Vol 9, No 4 (2018)

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.

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.

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.

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.

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.

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.

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.