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Abstract Background Acute respiratory distress syndrome (ARDS) patients with different lung morphology have distinct pulmonary mechanical dysfunction and outcomes. Whether lung morphology impacts the association between ventilatory variables and mortality remains unclear. Moreover, the impact of a novel combined ventilator variable [(4×DP) + RR] on morality in ARDS patients needs external validation. Methods We obtained data from the Chinese Database in Intensive Care (CDIC), which included adult ARDS patients who received invasive mechanical ventilation for at least 24 h. Patients were further classified into two groups based on lung morphology (focal and non-focal). Ventilatory variables were collected longitudinally within the first four days of ventilation. The primary outcome was 28-day mortality. Extended Cox regression models were employed to explore the interaction between lung morphology and longitudinal ventilatory variables on mortality. Findings We included 396 ARDS patients with different lung morphology (64.1% non-focal). The overall 28-day mortality was 34.4%. Patients with non-focal lung morphology have more severe and persistent pulmonary mechanical dysfunction and higher mortality than those with focal lung morphology. Time-varying driving pressure (DP) was more significantly associated with 28-day mortality in patients with non-focal lung morphology compared to focal lung morphology patients (P for interaction = 0.0039). The impact of DP on mortality was more significant than that of respiratory rate (RR) only in patients with non-focal lung morphology. The hazard ratio (HR) of mortality for [(4×DP) + RR] was significant in patients with non-focal lung morphology (HR 1.036, 95% CI 1.027–1.045), not in patients with focal lung morphology (HR 1.019, 95% CI 0.999–1.039). Interpretation The association between ventilator variables and mortality varied among patients with different lung morphology. [(4×DP) + RR] was only associated with mortality in patients with non-focal lung morphology. Further validation is needed.

Purpose of the study. An analysis of morphological features of the lung sarcoma 45 ectopic growth in rats of different sexes in course of experimental therapy with 1,3‑diethylbenzimidazolium triiodide.Materials and methods. Studies were carried out on 60 white nonlinear female and male rats weighing 180–220 g with transfusion of sarcoma cells 45 suspension from the subclavian vein into the lung, which resulted in subsequent ectopic tumor growth. At the same time, per os, 0.5 ml of an aqueous solution of 1,3‑diethylbenzimidazolium triiodide in a single dose of 0.4 mg/kg was administered. Morphological control of the lung tumor growth was carried out in stages, weeks 1 through 8, while assessing visual changes with Axiovert microscope (Carl 44 Zeiss, Germany) as well as with Axiovision 4 image visualization program (Carl Zeiss, Germany).Results. It was found out that, instead of the initial acute phase of blood flow reduction due to introduction of tumor cells resulting in neoplastic growth, activation of the immunity cellular link occurred under the influence of 1,3‑diethylbenzimidazolium triiodide along with a compensatory increase in bronchoalveolar structures, regression of tumor nodes and proliferation of connective tissue. At the same time, in females, a more rapid restructuring of the protective cellular systems of the lung occurs, and tumor regression is observed.Conclusion. The morphological manifestations of triiodide indicate the antitumor effect of 1,3‑diethylbenzimidazolium on the possibility of inhibiting lung sarcoma 45 ectopic growth and demonstrate a high reactivity of female rats to the damaging effect of the tumor and the rate of disturbed pulmonary structures compensation.

Background There are limited data on the clinical effects of prone positioning according to lung morphology. We aimed to determine whether the gas exchange response to prone positioning differs according to lung morphology. Methods This retrospective study included adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS). The lung morphology of ARDS was assessed by chest computed tomography scan and classified as “diffuse” or “focal.” The primary outcome was change in partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio after the first prone positioning session: first, using the entire cohort, and second, using subgroups of patients with diffuse ARDS matched 2 to 1 with patients with focal ARDS at baseline. Results Ninety-five patients were included (focal ARDS group, 23; diffuse ARDS group, 72). Before prone positioning, the focal ARDS group showed worse oxygenation than the diffuse ARDS group (median PaO2/FiO2 ratio, 79.9 mm Hg [interquartile range (IQR)], 67.7–112.6 vs. 104.0 mm Hg [IQR, 77.6–135.7]; P=0.042). During prone positioning, the focal ARDS group showed a greater improvement in the PaO2/FiO2 ratio than the diffuse ARDS group (median, 55.8 mm Hg [IQR, 11.1–109.2] vs. 42.8 mm Hg [IQR, 11.6–83.2]); however, the difference was not significant (P=0.705). Among the PaO2/FiO2-matched cohort, there was no significant difference in change in PaO2/FiO2 ratio after prone positioning between the groups (P=0.904). Conclusions In patients with moderate-to-severe ARDS, changes in PaO2/FiO2 ratio after prone positioning did not differ according to lung morphology. Therefore, prone positioning can be considered as soon as indicated, regardless of ARDS lung morphology.

