Bronchoalveolar lavage fluid assessment facilitates precision medicine for lung cancer

Lung cancer is the most common and fatal malignant disease worldwide and has the highest mortality rate among tumor-related causes of death.Early diagnosis and precision medicine can significantly improve the survival rate and prognosis of lung cancer patients.At present,the clinical diagnosis of lung cancer is challenging due to a lack of effective non-invasive detection methods and biomarkers,and treatment is primarily hindered by drug resistance and high tumor heterogeneity.Liquid biopsy is a method for detecting circulating biomarkers in the blood and other body fluids containing genetic information from primary tumor tissues.Bronchoalveolar lavage fluid(BALF)is a potential liquid biopsy medium that is rich in a variety of bioactive substances and cell components.BALF contains information on the key characteristics of tumors,including the tumor subtype,gene mutation type,and tumor environment,thus BALF may be used as a diagnostic supplement to lung biopsy.In this review,the current research on BALF in the diagnosis,treatment,and prognosis of lung cancer is summarized.The advantages and disadvantages of different components of BALF,including cells,cell-free DNA,extracellular vesicles,and micro RNA are introduced.In particular,the great potential of extracellular vesicles in precision diagnosis and detection of drug-resistant for lung cancer is highlighted.In addition,the performance of liquid biopsies with different body fluid sources in lung cancer detection are compared to facilitate more selective studies involving BALF,thereby promoting the application of BALF for precision medicine in lung cancer patients in the future.

Bronchoalveolar lavage fluid metagenomic next-generation sequencing assay for identifying pathogens in lung cancer patients

Background:For patients with lung cancer,timely identification of new lung lesions as infectious or non-infectious,and accurate identification of pathogens is very important in improving OS of patients.As a new auxiliary examination,metagenomic next-generation sequencing(mNGS)is believed to be more accurate in diagnosing infectious diseases in patients without underlying diseases,compared with conventional microbial tests(CMTs).We designed this study tofind out whether mNGS has better performance in distinguishing infectious and non-infectious diseases in lung cancer patients using bronchoalveolar lavagefluid(BALF).Materials and Methods:This study was a real-world retrospective review based on electronic medical records of lung cancer patients with bronchoalveolar lavage(BAL)and BALF commercial mNGS testing as part of clinical care from 1 April 2019 through 30 April 2022 at The First Affiliated Hospital of Sun Yat-sen University.164 patients were included in this study.Patients were categorized into the pulmonary non-infectious disease(PNID)group(n=64)and the pulmonary infectious disease(PID)group(n=100)groups based onfinal diagnoses.Results:BALF mNGS increased the sensitivity rate by 60%compared to CMTs(81%vs.21%,p<0.05),whereas there was no significant difference in specificity(75%vs.98.4%,p>0.1).Among the patients with PID,bacteria were the most common cause of infection.Fungal infections occurred in 32%of patients,and Pneumocystis Yersini was most common.Patients with Tyrosine kinase inhibitors(TKIs)therapy possess longer overall survival(OS)than other anti-cancer agents,the difference between TKIs and immuno-checkpoint inhibitors(ICIs)was insignificant(median OS TKIs vs.ICIs vs.Anti-angiogenic vs.Chemo vs.Radiotherapy=76 vs.84 vs.61 vs.58 vs.60).Conclusions:our study indicates that BALF mNGS can add value by improving overall sensitivity in lung cancer patients with potential pulmonary infection,and was outstanding in identifying Pneumocystis infection.It could be able to help physicians adjust the follow-up treatment to avoid the abuse of antibiotics.

Value of eosinophil count in bronchoalveolar lavage fluid for diagnosis of allergic bronchopulmonary aspergillosis: A case report

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.

Improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection

Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection.Methods:A total of 78 patients with lung cancer who received surgical treatment in our hospital between August 2013 and January 2015 and were with postoperative infection were selected as the research subjects and randomly divided into two groups, control group received mechanical ventilation therapy, observation group received bronchoalveolar lavage by bronchoscope combined with mechanical ventilation, and the inflammatory factor levels, RAAS system activity and respiratory mechanics indexes of two groups were determined after treatment.Results:3 d after treatment, serum hs-CRP, TNF-α, IL-8, PCT, renin, angiotensin II and aldosterone levels of observation group were lower than those of control group, and PIP, Raw and WOB values were lower than those of control group while Cdyn value was higher than that of control group.Conclusion:For lung cancer patients with postoperative pulmonary infection, bronchoalveolar lavage by bronchoscope combined with mechanical ventilation can optimize patients' condition, relieve systemic inflammatory response and improve respiratory function, and it has positive clinical significance.

Effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the SIRS and target organ damage in patients with severe pneumonia complicated by respiratory failure

Objective:To study the effect of fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol on the systemic inflammatory response syndrome (SIRS) and target organ damage in patients with severe pneumonia complicated by respiratory failure.Methods: A total of 68 patients with severe pneumonia complicated by respiratory failure who received inpatient treatment in our hospital between July 2013 and December 2016 were collected and then divided into the control group (n=35) who received conventional therapy and the observation group (n=33) who received fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol + conventional therapy after the therapies were reviewed. The systemic inflammatory response as well as cardiac and liver function before and after treatment were compared between two groups of patients.Results: Before treatment, differences in serum levels of inflammatory factors, myocardial enzyme spectrum and liver function indexes were not statistically significant between the two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, TNF-α and CRP levels in observation group were lower than those in control group;serum myocardial enzyme spectrum LDH,α-HBDH, CKMB and cTnI levels were lower than those in control group;serum liver function index Alb content was higher than that in control group while ALP, TBA, ALT and AST contents were lower than those in control group.Conclusion:Fiberoptic bronchoscopic bronchoalveolar lavage with ambroxol can effectively reduce the degree of SIRS, and also reduce the cardiac and liver function injury in patients with severe pneumonia complicated by respiratory failure.

HPLC Quantification of Dexamethasone Palmitate in Bronchoalveolar Lavage Fluid of Rat after Lung Delivery with Large Porous Particles

A high-performance liquid chromatography (HPLC) method has been developed and validated for the determination of dexamethasone palmitate (DXP) in bronchoalveolar fluid lavage samples (BALF). DXP in rat BALFs containing the internal standard (IS), testosterone decanoate (TD), was extracted using a mixture of chloroform and methanol (9:1, v/v). Extracts were then centrifuged, dried and dissolved in acetonitrile. A chromatographic separation based on an isocratic elution was done using acetonitrile and water (85:15, v/v) as a mobile phase at a flow rate of 1.2 mL/min. The graph of the developed method was linear within the tested calibration range of 0.5 - 40 μg/mL. The overall extraction recovery of DXP from BALF samples was 84.3% ± 1.6%. The accuracy (relative error) and precision (coefficient of variation) values were within the pre-defined limits of ≤15% at all concentrations. This methodology has been applied to determine levels of DXP in BALF samples collected from rats treated with DXP large porous particles. The measured concentrations were successfully evaluated using a non-compartment pharmacokinetic model. Since the developed method requires only a microvolume (100 μL) of BALF sample for analysis, it is therefore particularly suitable for the evaluation of drug biodistribution in lung.

Effects of early bronchoalveolar lavage fluid collected from dogs with smoke inhalation injury on the lungs of rats

Objective: Whether early massive bronchoalveolar lavage can remove the harmful substances from the lungs injured with smoke inhalation remains uncertain. This study was designed to observe the effects of early massive bronchoalveolar lavage fluid (BALF) on the healthy lungs in rats. Methods: Mongrel dogs were inflicted with severe smoke inhalation injury. The injured lungs were lavaged with large amount of normal saline in the first hour after injury and the BALF was collected. The BALF was injected into the healthy lungs of 30 rats (group C) in the dosage of 5 ml/kg. The functions and pathological changes of the lungs were observed 24 h after perfusion with the BALF. The data were compared with those of 23 rats (group B) whose lungs were perfused with the BALF collected from normal dogs and those of 21 rats (group A) whose lungs were perfused with normal saline. Results: The mortality rate 24 h after lung perfusion was higher in group C than in groups A and B. The survivors of group C exhibited fluctuation of respiratory rate (RR), remarkable decrease of PaO 2, significantly higher content of lung water, decrease of total static pulmonary compliance and pulmonary expansion index, and increasse of inflammatory cytokines in the tissues of lungs. Only slight mechanic obstructive effect on the airway was observed in rats of group A and B. The pathological changes of the lungs of the rats in group C were similar to those of the dogs with actual smoke inhalation injury. Conclusion: Our findings indicate that the BALF collected from dogs with acute severe smoke inhalation injury in the early stage after injury injured the normal lungs of rats with the bioactive substances in the BALF. These findings show us that it is a valuable therapeutic procedure to apply massive bronchoalveolar fluid lavage in the early stage after inhalation injury.

