OBJECTIVE: To evaluate the accuracy and diagnostic value of bronchoalveolar lavage fluid galactomannan test (BALF-GM) combined with serum GM test on invasive pulmonary aspergillosis (IPA). METHODS: 190 cases of BALF-GM and 4 787 cases of serum GM specimens suspected of fungal infection in patients admitted to Affiliated Hospital of Jining Medical University from January 2016 to June 2018 were enrolled and analyzed. All patients were classified into clinically confirmed IPA, clinically diagnosed IPA, suspected IPA and excluded IPA according to the classification standard of Expert consensus on diagnosis and treatment of pulmonary mycosis. The coincidence rate of BALF and serum GM test results with clinical diagnosis was analyzed. Receiver operating characteristic (ROC) curve was performed, and the diagnostic value of BALF and serum GM test alone or in combination for IPA was evaluated. Subgroup analysis was performed in patients with normal or abnormal immune function, and the sensitivity and specificity of BALF and serum GM test were compared separately or jointly. RESULTS: The positive rate of BALF-GM was 46.8% (89/190), and 10.4% (497/4 787) on serum GM. Among them, 156 patients were both tested on BALF and serum GM. There were 44 cases with both positive in BALF and serum GM, the coincidence rate of clinical definite was 93.2% (41/44). There were 34 cases with positive BALF-GM and negative GM test in serum, and the coincidence rate of clinical definite was 64.7% (22/34). There were 56 cases positive in serum GM and negative in BALF-GM, and the coincidence rate of clinical definite was 48.2% (27/56). BALF and serum GM tests were both negative in 22 cases, and the coincidence rate of exclusion diagnosis was 90.9% (20/22). ROC curve analysis showed that the diagnostic value of BALF-GM test combined with serum GM test for IPA was better than that of BALF-GM test or serum GM test alone [area under ROC curve (AUC): 0.992 vs. 0.983, 0.976]. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.3%, 87.0%, 93.2% and 90.9%, respectively. Subgroup analysis showed that among 89 patients with positive BALF-GM test, 85 cases (95.5%) had normal immune function and 4 cases (4.5%) had unknown condition. Among 497 patients with positive serum GM test, 12 cases (2.4%) had normal immune function, 372 cases (74.9%) had abnormal immune function and 113 cases (22.7%) were uncertain. It was shown by ROC curve analysis that the sensitivity of positive BALF-GM test in diagnosis of IPA in patients with normal immune function was higher than that of positive serum GM test (95.6% vs. 88.9%), while the sensitivity of positive serum GM test in patients with abnormal immune function was higher than that of positive BALF-GM test (91.8% vs. 89.9%). CONCLUSIONS The results of BALF and serum GM tests are in good agreement with clinical diagnosis, and the combined detection of BALF and serum GM is more valuable for IPA diagnosis than single detection, especially for patients with unknown immune function.
Bronchoalveolar Lavage Fluid/chemistry* ; Galactose/analogs & derivatives* ; Humans ; Invasive Pulmonary Aspergillosis/diagnosis* ; Mannans/blood* ; Sensitivity and Specificity

BACKGROUND: Specimen requirements such as type of anticoagulant and number of tube for body fluid analysis vary with specimen type and requested laboratory tests. We compared the results of six clinical chemistry tests between EDTA anticoagulated and anticoagulant-free body fluids. METHODS: A total of 191 body fluids (45 pleural, 28 bronchoalveolar lavage, 35 peritoneal, 45 peritosol, and 38 synovial fluids) were aliquoted into EDTA tubes and anticoagulant-free tubes, and were simultaneously tested for total protein, albumin, glucose, lactate dehydrogenase, adenosine deaminase, and amylase. RESULTS: The coefficient of determination (R2) for all six clinical chemistry test results between EDTA anticoagulated and anticoagulant-free body fluids are more than 0.95 with the exception of glucose in bronchoalveolar lavage fluid (R2= 0.78). CONCLUSIONS: EDTA anticoagulated specimen could be used for testing routinely requested clinical chemistry tests in body fluid analysis, that only one tube of specimen is necessary to perform cell count, differential count, and clinical chemistry tests.
Adenosine Deaminase ; Anticoagulants ; Body Fluids ; Bronchoalveolar Lavage ; Bronchoalveolar Lavage Fluid ; Cell Count ; Chemistry, Clinical ; Clinical Chemistry Tests ; Edetic Acid ; Glucose ; L-Lactate Dehydrogenase

OBJECTIVETo investigate cytokine level in bronchoalveolar lavage fluid (BALF) in children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and the effects of methylprednisolone on RMPP.