Introduction: Lung fissures are partially incomplete in 50% of different populations. Incomplete formation of the fissures leads to a merging of lobes and conversely accessory lobes form due to the formation of new fissures. This study aims to describe the morphology of the lungs in terms of fissures and lobes. Materials and methods: A descriptive observational study was done on a total of 82 formalin fixed bodies. Both the left and right lungs of each body were examined for accessory lobes and fissures. Results: A wide range of variations was seen in the present study. On the right, the horizontal fissure was absent in six lungs (7.3%), incomplete in 32 lungs (39.0%) and complete in 33 lungs (40.2%). No lungs had an absent oblique fissure. The oblique fissure was incomplete in 24 lungs (29.3%) and complete in 47 lungs (57.3%). No right lung solely had an oblique fissure absent. However, both the horizontal and oblique fissures were absent in one lung (1.2%). In the left lungs, the obliques fissure was absent in one lung (1.2%), incomplete in 24 lungs (29.3%) and complete in 47 lungs (57.3%). An accessory fissure was seen in the territory of the upper lobe forming a partial separation in the right superior lobe of one lung. Conclusion: The high prevalence of morphological variations in this study emphasizes the need for greater understanding of lung fissure anatomy. For example, in video-assisted thoracoscopic surgery lobectomies, higher morbidity in patients is linked with incomplete fissures [12]. Thus, more knowledge of lung fissure and lobe variations will be of significant clinical relevance to anatomy students, cardiothoracic surgeons, and radiologists.

Abstract Background High frequency percussive ventilation (HFPV) combines diffusive (high frequency mini-bursts) and convective ventilation patterns. Benefits include enhanced oxygenation and hemodynamics, and alveolar recruitment, while providing hypothetic lung-protective ventilation. No study has investigated HFPV-induced changes in lung aeration in patients with early acute respiratory distress syndrome (ARDS). Methods Eight patients with early non-focal ARDS were enrolled and five swine with early non-focal ARDS were studied in prospective computed tomography (CT) scan and animal studies, in a university-hospital tertiary ICU and an animal laboratory. Patients were optimized under conventional “open-lung” ventilation. Lung CT was performed using an end-expiratory hold (Conv) to assess lung morphology. HFPV was applied for 1 hour to all patients before new CT scans were performed with end-expiratory (HFPV EE) and end-inspiratory (HFPV EI) holds. Lung volumes were determined after software analysis. At specified time points, blood gases and hemodynamic data were collected. Recruitment was defined as a change in non-aerated lung volumes between Conv, HFPV EE and HFPV EI. The main objective was to verify whether HFPV increases alveolar recruitment without lung hyperinflation. Correlation between pleural, upper airways and HFPV-derived pressures was assessed in an ARDS swine-based model. Results One-hour HFPV significantly improved oxygenation and hemodynamics. Lung recruitment significantly rose by 12.0% (8.5–18.0%), P = 0.05 (Conv-HFPV EE) and 12.5% (9.3–16.8%), P = 0.003 (Conv-HFPV EI). Hyperinflation tended to increase by 2.0% (0.5–2.5%), P = 0.89 (Conv-HFPV EE) and 3.0% (2.5–4.0%), P = 0.27 (Conv-HFPV EI). HFPV hyperinflation correlated with hyperinflated and normally-aerated lung volumes at baseline: r = 0.79, P = 0.05 and r = 0.79, P = 0.05, respectively (Conv-HFPV EE); and only hyperinflated lung volumes at baseline: r = 0.88, P = 0.01 (Conv-HFPV EI). HFPV CT-determined tidal volumes reached 5.7 (1.1–8.1) mL.kg-1 of ideal body weight (IBW). Correlations between pleural and HFPV-monitored pressures were acceptable and end-inspiratory pleural pressures remained below 25cmH20. Conclusions HFPV improves alveolar recruitment, gas exchanges and hemodynamics of patients with early non-focal ARDS without relevant hyperinflation. HFPV-derived pressures correlate with corresponding pleural or upper airways pressures. Trial registration ClinicalTrials.gov, NCT02510105. Registered on 1 June 2015. The trial was retrospectively registered.

