支气管肺冲洗加局部给药对顽固性肺感染疾病的疗效观察

用支气管肺冲洗加局部给药治疗３０例肺感染顽疾。结果示本法的疗效优于对照组（吸引组、非纤支镜组，Ｐ＜０．０５和Ｐ＜０．０１）。本文还就冲洗技术与疗效关系等有关问题作了简要的讨论。     

The Effectiveness of Immunotherapy in Treating Exercise-Induced Pulmonary Hemorrhage

Inflammatory airway disease has been linked to exercise-induced pulmonary hemorrhage (EIPH), and consequently, we hypothesized that immunomodulation via concentrated equine serum (CES) treatment would reduce EIPH as evidenced by red blood cell (RBC) concentrations in bronchoalveolar lavage fluid (BALF). Separate trials were conducted on Thoroughbred horses treated with either CES (n = 6) or placebo (0.9% saline; n = 4). All horses completed pre-treatment and post-treatment (2 and 4 weeks after initiating treatment) maximal exercise tests on a 10% inclined treadmill (1 m/s/min increments to fatigue) over a 10-week period (2−3 weeks between tests), with bronchoalveolar lavage (BAL) performed 30 minutes after exercise. Treatment ensued 10 days after the pre-treatment exercise test, with horses receiving a series of five CES or placebo injections 24 hours apart (20 mL intratracheal and 10 mL intravenously), with subsequent weekly injections for 5 weeks thereafter. After CES treatment, both EIPH (RBC in BALF) and inflammation (white blood cell concentration [WBC] in BALF) were significantly diminished by the 4-week posttreatment run, demonstrating 46 ± 12% and 24 ± 11% decreases, respectively (P < 0.05). In contrast, EIPH was elevated significantly at the 4-week time point, and inflammation remained constant in the placebo trial. In conclusion, these preliminary data suggest that therapeutic intervention involving immunomodulation may represent a viable approach to reducing the severity of EIPH.     

Proliferation of Streptococcus zooepidemicus and Pseudomonas aeruginosa within a simulated subpalpebral lavage flushed with equine serum

Objective  To evaluate whether equine serum administered via a simulated subpalpebral lavage system (SPL) supports proliferation of Streptococcus zooepidemicus or Pseudomonas aeruginosa within the tubing.
Procedures  A sterile i.v. catheter with injection cap was inserted into sterilized silicone tubing (Mila^®). To mimic an SPL within the dorsal conjunctival fornix, the tubing was secured to an elevated platform. The tip of the tubing extended from the platform into a vial containing culture medium just inoculated with approximately 1.5 × 10⁸ CFU/mL P. aeruginosa or S. zooepidemicus . To mimic administration of medication, the tubing was infused twice daily with equine serum, sterile saline (negative control), or culture medium (positive control) followed by air. Incubation was at 25 or 37 °C. At 24, 48, and 72 h postinoculation, samples were obtained for bacterial culture from one simulated SPL for each experimental variant. The following sections were cultured: (i) tubing tip previously submerged in the inoculated culture medium, (ii) tubing mid-section, and (iii) tip of the i.v. catheter. The experiment was performed in triplicate.
Results  Streptococcus zooepidemicus or P. aeruginosa were isolated from 100% of the tubing tips. Streptococcus zooepidemicus was isolated from one mid-section flushed with culture medium incubated at 37 °C. All other samples were negative for growth of the inoculated agents.
Conclusions  Streptococcus zooepidemicus and P. aeruginosa did not proliferate within silicone tubing infused with equine serum. These data suggest that topical serum can be safely administered through a superiorly placed SPL in clinical cases.     

Validation of a Rapid Bronchoalveolar Lavage Fluid Colorimetric Evaluation for Assessing the Severity of Exercise-Induced Pulmonary Hemorrhage in Horses in Field Conditions

Diagnosis and assessment of severity of exercise-induced pulmonary hemorrhage (EIPH) relies on postexercise visualization of fresh blood in the airways via tracheobronchoscopic examination (TBE) and/or counting erythrocytes in bronchoalveolar lavage fluid (BALFRBC). Determining the BALFRBC is more sensitive than TBE but its usefulness is hampered by the need to have BALFRBC counted at a laboratory. We explored the feasibility of evaluating the severity of EIPH by using a color chart comprised of five shades of red and matching those colors with the color of BALF immediately following collection. To validate the technique, sets of ten BALF samples with known BALFRBC numbers were created and randomly shown to two groups of 18 observers who independently matched the color of the BALF with one of the shades of red displayed on the screen of a smartphone. Interobserver and intra-observer agreements regarding colors were > 0.9. The utility of the color chart was further validated under field conditions at two barrel racing events where 63 BALF samples were collected from 21 horses and BALF color was graded independently by three observers. The number of BALFRBC in the 63 samples ranged from 25–1,100,000/μL. EIPH was diagnosed in 39 samples based on the detection of color, and all 5 colors were matched multiple times with BALF samples. Overall, the color of the BALF was related to the number of BALFRBC. Colorimetric evaluation of BALF represents a practical and reliable option for rapid postexercise assessment of the presence and severity of EIPH.     