Comparison on Detection Results of Pathogen Nucleic Acids for Bronchoalveolar Lavage Fluid of Lung Infection Infants Between Uighur Nationality and Han Nationality

Objective:To analyze the detection results of pathogen nucleic acids for bronchoalveolar lavage fluid(BALF)of lung infection infants from Uighur nationality and Han nationality.Methods:A retrospective analysis was performed on the 318 infants with lung infection who were admitted to the hospital from April 2018 to April 2019.According to their nationality,they were divided into Uighur nationality group(190 cases)and Han nationality group(128 cases).The BALF specimens were collected to test pathogen nucleic acid.The distribution and positive rates of[respiratory syncytial virus(RSV),adenovirus(ADV),influenza virus A(IFA),influenza virus B(IFB),parainfluenza virus type 1(PIV I),parainfluenza virus type 2(PIV II),parainfluenza virus type 3(PIV III)],bacteria(Streptococcus pneumoniae,Haemophilus influenzae,staphylococcus aureus,Pseudomonas aeruginosa,klebsiella pneumoniae),Mycoplasma pneumoniae(MP)and Chlamydia pneumoniae(CP)in both groups were observed and compared.Results:The virus detection for RSV,ADV and PIV III were on the top three in BALF from the children in both groups.The total positive rate of virus examination in Uighur nationality group was higher than that in Han nationality group(P<0.05).BALF in both groups was mainly on Streptococcus pneumoniae.The total positive rate of bacteria,MP and detection rate of chlamydia were higher in Uighur nationality group were higher than those in Han nationality group(P<0.05).Conclusion:The pathogen nucleic acid examination for bronchoalveolar lavage fluid in infants with lung viral infection is in the majority,mainly on RSV virus infection.The positive rates of virus,bacteria,MP and CP of children in Uighur nationality are high than those in Han nationality.

Expression of endostatin in serum and bronchoalveolar lavage fluid in patients with lung cancer

Objective To evaluate the expression of endostatin in bronchoalveolar lavage fluid (BALF) and serum in patients with lung cancer,and to analysis the relationship between endostatin expression and clinical prognosis as well as pathophysiological characteristics. Methods The samples of serum and BALF were obtained from 57

Assessment of Diagnostic Accuracy of Bronchoalveolar Lavage Cytology in the Diagnosis of Lung Tumors and Contribution to the Classification of Non-Small Cell Lung Cancer Entities:A Retrospective Clinocopathological Study

Background: Due to new therapeutic options in thoracic oncology, the pathological diagnosis of bronchial carcinoma has become more challenging. The majority of bronchial cancer is diagnosed from small biopsy specimens and the diagnosis often based on cytological methods. Aims: In this study, we reevaluated cytologic specimens in order to determine the diagnostic reliability of pulmonary cytopathologic techniques performed in our department. Material and methods: In our center bronchial lavage/bronchoalveolar lavage (BL/BAL) specimens are obtained both before and after forceps biopsy (FB) and subsequently processed. Retrospective data from a period of 60 months were retrieved from the institutional files. Sensitivity, specificity, as well as accuracy of cytological tumor typing were determined using histopathology of FB as gold standard. Also, the diagnostic yield of BL/BAL before and after FB was determined. Results: 678 cases were retrieved from the institutional files. The sensitivity and specificity of cytology were 83.0% and 83.4%, respectively. By FB in 3.9% of cytologically diagnosed non-small cell lung carcinomas (NSCLC) a histological assignment to a NSCLC entity was not possible. Conclusions: Cytology is a reliable diagnostic tool in the diagnosis of lung malignancies. High diagnostic accuracy is achieved by a combination of BL/BAL before and after FB. The diagnostic yield of BL/BAL after FB was significantly higher than BL/BAL before FB. Subsequent tumor typing of cytologically diagnosed NSCLC was feasible in more than 95% of cases.