Background: Preterm birth is associated with abnormal lung architecture, and a reduction in pulmonary function related to the degree of prematurity. A thorough understanding of the impact of gestational age on lung microarchitecture requires reproducible quantitative analysis of lung structure abnormalities. The objectives of this study were (1) to use quantitative histological software (ImageJ) to map morphological patterns of injury resulting from delivery of an identical ventilation strategy to the lung at varying gestational ages and (2) to identify associations between gestational age-specific morphological alterations and key functional outcomes.Method: Lung morphology was compared after 60 min of a standardized ventilation protocol (40 cm H2O sustained inflation and then volume-targeted positive pressure ventilation with positive end-expiratory pressure 8 cm H2O) in lambs at different gestations (119, 124, 128, 133, 140d) representing the spectrum of premature developmental lung states and the term lung. Age-matched controls were compared at 124 and 128d gestation. Automated and manual functions of Image J were used to measure key histological features. Correlation analysis compared morphological and functional outcomes in lambs aged ≤128 and >128d.Results: In initial studies, unventilated lung was indistinguishable at 124 and 128d. Ventilated lung from lambs aged 124d gestation exhibited increased numbers of detached epithelial cells and lung tissue compared with 128d lambs. Comparing results from saccular to alveolar development (120–140d), lambs aged ≤124d exhibited increased lung tissue, average alveolar area, and increased numbers of detached epithelial cells. Alveolar septal width was increased in lambs aged ≤128d. These findings were mirrored in the measures of gas exchange, lung mechanics, and molecular markers of lung injury. Correlation analysis confirmed the gestation-specific relationships between the histological assessments and functional measures in ventilated lambs at gestation ≤128 vs. >128d.Conclusion: Image J allowed rapid, quantitative assessment of alveolar morphology, and lung injury in the preterm lamb model. Gestational age-specific patterns of injury in response to delivery of an identical ventilation strategy were identified, with 128d being a transition point for associations between morphological alterations and functional outcomes. These results further support the need to develop individualized respiratory support approaches tailored to both the gestational age of the infant and their underlying injury response.

The lung-air sac system of modern birds is unique among vertebrates. However, debate surrounds whether an avian-style lung is restricted to birds or first appeared in their dinosaurian ancestors, as common osteological correlates for the respiratory system offer limited information on the lungs themselves. Here, we shed light on these issues by using axial morphology as a direct osteological correlate of lung structure, and quantifying vertebral shape using geometric morphometrics in birds, crocodilians and a wide range of dinosaurian taxa. Although fully avian lungs were a rather late innovation, we quantitatively show that non-avian dinosaurs and basal dinosauriforms possessed bird-like costovertebral joints and a furrowed thoracic ceiling. This would have immobilized the lung's dorsal surface, a structural prerequisite for a thinned blood-gas barrier and increased gas exchange potential. This could have permitted high levels of aerobic and metabolic activity in dinosaurs, even in the hypoxic conditions of the Mesozoic, contributing to their successful radiation.

Background. Despite the large number of studies devoted to the study of the functional state of the cardiovascular and respiratory systems after operations on the lungs, there are still many issues regarding the mechanisms of hemodynamic disorders in the postoperative period. It stipulates considerable difficulties in the treatment and prevention of functional disorders of respiration and circulation. Objective. The aim of this study is to determine the central hemodynamics parameters depending on the condition of ventilate lung function in thoracic oncology patients during the postoperative period and to determine the morphological features of the lungs that developed under the influence of intraoperative administration of refortan and perftoran. Methods. The condition of the central heamodynamic and morphological features of the lungs at patients with lung cancers with different level of the ventilating respiratory insufficiency in the early postoperative period after application of 3 and 1,5 ml/kg of perftoran and after traditional refortan (5 ml/kg) infusion-transfusion therapy were determined. Results and conclusion. It was proved that perftoran is much more effective than pefortan. The restoration of the normodynamic type of heamodynamic after infusion of perftoran (1,5 ml/kg) to patients with the an initial level of the ventilating respiratory insufficiency of I and II degree is observed during 1st postoperative week. The restoration of the normodynamic type of heamodynamic at to patients with the initial level of the ventilating respiratory insufficiency of III degree in postoperative period is reached by using perftoran in a dose 3 ml/kg. In the dead after pneumonectomy with intraoperative administration of perftoran there is increasing of synthetic activity of alveolocyte type II along with compensatory microcirculatory changes. Citation: Tverdokhlib IV, Novikov SP. [Сentral heamodynamic сondition and morphological characteristics of lungs at patients with lung cancer depending on components of the infusion-transfusion therapy]. Morphologia. 2015;9(4):76-84. Ukrainian.