Lung function and airway cytologic profiles in horses with recurrent airway obstruction maintained in low-dust environments

BACKGROUND: The effects of long-term environmental management on airway obstruction and inflammation in horses with recurrent airway obstruction (RAO) are unknown. HYPOTHESIS: Horses with RAO maintained in low-dust environments have persistent airway obstruction and neutrophilic inflammation. ANIMALS: Study horses were treated for RAO and then maintained in low-dust environments with no medical management. Horses were classified into 3 groups by years after diagnosis: 1 year (time 1, n = 9), 2-3 years (time 2, n = 7), and 5-6 years (time 3, n = 8). The comparison groups were age-matched healthy horses. METHODS: In this cross-sectional study, a clinical examination was performed, and the clinical score was calculated. Standard lung function, forced expiratory maneuvers, and the cytology of bronchoalveolar lavage fluid (BALF) were evaluated. RESULTS: The clinical scores of the RAO horses were higher than those of the non-RAO horses at time 2 (P = .018). Standard lung function data were not different between the groups at any time point. The forced expiratory flow between 75-95% of exhaled vital capacity was lower in RAO horses than in non-RAO horses at all time points (P < .02), indicating persistent peripheral airway obstruction. Cytologic evaluation of BALF revealed no difference in total nucleated cell numbers or differential cell counts between RAO and non-RAO horses at any time point. CONCLUSIONS AND CLINICAL IMPORTANCE: The peripheral airway obstruction detected in horses with RAO maintained in low-dust environments likely is due to irreversible airway remodeling but is not associated with cytologic evidence of airway inflammation.     

Influence of subclinical inflammatory airway disease on equine respiratory function evaluated by impulse oscillometry

Reasons for performing study: Inflammatory airway disease (IAD) is a nonseptic condition of the lower respiratory tract. Its negative impact on respiratory function has previously been described using either forced expiration or forced oscillations techniques. However, sedation or drug‐induced bronchoconstriction were usually required. The impulse oscillometry system (IOS) is a noninvasive and sensitive respiratory function test validated in horses, which could be useful to evaluate IAD‐affected horses without further procedures. Objectives: To determine the sensitivity of IOS in detecting alterations of the respiratory function in subclinically IAD‐affected horses without inducing bronchoprovocation and to characterise their respiratory impedance according to frequency for each respiratory phase. Methods: Pulmonary function was evaluated at rest by IOS in 34 Standardbred trotters. According to the cytology of bronchoalveolar lavage fluid (BALF), 19 horses were defined as IAD‐affected and 15 horses were used as control (CTL). Total respiratory resistance (Rrs) and reactance (Xrs) from 1–20 Hz as well as their inspiratory and expiratory components were compared between groups. Results: A significant increase of Rrs at the lower frequencies (R_{1–10 Hz}) as well as a significant decrease of Xrs beyond 5 Hz (X_{5–20 Hz}) was observed in IAD compared to CTL horses. IOS‐data was also significantly different between inspiration and expiration in IAD‐affected horses. In the whole population, both BALF eosinophil and mast cell counts were significantly correlated with IOS measurements. Conclusions: Functional respiratory impairment may be measured, even in the absence of clinical signs of disease. In IAD‐affected horses, the different parameters of respiratory function (Rrs or Xrs) may vary depending on the inflammatory cell profiles represented in BALF. Potential relevance: Impulse oscillometry could be used in a routine clinical setting as a noninvasive method for early detection of subclinical respiratory disease and of the results of treatment in horses.     

Effect of type of dietary polyunsaturated fatty acid supplement (corn oil or fish oil) on immune responses in healthy horses

The objective of this study was to compare effects of dietary polyunsaturated fatty acid supplementation (corn oil or fish oil) on selected immune responses in normal horses. Two groups of horses (n = 5) were randomly assigned a dietary supplement with either 3.0% corn oil or fish oil for a period of 14 weeks. Plasma fatty acid profiles were monitored to ensure uptake of dietary fatty acids. Cell-mediated immunity was assessed by a delayed-type hypersensitivity (DTH) skin test to keyhole limpet hemocyanin (KLH), and humoral immunity was assessed by measuring antibody titers to KLH. Production of prostaglandin E2 (PGE2), expression of tumor necrosis factor-alpha (TNF-alpha), and phagocytosis of latex beads by bronchoalveolar lavage fluid (BALF) cells were also assessed. Lipopolysaccharide (LPS)-stimulated BALF cells from horses fed corn oil showed a higher production of PGE2 compared with those from horses fed fish oil at 6 and 12 weeks. Production of TNF-alpha by LPS-stimulated BALF cells was higher in both groups of horses at 6, 8, and 12 weeks compared with pretrial values, and phagocytic activity of BALF cells was higher at 8 and 12 weeks, however, there were no differences between the 2 groups of horses. The DTH skin test and antibody titers to KLH revealed no differences between horses fed corn or fish oil. Based on these studies, dietary polyunsaturated fatty acids modulate the inflammatory response of horses. Both fatty acid supplements increased production of the proinflammatory cytokine TNF-alpha, whereas only corn oil increased production of the proinflammatory eicosanoid PGE2 by LPS-stimulated BALF cells. It is possible that fish oil, because it did not increase production of PGE2, could have value in the treatment of equine recurrent airway obstruction or other equine inflammatory diseases.     

Awara (Astrocaryum vulgare M.) pulp oil: chemical characterization, and anti-inflammatory properties in a mice model of endotoxic shock and a rat model of pulmonary inflammation

Awara (Astrocaryum vulgare M.) is a palm fruit mainly used in nutrition. We analysed the pulp oil for fatty acid, tocopherol, carotenoid, and phytosterol and we evaluated whether this oil may attenuate inflammation in vivo. In an endotoxic shock model, awara pulp oil treatment decreased pro-inflammatory cytokines and increased anti-inflammatory cytokines. In a pulmonary inflammation model, awara pulp oil treatment reduced eosinophil and lymphocyte numbers recovered into the broncho-alveolar lavages. These results suggest that awara pulp oil administration can efficiently counteract an acute and chronic inflammatory response in vivo that is probably mediated by fatty acids and minor compounds.