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      Bronchoalveolar lavage as a diagnostic procedure: a review of known cellular and molecular findings in various lung diseases

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          Abstract

          Bronchoalveolar lavage (BAL) is a commonly used procedure in the evaluation of lung disease as it allows for sampling of the lower respiratory tract. In many circumstances, BAL differential cell counts have been reported to be typical of specific lung disorders. In addition, more specific diagnostic tests including molecular assays such as polymerase chain reaction (PCR) or enzyme-linked immunosorbent assay, special cytopathologic stains, or particular microscopic findings have been described as part of BAL fluid analysis. This review focuses on common cellular and molecular findings of BAL in a wide range of lung diseases. Since the performance of the first lung irrigation in 1927, BAL has become a common and important diagnostic tool. While some pulmonary disorders have a highly characteristic signature of BAL findings, BAL results alone often lack specificity and require interpretation along with other clinical and radiographic details. Development of new diagnostic assays is certain to reinforce the utility of BAL in the future. Our review of the BAL literature is intended to serve as a resource to assist clinicians in the care of patients with lung disorders.

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          Single-cell landscape of bronchoalveolar immune cells in patients with COVID-19

          Respiratory immune characteristics associated with Coronavirus Disease 2019 (COVID-19) severity are currently unclear. We characterized bronchoalveolar lavage fluid immune cells from patients with varying severity of COVID-19 and from healthy people by using single-cell RNA sequencing. Proinflammatory monocyte-derived macrophages were abundant in the bronchoalveolar lavage fluid from patients with severe COVID-9. Moderate cases were characterized by the presence of highly clonally expanded CD8+ T cells. This atlas of the bronchoalveolar immune microenvironment suggests potential mechanisms underlying pathogenesis and recovery in COVID-19.
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            An Official ATS/ERS/JRS/ALAT Statement: Idiopathic Pulmonary Fibrosis: Evidence-based Guidelines for Diagnosis and Management

            American Journal of Respiratory and Critical Care Medicine, 183(6), 788-824
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              Incidence of Programmed Cell Death 1 Inhibitor-Related Pneumonitis in Patients With Advanced Cancer: A Systematic Review and Meta-analysis.

              Programmed cell death 1 (PD-1) inhibitor-related pneumonitis is a rare but clinically serious and potentially life-threatening adverse event. Little is known about its incidence across different tumor types and treatment regimens.
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                Author and article information

                Journal
                J Thorac Dis
                J Thorac Dis
                JTD
                Journal of Thoracic Disease
                AME Publishing Company
                2072-1439
                2077-6624
                September 2020
                September 2020
                : 12
                : 9
                : 4991-5019
                Affiliations
                [1 ]Division of Pulmonary Sciences & Critical Care Medicine, University of Colorado Anschutz Medical Campus , Aurora, Colorado, USA;
                [2 ]Rocky Mountain Regional Veterans Affairs Medical Center , Aurora, Colorado, USA;
                [3 ]Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA;
                [4 ]National Jewish Health , Denver, Colorado, USA
                Author notes

                Contributions: (I) Conception and design: KR Davidson, ED Chan; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: None; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

                Correspondence to: Edward D. Chan, MD. D509, Neustadt Building, National Jewish Health, 1400 Jackson St, Denver, Colorado 80206, USA. Email: ChanE@ 123456NJHealth.org .
                Article
                jtd-12-09-4991
                10.21037/jtd-20-651
                7578496
                33145073
                89402d9f-71f4-4792-99fe-068cc903c9a4
                2020 Journal of Thoracic Disease. All rights reserved.

                Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

                Categories
                Review Article

                bronchoalveolar lavage (bal),bronchoscopy,cell count differential,lung disease,pneumonitis,signature

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