O tabaco está implicado na carcinogénese multiorgânica, com identificação de mais de cinquenta substâncias carcinogénicas que induzem mutações, alterando o ciclo celular, a resposta auto-imune e a regulação endócrina. É um dos nove factores identificados responsáveis por um terço de mortes por neoplasias malignas juntamente com erros dietéticos, obesidade, sedentarismo, consumo de álcool, promiscuidade sexual, toxicodependência e poluição ambiental geral e limitada. Está implicado nas doenças cardiovasculares que representam a primeira causa de morte nos países civilizados e, no aparelho respiratório, é o factor principal para o desenvolvimento de DPOC (doença pulmonar obstrutiva crónica), RB-ILD (bronquiolite respiratória e doença pulmonar intersticial), DIP (pneumonia intersticial descamativa), bronquiolite e fibrose intersticial bronquiolocêntrica, histiocitose de células de Langerhans, pneumonia eosinofílica, sarcoidose, metaplasia epidermóide do epitélio respiratório e carcinoma bronco-pulmonar. O estado inflamatório crónico sistémico induzido pelo tabaco constitui a base de desenvolvimento de alterações genéticas também dependentes dos contaminantes do tabaco.Tobacco is implicated in multisystemic carcinogenesis through more than fifty identified carcinogenic metabolites that produce mutations responsible for alterations in cell cycle, immune response and endocrine regulation. Is one of nine risk factors identified in one third of cancer deaths together with obesity, sedentary, alcohol consumption, sexual promiscuity, drug addiction, and open and closed air contamination. Answering for cardiovascular diseases as the first cause of death in civilized world, tobacco is also pointed as the major factor implicated in the development of COPD (chronic obstructive pulmonary disease), RB-ILD (respiratory bronchiolitis and interstitial lung disease), DIP (desquamative interstitial pneumonia), bronchiolitis and bronchiolocentric interstitial fibrosis, Langerhans cells histiocytosis, eosinophilic pneumonia, sarcoidosis, epidermoid metaplasia in respiratory epithelium and lung cancer. The chronic tobacco induced inflammatory state is the basis for the acquisition of genetic alterations dependent on the tobacco contaminants.

Objective: to investigate pulmonary morphological changes in animals with limb ischemic and reperfusion lesions, which were treated with hemocarboperfusion on sodium hypochlorite-modified sorbents.Materials and methods. The investigation was conducted on 94 mature mongrel male dogs with 4-hour limb ischemia and subsequent reperfusion. Limb ischemia was induced by applying a tourniquet to the isolated vascular fascicle of an experimental limb proximal to the origin of the deep artery of the thigh. Following 4 hours, reperfusion was made, by removing the tourniquet. Three hours of the initiation of reperfusion, one-hour hemocarboperfusion was performed thrice for 72 hours. Lung biopsy samples were used for morphological studies. Morphological changes were evaluated, by employing the hematoxylin- and eosin-stained semifine sections. The visceral histological pattern was assessed by a light trinocular microscope (OLYMPUS, Japan) (microscope objective 10).Results. The development of 4-hour limb ischemia is accompanied by significant microcirculatory disorders in the lungs that exhibit dyscirculatory and dystrophic processes concurrent with the signs of tissue dyscomplexation without the signs of an inflammatory reaction. In the reperfusion period, there was a significant progression of lung tissue morphological changes corresponding to the pattern of phase 2 respiratory distress syndrome. Sodium hypochlorite-modified CKN-1K sorbent hemocarboperfusion resulted in a virtually complete restoration of the lung architectonics in the presence of insignificant microcirculato-ry and ventilatory disorders. After standard hemocarboperfusion, the lung tissue may be defined as a slightly reduced pattern of acute pulmonary lesion.Conclusion. Sodium hypochlorite-modified CKN-1K sorbent hemocarboperfusion is an effective technique in abolishing ischemic and reperfusion lesions.

The morphology of the rat lung was studied by light microscopy in different situations: after surgical and pharmacological castration and after administration of testosterone to the castrated rat to determine if the androgen is required to maintain the normal morphology of the lung. We also determined the effect of flutamide on the phospholipid composition of both the surfactant and microsomes of the lung. Rats were separated into five groups: I - control non-castrated rats, II - castrated rats sacrificed 21 days after castration, III - castrated rats that received testosterone daily from day 2 to day 21 after castration, IV - castrated rats that received testosterone from day 15 to day 21 after castration, and V - control rats injected with flutamide for 7 days. The amount of different phospholipids in the surfactant and microsomes of the lung was measured in group I and V rats. At the light microscopy level, the surgical and pharmacological castration provoked alterations in the morphology of the lung, similar to that observed in human lung emphysema. The compositions of surfactant and microsomes of the lung were similar to those previously reported by us for the surgically castrated rats. These results indicate that androgens are necessary for the normal morphology as well as for some metabolic aspects of the lung.