Pulsed lavage in joint arthroplasty: A systematic review and metaanalysis

BACKGROUND Knee and hip osteoarthritis affects millions of people around the world and is expected to rise even more in frequency as the population ages.Joint arthroplasty is the surgical management of choice in these articulations.Heterotopic ossi-fication and radiolucent lines formation are two frequent problems faced in hip and knee replacements respectively.Some studies show that the usage of pulsed lavage may prevent their formation.AIM To compare pulsed lavage to standard lavage in joint arthroplasty.METHODS PubMed,Cochrane,and Google Scholar(page 1-20)were searched till December 2023.Only comparative studies were included.The clinical outcomes evaluated were the heterotopic ossification formation in hip replacements,radiolucent lines formation,and functional knee scores in knee replacements.RESULTS Four studies met the inclusion criteria and were included in this meta-analysis.Pulsed lavage was shown to reduce the formation of radiolucent lines(P=0.001).However,no difference was seen in the remaining outcomes CONCLUSION Pulsed lavage reduced the formation of radiolucent lines in knee replacements.No difference was seen in the remaining outcomes.Furthermore,the clinical significance of these radiolucent lines is poorly understood.Better conducted randomized controlled studies and cost-effectivity studies are needed to reinforce these findings.

The Role of Abdominal CT in the Assessment of the Effectiveness of Gastric Lavage after Pesticide Poisoning

Pesticide poisoning is one of the most common diseases in the emergency department, characterized by rapid changes in condition, a high misdiagnosis rate, and a poor prognosis. Measures for early removal of poisons are crucial, and gastric lavage is one of the important measures. Regarding the post-gastric lavage effect, abdominal CT scanning has an important application value in the assessment of the gastric lavage effect after pesticide poisoning.

Analysis of the T cell receptor Vδ region gene repertoire in bronchoalveolar lavage fluid (BALF) and peripheral blood of asthmatics

Objective To explore the role of γδT cells in the airway of asthmatics and to identify the forces which induce and maintain the inflammatory processMethods Peripheral blood (PB) and bronchoalveolar lavage fluid (BALF) were obtained from7 asthmatic subjects and 7 nonsmoker control subjects The percentage of γδT cells in the PB and BALF was measured by immunofluorescent staining and flow cytometry The frequency of usage and the clonality of Vδ subfamilies (Vδ 1-Vδ 3) were assessed by RTPCR and gene scanning Results A higher proportion of γδT cell was detected in the BALF of asthmatic subjects (7.8%±4.7%) than that from control subjects (3.3%±3.0%, P=0.04) No selective usage for a particular Vδ subfamily was found, but the relative expression level of Vδ 1 was significantly higher in the asthmatic airway (44%±13%) than in the control (19%±5%, P=0.0002) In asthmatic subjects, the monoclonal or oligoclonal expansion of γδT lymphocytes was predominant in the BALF, especially Vδ 1+ T lymphocytes Conclusions Antigenic specific γδT cells might play an important role in the inducement and maintenance of airway inflammation Persistent antigenic stimulation may be the key factor that maintains chronic airway inflammation in asthma

Interleukin-6 in bronchoalveolar lavage fluid from patients with COPD

Objective To obtain new insights into the behavior of Interleukin-6(IL-6)in bronchoalveolar lavage fluid (BALF)and released from alveolar macrophages(AM)in chronic obstructive pulmonary diseases (COPD),and reveal the relationship between IL-6 and the development of emphysema in COPD.Methods IL-6 in BALF and released by AM in BALF were examined in 7 non-smoking subjects and 21 patients with COPD.According to the 95% confidence limits of IL-6 in BALF from non-smoking subjects,the patients were divided into two groups:those who were within the limits were assigned to the first group,and those who were above the limits were assigned to the second group.Results The concentration of IL-6 released by AM was much higher in the second group than in the first one.Between the two groups,significant differences were found in pulmonary function.Conclusion Our results suggest that the concentration of IL-6 released by AM may be related with pulmonary function,and IL-6 may play a role in the development of emphysema in patients with COPD.

