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Background Particulate matter (PM) is the major component of air pollution, which includes emissions from both anthropogenic and natural sources. PM, with aerodynamic diameter of 2.5 ± 10 μm can remain in the air for a long time and be deposited in the lungs through inhalation and hence, is a major threat to human health. Objective(s) The objective of the present study was to examine the protective effect of Chyawanprash (CP) on PM-induced pulmonary disease through estimation of cytokines and immunoglobulins. Materials and methods CP, standard drug, and vehicle (Group G1 to Group G7) were administered orally at the dose volume of 10 ml/kg, for 28 consecutive days (Prophylactic treatment; i.e., Day 1 to Day 28) and next 10 days (i.e., Day 29 to Day 38) of co-treatment with inducing agent PM2.5 intratracheally. Animals of group G6 (Inhalation + control) and G7 (Inhalation + CP) were exposed group-wise to PM2.5 aerosol (2 mg/5 ml, 15 min) via inhalation in histamine chamber on Days 29, 31, 33, 35, and 37. On Day 38, animals were anesthetised and blood and broncho alveolar lavage fluid (BALF) were collected. Animals were sacrificed and lungs were collected for histology. Results Prophylactic benefit of CP against pulmonary pathology was evidenced by the inhibition of inflammatory cytokines (BALF: TNF a, IFN-g, IL-7, IL-6 and lung: TNFa, Histamine and IL-6), chemokines (Lung: MMP-9), inflammatory cell infiltration (cell counts in BALF), and histopatholoy in experimental mice model. Conclusion These findings suggest that CP has potential benefit in protecting from harmful effects caused by air pollutants such as PM2.5.

Highlights • Surgical management of left superior pulmonary venous return directly to the left innominate/brachiocephalic vein in patient with pulmonary adenocarcinoma. • Left upper lobectomy in patient with adenocarcinoma of the lung in the presence of partial anomalous pulmonary venous return. • Case report describing operative management of adenocarcinoma of the lung in a patient afflicted with partial anomalous pulmonary venous return of left superior pulmonary vein into the left brachiocephalic vein., Introduction Partial anomalous pulmonary venous return (PAPVR) is a rare congenital heart disease that complicates surgical management of pulmonary pathology. Case presentation This case describes the successful management of a 73-year-old female with a left upper lobe adenocarcinoma and pre-operative discovery of left superior anomalous pulmonary venous return into the innominate vein. This patient presented to our clinic for evaluation regarding her newly discovered adenocarcinoma of the lung. Here, we also discuss findings in the literature for management of these patients regarding the importance of preoperative evaluation to determine the extent to which a lobectomy will alter pulmonary function with special emphasis on identifying patients at risk of increased shunting leading to cardiopulmonary failure. Conclusion Consideration should focus on the extent of the shunting, the presence of symptoms, and underlying right heart strain or pulmonary hypertension.

Publisher Summary Pulmonary pathology includes a large spectrum of both neoplastic and non-neoplastic diseases that affect the lung. Many of these are a result of the unusual relationship of the lung with the outside world. Every breath that a human takes brings the outside world into the body in the form of infectious agents, organic and inorganic particles, and noxious agents of all types. Although the lung has many defense mechanisms to protect itself from these insults, these are not infallible; therefore, lung pathology arises. Damage to the lung is particularly important given the role of the lung in the survival of the organism. Any impairment of lung function has widespread effects throughout the body, since all organs depend on the lungs for the oxygen they need. Pulmonary pathology catalogs the changes in the lung tissues and the mechanisms through which these occur. This chapter presents a review of lung pathology and the current state of knowledge about the pathogenesis of each disease. It suggests that a clear understanding of both morphology and mechanism is required for the development of new therapies and preventive measures.

