-73
Vocal cord dysfunction and bronchial asthma
Osipova G.L., Osipova V.V., Rvacheva A.V., Terekhov D.V., Sinitsyn E.A.

The syndromology of dysfunction of the vocal cords varies widely from the absence of symptoms to mild shortness of breath to acute respiratory disfunction, which can mimic an asthma attack. The treatment of vocal dysfunction and bronchial asthma is different. An early fold diagnosis of vocal dysfunction can prevent improper treatment and, therefore, minimize the rising costs of health care.

Journal of Clinical Practice. 2018;9(4):74-79
Case report
Congenital lobar emphysema in 16-year-old girl: clinical observation
Samsonova M.V., Mikhaylichenko K.Y., Chernyayev A.L., Chernyak A.V., Tyurin I.Y., Stepanyan I.E.

Congenital lobar emphysema is a rare variant of lung malformation, which is characterized by hyperinflation of one or more lobes, usually diagnosed in early childhood. In this article, we demonstrate a clinical case of asymptomatic middle lobe emphysema diagnosed in a 16-year-old girl.

Journal of Clinical Practice. 2018;9(4):80-83
Healthcare system administration
ICF and the quality of medical care
Kochoubey A.V., Kochubey V.V., Lastovetsky A.G.

Based on the content analysis of classical works on the quality of medical care, ICF, organization management, the synthesis was performed for of the efficiency criteria at the physician level, the prospects for using classification to improve the quality of medical care and the principles of using ICF to assess the quality of medical care.

Journal of Clinical Practice. 2018;9(4):84-89

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