Alteration of surfactant proteins A and D in bronchoalveolar lavage fluid of pneumocystis carinii pneumonia

Objective To understand the interaction between surfactant proteins and pneumocystis carinii pneumonia (PCP),and the impact of corticosteriods on surfactant proteins.Methods We established rat models of PCP and bacterial pneumonia induced by subcutaneous injection of 25mg cortisone acetate.At 8- 12 wk,the bronchoalveolar lavage fluid(BALF)of rats was collected.Total nucleated cells of BALF were counted and differentiated,and the concentrations of surfactant protein A(SP-A)and surfactant protein D(SP-D)were measured by immunoblotting assay.The rats were divided into three immunosuppressive groups and a normal control group.Group I,normal control(n = 6),consisted of healthy SD rats;group Ⅱ,negative control(n = 6),consisted of rats with cortisone acetate injection for over 8 wk without lung infection;group Ⅲ,bacterial pneumonia(n = 11),rats were injected with cortisone acetate over 8 wk that resulted in bacterial pneumonia without other pathogens isolated;and group Ⅳ,PCP(n = 14),rats with injected cortisone acetate for 8 - 12 wk and developed PCP without other pathogens isolated.Results Our results indicated that the total cell count in BALF in the negative control group was lower than that in the normal control group(P ＜ 0.001).During PCP infection,the total cell count and the percentage of polymorphonuclearcytes(PMNs)in BALF were significantly increased(P ＜ 0.01),but were lower than those in the bacterial pneumonia group.The concentration of SP-A of BALF in PCP(45.1 ± 22.1 μg/ml)was significantly increased in comparison with that in the negative control(16.2 ± 9.9 μg/ml,P ＜ 0.05)and bacterial pneumonia groups(6.2 ± 5.6 μg/ml,P ＜ 0.001).We also found that the relative content of SP-D was significantly higher in PCP(24249 ±4780 grey values)than that in the negative control (13 384 ± 2887 grey values,P ＜ 0.001)and that in bacterial pneumonia(11 989 ± 2750 grey values,P＜0.001).SP-A and SP-D were also higher in the moderate to heavy group of PCP than those seen in the mild group(P ＜ 0.01,P ＜ 0.001).SP-A and SP-D were higher in the negative control group than those in the normal control group,but there was no significant difference between the 2 groups.Conclusion These results suggest that the concentrations of SP-A and SP-D in BALF are increased by pneumocystis carinii specific stimulation,but the alteration is not related to the corticosteriod usage.

Distribution of Major Pathogens from Sputum and Bronchoalveolar Lavage Fluid in Patients with Noncystic Fibrosis Bronchiectasis： A Systematic Review

Objective： Noncystic fibrosis （non-CF） bronchiectasis remains as a common health problem in Asia. Pathogens＇ distribution in airways of patients with non-CF bronchiectasis is important for doctors to make right decision. Data Sources： We performed this systematic review on the English language literatures from 1966 to July 2014, using various search terms included ＂pathogens＂ or ＂bacteria＂ or ＂microbiology＂ and ＂bronchiectasis＂ or ＂non-cystic fibrosis bronchiectasis＂ or ＂non-CF bronchiectasis＂ or ＂NCFB.＂ Study Selection： We included studies of patients with the confirmed non-CF bronchiectasis for which culture methods were required to sputum or bronchoalveolar lavage fluid （BALF）. Weighted mean isolation rates for Haemophilus influenzae, Pseudomonas aeruginosa, Streptococcus pneumoniae, Stapylococcus aureus, Moxarella catarrhails were compared according to different methodology. Results： The total mean bacterial culture positive rates were 63%. For studies using sputum samples, the mean positive culture rates were 74%. For studies using BALF alone or BALF and sputum, it was 48%. The distributions of main bacterial strains were 29% for 1-1. influenzae, 28% for P. aeruginosa, 11% for S. pneumoniae, 12% for S. aureus, and 8% for M. catarrhails with methodology of sputum. Meanwhile, the bacterial distributions were 37% for H. influenzae, 8% for P aeruginosa, 14% for S. pneumoniae, 5% for S. attretts, and 10% for M. catarrhails with methodology of BALF alone or BALF and sputum. Analysis of the effect of different methodology on the isolation rates revealed some statistically significant differences. Conclusions： H. influenzae accounted for the highest percentage in different methodology. Our results suggested that the total positive culture rates and the proportion of P. aeruginosa from sputum and BALF specimens had significant differences, which can be used in further appropriate recommendations for the treatment of non-CF bronchiectasis.