Introduction: Hard metal pneumoconiosis is a rare but serious disease of the lungs associated with inhalational exposure to tungsten or cobalt dust. Little is known about the radiologic and pathologic characteristics of this disease and the efficacy of treating with immunosuppression. Objective: We describe the largest cohort of patients with hard metal pneumoconiosis in the literature, including radiographic and pathologic patterns as well as treatment options. Methods: We retrospectively identified patients from the University of Pittsburgh pathology registry between the years of 1985 and 2016. Experts in chest radiology and pulmonary pathology reviewed the cases for radiologic and pathologic patterns. Results: We identified 23 patients with a pathologic pattern of hard metal pneumoconiosis. The most common radiographic findings were ground glass opacities (93%) and small nodules (64%). Of 20 surgical biopsies, 17 (85%) showed features of giant cell interstitial pneumonia. Most patients received systemic corticosteroids and/or steroid-sparing immunosuppression. Conclusions: Hard metal pneumoconiosis is characterized predominately by radiographic ground glass opacities and giant cell interstitial pneumonia on histopathology. Systemic corticosteroids and steroid-sparing immunosuppression are common treatment options. Keywords: Lung diseases, Interstitial, Hard metal pneumoconiosis, Giant cell interstitial pneumonia

A diagnosis of ‘chronic cough’ (CC) requires the exclusion of sinister pulmonary pathology, including infection and malignancy. We present a patient with a 3 month history of CC who had an extensive workup including a normal high resolution computed tomography of the chest (HRCT) 6 weeks prior to consultation at our center. He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation. A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary. Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution. PLC is a very rare cause of ‘chronic cough’ and incipient/occult PLC presenting with chronic cough and a normal initial HRCT chest has not been previously reported., Highlights • Asthma, GERD and postnasal drip are the 3 most common causes of chronic cough. • Constitutional symptoms (weight loss etc.) never occur in chronic cough. • Pulmonary lymphangitic carcinomatosis can rarely present with chronic cough.

Ending the tuberculosis (TB) epidemic by 2030 was recently listed in the United Nations (UN) Sustainable Development Goals alongside HIV/AIDS and malaria as it continues to be a major cause of death worldwide. With a significant proportion of TB cases caused by resistant strains of Mycobacterium tuberculosis (Mtb), there is an urgent need to develop new and innovative approaches to treatment. Since 1989, researchers have been assessing the anti-bacterial effects of the active metabolite of vitamin A, all trans-Retinoic acid (ATRA) solution, in Mtb models. More recently the antibacterial effect of ATRA has been shown to regulate the immune response to infection via critical gene expression, monocyte activation and the induction of autophagy leading to its application as a host-directed therapy (HDT). Inhalation is an attractive route for targeted treatment of TB, and therefore we have developed ATRA-loaded microparticles (ATRA-MP) within the inhalable size range (2.07 ± 0.5 µm) offering targeted delivery of the encapsulated cargo (70.5 ± 2.3%) to the site of action within the alveolar macrophage, which was confirmed by confocal microscopy. Efficient cellular delivery of ATRA was followed by a reduction in Mtb growth (H37Ra) in THP-1 derived macrophages evaluated by both the BACT/ALERT® system and enumeration of colony forming units (CFU). The antibacterial effect of ATRA-MP treatment was further assessed in BALB/c mice infected with the virulent strain of Mtb (H37Rv). ATRA-MP treatments significantly decreased the bacterial burden in the lungs alongside a reduction in pulmonary pathology following just three doses administered intratracheally. The immunomodulatory effects of targeted ATRA treatment in the lungs indicate a distinct yet effective mechanism of action amongst the formulations. This is the first study to-date of a controlled release ATRA treatment for TB suitable for inhalation that offers improved targeting of a HDT, retains antibacterial efficacy and improves pulmonary pathology compared to ATRA solution.

The reaction patterns of each of the compartments of the lung are largely stereotypic. To assess pulmonary pathology, one should become conversant with the temporal sequences of pulmonary inflammation.

The structure of the lung determines its function. The various compartments of the lung are specially adapted to serve the activities of the lung. Pulmonary pathology is defined by the changes that occur in the underlying anatomy of the lung.

Recent advances in molecular biology have improved our understanding of the biology and etiology of neoplastic and non-neoplastic lung diseases, resulting in the development of novel molecular approaches for detection, diagnosis, and prognosis. Two major areas of molecular testing in pulmonary pathology include lung neoplasia and infectious diseases. Although our understanding of the pathogenesis of interstitial lung diseases has improved in recent years, no diagnostic or prognostic clinical molecular testing is available at this time. Some brief examples of current clinical applicators are given later, followed by more detailed discussion of selected topics outlined in Table 21-1 .