METHODSixty cases with RMPP and 20 cases with bronchial foreign body with no respiratory tract infection as control group hospitalized in Department of Pulmonary Diseases, the Children's Hospital Affiliated to Medical School of Zhejiang University from February 2012 to February 2013 were enrolled. The RMPP patients were divided into two groups randomly (30 cases in each). Steroid group were given methylprednisolone 2 mg/(kg·d) intravenously for 3 days, and the cases in non steroid group were not given steroid therapy. Patients whose fever relieved after steroid treatment were classified as defervesced group while the others were classified as non defervesced group. Each patient was examined with fiberoptic bronchoscopy and bronchoalveolar lavage 3 days after admission and cytokine level in BALF of each patient was detected.

RESULT(1) In steroid group, the proportion of patients whose fever disappeared within 3 days after steroid therapy was 9/30 cases (30%), and in non steroid group no one responded within 3 days after medication, showing statistically significant difference (χ² = 14.073, P=0.002), at the same time, the duration of cough in steroid group was significantly shorter than that in non steroid group (5.1 d vs. 7.0 d, t=-2.276, P=0.027). The total fever time of steroid group was 4.7 days, which as compaired with non steroid group (6.7 days) was shorter, but the difference was not significant (t=-1.351, P=0.134). (2) IL-1 β, IL-4, IL-6, IL-8, IL-10, IFN-γ in BALF of steroid group and non steroid group were both significantly higher than that of control group. But the same comparison between steroid group and non steroid group showed no significant difference. (3) In steroid group, IL-2 and IL-8 in BALF of patient whose fever disappeared after steroid therapy were both significantly lower than that of patients who still had fever (t=2.771, 2.054, P=0.010, 0.049) , but no significant difference was found between the two groups in BALF IL-1 β, IL-4, IL-6, IL-10, IFN-γ levels (P>0.05).

CONCLUSION(1) Three days of 2 mg/(kg·d) methylprednisolone therapy had the antipyretic effect in children with RMPP, and could shorten the length of cough. (2) Incresed BALF IL-1 β, IL-4, IL-6, IL-8, IL-10, IFN-γ levels were observed in RMPP and high level of BALF IL-2 and IL-8 might have some relevance with persistent fever of RMPP in children.

Bronchoalveolar Lavage Fluid ; chemistry ; Bronchoscopy ; Child ; Cytokines ; chemistry ; Fever ; Humans ; Methylprednisolone ; therapeutic use ; Mycoplasma pneumoniae ; Pneumonia, Mycoplasma ; drug therapy

OBJECTIVETo study the changes to surfactant proteins in the serum and bronchoalveolar lavage fluids (BALF) of children with Mycoplasma pneumoniae pneumonia (MPP) and their significance.

METHODSSelf-control method was used in the study. Forty-seven MPP children were divided into single lung infected (n=32) and bilateral lung infected groups (n=15) according to lung CT results. Surfactant proteins SP-A, B, C and D were measured using ELISA in the serum and BALF in the two groups. The correlations between SP-A, B, C and D content in the serum and BALF were evaluated by Spearman correlation analysis.

RESULTSSP-A, B, C and D content in BALF from the majorly infected or infected lung were significantly higher than from the opposite lung and serum (P<0.01). SP-A, B and C content in serum was significantly lower than in BALF from the non-infected lung in the single-side infected lung group (P<0.01 or 0.05), but there was no significant difference between serum SP-D content and BALF SP-D content from the non-infected lung. There were no significant differences in SP-A, B, C and D content in serum and BALF from the minorly infected lung in the bilateral lung infected group. Serum SP-D content was positively correlated with BALF SP-D content from the majorly infected lung in the bilateral lung infected group (P<0.01).

CONCLUSIONSSerum SP-D content may serve as a biomarker for evaluating the severity of pulmonary infection in children with community-acquired pneumonia.

Bronchoalveolar Lavage Fluid ; chemistry ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Pneumonia, Mycoplasma ; metabolism ; Pulmonary Surfactants ; analysis ; blood

Acute Disease ; Adult ; Altitude Sickness ; blood ; pathology ; Bronchoalveolar Lavage Fluid ; chemistry ; Case-Control Studies ; Humans ; Inflammation Mediators ; metabolism ; Male

OBJECTIVETo investigate the effects of composite grinding dusts on rat respiratory system.

METHODSRats were administrated with grinding dusts by intratracheal injection. After 2 weeks, the total numbers of cells, the percentage of differential cell, the survival rate of cell, and the activity of lactate dehydrogenase(LDH) and alkaline phosphatase(ALP) in bronchoalveolar lavage fluid were analyzed.