Microscopic examination of intracellular organisms in bronchoalveolar lavage fluid for the diagnosis of ventilator-associated pneumonia：a prospective multi-center study

Background The presence of intracellular organisms （ICOs） in polymorphonuclear leukocytes obtained from bronchoalveolar lavage fluid （BALF） is a possible method for rapid diagnosis of ventilator-associated pneumonia （VAP）.However,the validity of this diagnostic method remains controversial and the diagnostic thresholds reported by investigators were different.Our objective was to evaluate the accuracy of quantification of ICOs in BALF for the diagnosis of VAP,and to detect the best cutoff percentage of PMNs containing ICOs （PIC） in the microscopic examination of BALF for the diagnosis of VAP.Methods This was a prospective multi-center study conducted in 4 ICUs in Wuhan,China,which involved 181 patients suspected of first episode of VAP.BALF was obtained from all enrolled patients.The BALF samples underwent quantitative culture,cytological and bacteriological analysis to detect the culture results,PIC values and the morphological features of microorganisms.Definite diagnosis of VAP was based on pre-set criteria.The receiver-operating characteristic curve was used to detect the best cutoff point for PIG to diagnose VAP,and the diagnostic accuracy was calculated.Moreover,quantitative culture and Gram＇s stain of BALF were adopted to diagnose VAP,and their diagnostic accuracy was evaluated as well.Results There were 102 patients definitely diagnosed with VAP （VAP group）,and 60 patients definitely diagnosed without VAP （no VAP group）.We found that ICOs were present in 96.08％ （98 out of 102） of VAP patients and 20.00％ （12 out of 60） of no VAP patients.The PICs were significantly higher （（9.53±6.65）％ vs.（0.52±1.33）％,P＜0.01） in VAP group.In our study,the best cutoff point for PIC to diagnose VAP was 1.5％,which had a sensitivity of 94.12％,a specificity of 88.33％,a positive predictive value （PPV） of 93.20％ and a negative predictive value （NPV） of 89.83％.The area under the receiveroperating characteristic curve was 0.956 （95％ confidence interval,0.925-0.986; P＜0.01）.When the positive quantitative culture results of BALF were used to diagnose VAP,the sensitivity,specificity,PPV and NPV were 65.69％,95.00％,95.71％ and 61.96％,respectively.Whereas they were 70.59％,76.67％,83.72％ and 60.53％,respectively,when the positive Gram＇s stain results of BALF were used to diagnose VAP.The concordance between the results of Gram＇s stain and quantitative cultures was poor,only 32.10％ （52 out of 162） was totally right,and 17.28％ （28 out of 162） was partially right.Conclusions PIC＞1.5％ has good diagnostic performance in the microscopic examination of BALF for the diagnosis of VAP.However,Gram＇s stain is not reliable for the early application of antibiotic therapy,due to the poor bacteriological predictive value.

Indicators for prediction of Mycobacterium tuberculosis positivity detected with bronchoalveolar lavage fluid