This chapter highlights the application of analytical electron microscopy (AEM) to pulmonary diseases for diagnostic purposes. The most successful AEM studies to date have involved environmental diseases, especially the mineral pneumoconioses. Analytical techniques, such as energy dispersive X-ray analysis (EDXA), are useful in localizing, identifying, and quantifying exogenous substances in such cases and in studying the mechanisms of disease, including environmental lung disorders. Because diverse toxic insults may elicit similar patterns of lung injury, AEM is often helpful in distinguishing different clinical conditions that share similar morphologies by light microscopy. AEM techniques are also useful in veterinary pulmonary medicine. In fact, studies on animals are crucial because they are useful models in understanding the biological consequences of environmental toxins. In lung, as well as in other anatomic sites, AEM offers the ability to simultaneously correlate ultrastructural and microchemical information. This represents an enormous advantage over traditional bulk methods of chemical analysis, such as mass spectroscopy or atomic absorption spectroscopy, which necessitate the physical disruption or consumption of tissue. Specifically, AEM enables the geometry, location, quantity, and distribution pattern of foreign particulates in lung tissue to be ascertained at the same time as their elemental composition is determined. Such information, when correlated with clinical and radiographic data, may provide valuable diagnostic information.

Sarcoidosis has been rarely described in literature as a cause of interstitial pulmonary disease associated with AIDS. This study reports a case of immune reconstitution inflammatory syndrome associated with pulmonary sarcoidosis in a patient with a history of previous pulmonary tuberculosis concomitant with HIV infection. Results of the immunohistochemical study of samples from the resected right lower lobe are described. Pathological findings suggest a role of Th1, Th2 and Th17 response in IRIS associated sarcoidosis. Keywords: acquired immunodeficiency syndrome, sarcoidosis, pulmonary, immune reconstitution inflammatory syndrome, immunohistochemistry

Because of reported changes in lung function and morphology in cannabis users and animals exposed to marihuana smoke, a rat model was developed for standardized automatic chronic exposure to marihuana smoke. The smoking apparatus was regulated to present a 50-ml puff volume simultaneously from each of 3 NIDA cigarettes in a 2-sec puff for a 30-sec exposure interval followed by 30-sec of fresh air each min. Estimated Δ9-THC doses in marihuana smoke were 0.4–5 mg/kg and were relevant to those used by man. The doses were attained by varying the number of puffs from 4 to 16 which correlated with carboxyhemoglobin levels between 15 and 48% and plasma Δ9-THC levels of 34–313 ng/ml. The latter were similar to those found in human cannabis consumers (20–300 ng/ml). Behavioral signs of CNS-inhibition and CNS-stimulation were in accord with dosages and development of tolerance was observed. No pulmonary pathology could be attributed to marihuana smoke when exposure was for 14–57 days. In contrast, exposures for 87–360 days induced a dose-related focal alveolitis or pneumonitis which progressed from extensive mobilization of alveolar macrophages and foreign body cell inflammation to pronounced focal proliferative aberrations associated with focal granulomatous and cholesterol clefts. In all chronic studies, the effects of marihuana smoke were distinguished from those of placebo and tobacco smoke. The lung pathology was due to a combination of non-specific smoke particulates and cannabinoids.

Nude mice failed to clear influenza virus from their lungs, and eventually died from pneumonia. In this report we describe the pulmonary pathology seen in nude and BALB/c immunocompetent mice infected with mouse adapted A/Port Chalmers/1/73 (H3N2) virus. Experiments were performed in an attempt to alter the course of influenza pneumonia by passive transfer of donor immune spleen cells to infected nude mice. As we reported earlier (1,2), immune spleen cells which are restimulated in vitro have enhanced cytotoxic T cell activity and when transferred to infected nude mice effect recovery. On the contrary, immune spleen cells which are not restimulated prior to transfer augment the antibody response of recipient mice, but do not effect recovery. We now describe the specificity of this protection afforded by these immune spleen cells following secondary in vitro stimulation. These spleen cells were highly protective against lethal challenge by homologous and heterologous virus strains. The strain specific protection was highest but very significant cross subtype protection was observed. This in vivo protection reflected the cross subtype cytotoxic activity noted in target cells following in vitro stimulation prior to transfer of these immune spleen cells to recipient mice. The cross reactive protection was type A specific, since immune spleen cells stimulated by type B virus did not protect.