RESULTSAlong with increasing concentration of grinding dusts, the total number of cells in lavage also increased, and was more than that in quartz group. Compared with control group, the percentage of neutrophil in lavage of rats treated with grinding dust and quartz significantly increased and meanwhile that of macrophage significantly decreased[PMN: quartz group (33.83 +/- 4.54)%; grinding dusts group (26.50 +/- 3.99)%, (36.00 +/- 3.58)%, (38.00 +/- 2.10)% at 10, 25, 50 mg/ml respectively. Macrophages: quartz group (62.17 +/- 4.54)%; grinding dusts group (70.83 +/- 3.66)%, (60.83 +/- 2.14)%, (58.17 +/- 2.48)%] while those in control group were (2.83 +/- 0.75)%, (95.67 +/- 1.21)% respectively. The cell survival rate in lavage in control group was 80%, but that in grinding dust and TiO2 group significantly decreased(P < 0.01). The activity of LDH and ALP in all rats treated with dusts obviously increased, and there was significant difference compared with control group(P < 0.01 or P < 0.05). Furthermore, there was significant difference between grinding dust group and quartz group, and between grinding dust group and TiO2 group respectively.

CONCLUSIONMetal grinding dust is very harmful to rat's lung cells and may cause fibrogenesis in the lungs.

Alkaline Phosphatase ; metabolism ; Animals ; Bronchoalveolar Lavage Fluid ; chemistry ; cytology ; Dust ; L-Lactate Dehydrogenase ; metabolism ; Lung ; pathology ; Metals ; Rats

OBJECTIVETo observe the ultrastructures of rat alveolar type II cells and change of composition of phospholipid(PL) and content of protein in pulmonary surfactant(PS), to investigate the relation between change in composition of PL and activity of alveolar type II cells.

METHODSThe rats lung injury models were made by intratracheally instilling bleomycin(BLM) (4 mg/ml, 5 mg/kg). 28 rats were divided into four groups: 3-day group, 7-day group, 14-day group and 28-day group. Preparations of each group were stained histochemically and examined by electron microscope, content of PL in BALF, composition of PL and content of protein of each group were determined respectively.

RESULTS(1) Rats lungs in experimental groups were found that PS lost continuously, appeared homogenous and chorionic, dropped in the pulmonary alveolies. 3-day group was more apparent. Ruthenium red attaching on pulmonary surfactant was thicker in 3-day group, and the colour deeper, no difference in 7-day group and 14-day group, thinner in 28-day group. Content of PL in PS of BALF was increasing. Content of phosphatidylglycerol(PG) increased in 3-day group, decreased in 7-day, 14-day and 28-day group. The change of content of phosphatidylinositol(PI) was reversed. (2) Alveolar type II cells degenerated, necrotized, even disintegrated in 3-day group and 7-day group. 3-day group was more apparent. Proliferations of alveolar type II cells were found in each group, 7-day group was more apparent. We found that type II cells transformed to type I cells in 14-day group, extended and attached on bare basement membrane. Content of protein in PS was the highest in 3-day group, almost equal to the content of the control group in 28-day group.

CONCLUSIONMorphologic change and alternation of quality and quantity of PS after bleomycin-induced pulmonary injures specifically reflect the activity of alveolar type II cells. Measuring content of PL in BALF is one of simple and feasible method judging activity of alveolar type II cells when lungs of the rats are injured early by bleomycin.

Animals ; Antibiotics, Antineoplastic ; toxicity ; Bleomycin ; toxicity ; Bronchoalveolar Lavage Fluid ; chemistry ; Lung ; drug effects ; pathology ; ultrastructure ; Pulmonary Alveoli ; chemistry ; Pulmonary Surfactants ; analysis ; Rats

OBJECTIVEAquaporin (AQP) is a group of cell membrane transporting proteins. The study was designed to investigate the changes of AQP1 and AQP5 in the lung tissue under hyperoxia and their roles in pulmonary edema.

METHODSTwo hundred newborn rats were randomized into different oxygen concentrations exposure: FiO2=0.80 (Experimental group 1), FiO2=0.60 (Experimental group 2), FiO2=0.40 (Experimental group 3) and FiO2=0.21 (Air control group). Rats were sacrificed at 1, 3, 5, 7 and 14 days after the beginning of experiment (10 rats each time point). The expressions of AQP1 and AQP5 were examined by Western Blot. The ratio of lung wet weight to lung dry weight (wet-to-dry weight ratio, W/D), and the protein content in bronchoalveolar lavage fluid (BALF) were measured.