Background:The diagnosis of active pulmonary tuberculosis(TB)remains a challenge in clinic,especially for sputum negative pulmonary TB.Bronchoalveolar lavage fluid(BALF)has higher sensitivity than sputum for detection of Mycobacterium tuberculosis(Mtb).However,bronchoscopy is invasive and costly,and not suitable for all patients.In order to make TB patients get more benefit from BALF for diagnosis,we explore which indicator might be used to optimize the choice of bronchoscopy.Methods:A total of 1539 sputum-smear-negative pulmonary TB suspects who underwent bronchoscopy were recruited for evaluation.The sensitivity,specificity and accuracy of Mtb detection in sputum and BALF were compared.Odds ratios and 95%confidence intervals were used to assess variables that associated with positive acid-fast bacilli(AFB)smear,Mtb culture and nucleic acid amplification test(NAAT)of BALF in sputum-negative and non-sputum-producing pulmonary TB suspects.Results:BALF has significantly higher sensitivity(63.4%)than sputum(43.5%)for Mtb detection by culture and NAAT.19.7%(122/620)sputum-negative and 40.0%(163/408)non-sputum-producing suspects had positive bacteriological results in BALF.Among sputum-negative and non-sputum-producing pulmonary TB suspects,the positivity of Mtb detection in BALF is associated with a younger age,the presence of pulmonary cavities and a positive result of interferon-gamma release assay(IGRA).Sputum-negative patients under 35 years old with positive IGRA and pulmonary cavity had 84.8%positivity of Mtb in BALF.Conclusions:Our study indicated that combination of age,the presence of pulmonary cavity,and the result of IGRA is useful to predict the positivity of Mtb detection in BALF among sputum-negative and non-sputum producing pulmonary TB suspects.Those who are under 35 years old,positive for the presence of pulmonary cavity and IGRA,should undergo bronchoscopy to collect BAFL for Mtb tests,as they have the highest possibility to get bacteriologically confirmation of TB.

XpertMTB/RIF Assay for the Diagnosis of Pulmonary Tuberculosis Based on Bronchoalveolar Lavage Fluid:A Systematic Review and Meta-analysis

Currently,tuberculosis(TB)is the second most lethal disease in the world caused by a single infectious pathogen.Rapid diagnosis of TB is of great importance for its treatment and management.Xpert MTB/RIF is a novel rapid diagnostic assay for the diagnosis of pulmonary TB(PTB).Use of the Xpert assay based on bronchoalveolar lavage fluid(BALF)samples is indicated when TB is suspected and sputum smears or cultures are negative.The aim of this meta-analysis was to systematically evaluate the diagnostic performance of the Xpert assay based on BALF samples for the diagnosis of PTB.A systematic review of previously published articles was performed,and rel-evant data were extracted.Meta-DiSc 1.4 and Stata 12.0 were used to analyze the data.When Mycobacterium tuberculosis cultures were used as the criterion standard,the combined sensitivity of BALF-based Xpert was 0.89(95%CI,0.87–0.91),the specificity was 0.87(95%CI,0.85-0.88),the positive likelihood ratio was 8.28(95%CI,5.39–12.71),the negative likelihood ratio was 0.14(95%CI,0.10–0.19)and the diagnostic ratio was 84.08(95%CI,42.00–168.31).When composite reference standard was used as the criterion standard,the above observations were 0.69(95%CI,0.67–0.72),0.98(95%CI,0.97–0.98),41.40(95%CI,14.56–117.71),0.28(95%CI,0.21–0.37)and 190.47(95%CI,50.56–717.54),respectively.The area under the summary receiver operating characteristic curve was close to 1 for both.Overall,the Xpert MTB/RIF assay based on BALF samples showed high sensitivity and specificity for the diag-nosis of PTB and seems to be a reliable rapid detection method.

Cellular changes in bronchoalveolar lavage fluid in hyperoxiainduced lung injury

It is well known that high concentration oxy-gen exposure is a model of acute lung injury(ALI).However,controversy exists over the mechanism.This study was designed to clarify the cellular characteristics in bronchoalveolar lavage fluid(BALF)and body weight loss of rats exposed to oxygen(.90%).Young male Wistar rats,aged 6 weeks,were divided into three groups:(1)room air group(exposed to room air,n 522);(2)hyperoxia,48 h group(exposed to over 90%oxygen for less than 48 h,n 518);(3)hyperoxia 66–72 h group(exposed to over 90%oxygen for 66–72 h group,n 57).Compared to the room air group,the total cell counts in the hyperoxia 66–72 h group decreased,whereas the neu-trophils increased significantly.The body weights of the rats exposed to room air continued to increase.However,the body weights of oxygen-exposed rats increased slightly on the first day and weight loss was seen from the second day.All rats were noted to have bilateral pleural effusion in the hyperoxia 66–72 h group.The data suggests that(1)an increase in neutrophil count is an evident feature of hyperoxia-induced lung injury;(2)high concentration oxygen exposure can give rise to anorexia and malnutri-tion,which may play a role in hyperoxia-induced lung injury.Blocking neutrophil influx into lung tissue in the early phase and improving malnutrition are two effective methods to reduce hyperoxic lung injury.