RESULTSCompared with the Air control group, the W/D ratio and the protein content in BALF in the three experiment groups increased significantly and the increased extent was positively related to the duration and the oxygen concentration of hyperoxia-exposure. The expression of AQP1 in the experimental groups began to decrease at the 3rd day and significant differences were found at the 5th and the 7th days after hyperoxia-exposure compared with that in the Air control group (P < 0.05). The AQP1 expression was restored somewhat at the 14th day after hyperoxia-exposure, but it was still lower in the Experimental groups 1 and 2 than that in the Air control group (P < 0.05). The expression of AQP5 in the experimental groups were reduced compared with that in the Air control group 3 days after hyperoxia-exposure and the decrease of AQP5 expression was associated with duration of hyperoxia-exposure. The comparison among three experimental groups showed that the decrease of AQP1 and AQP5 expressions was associated with the concentration of hyperoxia-exposure.

CONCLUSIONSThe expressions of AQP1 and AQP5 decreased in hyperoxia-induced lung injury and correlated with the severity of pulmonary edema.

Animals ; Aquaporin 1 ; analysis ; Aquaporin 5 ; analysis ; Bronchoalveolar Lavage Fluid ; chemistry ; Female ; Hyperoxia ; metabolism ; Lung ; chemistry ; Male ; Pulmonary Edema ; etiology ; Rats ; Rats, Wistar

BACKGROUNDPneumocystis jirovecii pneumonia (PCP) is one of the most common and fatal infections in non-AIDS immunocompromised patients, which is difficult to diagnose by traditional morphologic methods. This study evaluated polymerase chain reaction (PCR) assays of Pneumocystis jirovecii mitochondrial large subunits ribosomal RNA in sputum and bronchioalveolar lavage fluid (BALF) for diagnosing PCP.

METHODSSputum and BALF specimens from two groups were collected: one group (PCP group) included 20 patients definitely diagnosed of PCP by Gomori methenamine silver (GMS) stains of BALF; the other group (non-PCP group) included 40 patients. Each specimen was examined by GMS stains and PCR assays.

RESULTSGMS stains of BALF in PCP group were 100% positive (20/20), GMS stains of sputum in PCP group were 35% positive (7/20); GMS stains of BALF in non-PCP group were 100% negative (40/40), GMS stains of sputum in non-PCP group were 100% negative (40/40). PCR assays of BALF in PCP group were 100% positive (20/20), PCR assays of sputum in PCP group were 100% positive (20/20); PCR assays of BALF in non-PCP group were 100% negative (40/40), PCR assays of sputum in non-PCP group were 100% negative (40/40). Sensitivity and specificity of PCR assays of sputum and BALF were both 100%; positive and negative predictive values were also both 100%.

CONCLUSIONThe diagnostic value of PCR assays of Pneumocystis jirovecii mitochondrial large subunits ribosomal RNA on sputum and BALF for pneumocystis pneumonia are both high and equivalent.

Acquired Immunodeficiency Syndrome ; diagnosis ; genetics ; Bronchoalveolar Lavage Fluid ; chemistry ; Humans ; Pneumonia, Pneumocystis ; diagnosis ; genetics ; metabolism ; Polymerase Chain Reaction ; methods ; Sputum ; chemistry

OBJECTIVETo detect the inflammatory factors of induced sputum (IS) and whole lung lavage fluid in pneumonoconiosis patients and to explore the correlation between the inflammatory factors with pulmonary function.

METHODSThe records of 45 cases of pneumonoconiosis patients were observed. All patients underwent lung function examination, sputum induction and massive whole lung lavage (WLL) sequentially through advance. IS and whole lung lavage fluid were collected respectively. Inflammatory factors of the two specimens were detected by using enzyme linked immunosorbent assay. The correlation of inflammatory factors between the two specimens was analyzed. The relationship between the inflammatory factor and lung function index was observed. The statistical analysis is performed with SPSS 17.0 for Windows. P < 0.05 is considered to be statistically significant.

RESULTSCytokines (MCP-1, TNF-α MIP-1α, NO(2)(-)/NO(3)(-) and IL-16) were significantly associated between IS and whole lung lavage fluid (P < 0.05), while TNF-α, MCP-1, NO(2)(-)/NO(3)(-) and IL-16 were no significantly associated with lung function index (P > 0.05). MIP-1α was significantly associated with FEV(1.0)/VCmax and MEF(25), respectively (P < 0.05).

CONCLUSIONSInflammatory factors were significantly associated between IS and whole lung lavage fluid, which could indicate early lung injury in pneumonoconiosis patients.

Bronchoalveolar Lavage Fluid ; chemistry ; Chemokine CCL2 ; Chemokine CCL3 ; Cytokines ; analysis ; Humans ; Interleukin-16 ; Lung ; Respiratory Function Tests ; Silicosis ; Sputum ; chemistry ; Tumor Necrosis Factor-alpha