Integrating multi-disciplinary discussion in clinical practice

Interstitial lung diseases are very heterogeneous. We present a case of usual interstitial pneumonia pattern on high resolution computed tomography of the chest that was diagnosed successfully after multi-disciplinary discussion. Pulmonologists should be aware of the pitfalls in the diagnostic management of interstitial lung diseases, especially in cases with atypical clinical presentation and systemic signs and symptoms

The Role of Endoscopic Ultrasound in the Diagnosis and Management of Primary Gastric Lymphoma

Endoscopic ultrasound (EUS) is considered a valuable diagnostic tool during the workup of malignant gastric lesions, including primary gastric lymphomas (PGL). Although endoscopy combined with multiple biopsies remains essential in the establishment of PGL diagnosis, EUS utilization in locoregional disease staging has been well documented in the literature. Data also support the possible role of EUS in prediction of response to first-line treatment, that is, Helicobacter pylori eradication. However, its application in the posttreatment setting remains problematic, since concordance rates between endosonography and histology findings during follow-up seem to vary substantially. The aim of the present review is to summarize all available data regarding the role of EUS in the management of PGL

Obstetric outcomes after treatment of periodontal disease during pregnancy: systematic review and meta-analysis

Objective To examine whether treatment of periodontal disease with scaling and root planing during pregnancy is associated with a reduction in the preterm birth rate

Serum Levels of Surfactant Proteins in Patients with Combined Pulmonary Fibrosis and Emphysema (CPFE)

Introduction Emphysema and idiopathic pulmonary fibrosis (IPF) present either per se or coexist in combined pulmonary fibrosis and emphysema (CPFE). Serum surfactant proteins (SPs) A, B, C and D levels may reflect lung damage. We evaluated serum SP levels in healthy controls, emphysema, IPF, and CPFE patients and their associations to disease severity and survival. Methods 122 consecutive patients (31 emphysema, 62 IPF, and 29 CPFE) and 25 healthy controls underwent PFTs, ABG-measurements, 6MWT and chest HRCT. Serum levels of SPs were measured. Patients were followed-up for 1-year. Results SP-A and SP-D levels differed between groups (p = 0.006 and p= 26 ng/mL) presented a weak association with reduced survival (p = 0.05). Conclusion In conclusion, serum SP-A and SP-D levels were higher where fibrosis exists or coexists and related to disease severity, suggesting that serum SPs relate to alveolar damage in fibrotic lungs and may reflect either local overproduction or overleakage. The weak association between high levels of SP-B and survival needs further validation in clinical trials

Post-COVID-19 interstitial lung disease: Insights from a machine learning radiographic model

IntroductionPost-acute sequelae of COVID-19 seem to be an emerging global crisis. Machine learning radiographic models have great potential for meticulous evaluation of post-COVID-19 interstitial lung disease (ILD).MethodsIn this multicenter, retrospective study, we included consecutive patients that had been evaluated 3 months following severe acute respiratory syndrome coronavirus 2 infection between 01/02/2021 and 12/5/2022. High-resolution computed tomography was evaluated through Imbio Lung Texture Analysis 2.1.ResultsTwo hundred thirty-two (n = 232) patients were analyzed. FVC% predicted was ≥80, between 60 and 79 and <60 in 74.2% (n = 172), 21.1% (n = 49), and 4.7% (n = 11) of the cohort, respectively. DLCO% predicted was ≥80, between 60 and 79 and <60 in 69.4% (n = 161), 15.5% (n = 36), and 15.1% (n = 35), respectively. Extent of ground glass opacities was ≥30% in 4.3% of patients (n = 10), between 5 and 29% in 48.7% of patients (n = 113) and <5% in 47.0% of patients (n = 109). The extent of reticulation was ≥30%, 5–29% and <5% in 1.3% (n = 3), 24.1% (n = 56), and 74.6% (n = 173) of the cohort, respectively. Patients (n = 13, 5.6%) with fibrotic lung disease and persistent functional impairment at the 6-month follow-up received antifibrotics and presented with an absolute change of +10.3 (p = 0.01) and +14.6 (p = 0.01) in FVC% predicted at 3 and 6 months after the initiation of antifibrotic.ConclusionPost-COVID-19-ILD represents an emerging entity. A substantial minority of patients presents with fibrotic lung disease and might experience benefit from antifibrotic initiation at the time point that fibrotic-like changes are “immature.” Machine learning radiographic models could be of major significance for accurate radiographic evaluation and subsequently for the guidance of therapeutic approaches

Innate immunity involvement in the pathogenesis of interstitial lung diseases

Background: This is a prospective cohort study elucidating innate immunity in Idiopathic Pulmonary Fibrosis (IPF), Cryptogenic Organizing Pneumonia (COP), Rheumatoid Arthritis-associated Usual Interstitial Pneumonia (RA-UIP) and RA-associated Non Specific Interstitial Pneumonia (RA-NSIP).Methods: 23 IPF subjects, 9 COP subjects, 5 RA-UIP subjects, 8 RA-NSIP subjects were enrolled. 10 subjects were excluded. 19 healthy subjects served as controls. Blood and Bronchoalveolar Lavage (BAL) were obtained. Natural Killer (NK) and NKT cells, NK cells apoptosis and the expression of Triggering Receptor Expressed on Myeloid Cells type 1 (TREM-1) were assessed. Tumor necrosis factor-α (TNF-α) production was measured in cell cultures after stimulation with lipopolysaccharide endotoxin (LPS) and Pam3CysSK3, and in BAL. Surface expression of Toll-Like Receptors (TLR) 2 and 4 on Peripheral Blood Monocytes (PBMC`s) and circulating NK cells was also assessed.Results: RA-NSIP had low blood NKs, marginally insignificant (p=0.07). These NKs poorly produced TNF-α after LPS stimulation. TLR`s expression on NK cells was similar throughout disease groups and controls. PBMC`s mainly from IPF patients exhibited low TNF-α production after LPS stimulation but not after Pam3CysSK3 stimulation, while TLR4 expression on PBMC`s was found normal in all study groups. TLR2 expression on PBMC`s was increased in IPF, but mainly in COP, RA-UIP and RA-NSIP (p=0.015). TREM-1 expression was significant on COP monocytes and on COP neutrophils versus controls. RA-NSIP monocytes also exhibited TREM-1 expression (p=0.07). Decreased TNF-α concentration in BAL was finally observed in IPF and RA-UIP. Conclusions: Innate immunity in the lungs and the peripheral circulation in IPF and RA-UIP is similar and more fibrotic than in RA-NSIP which is characterized by NK cell depletion and dysfunction. TREM-1 and TLR`s likely affect patterns of inflammation in various interstitial lung diseases.Εισαγωγή: Διενεργήσαμε μία προοπτική μελέτη με σκοπό τη διερεύνηση της συμμετοχής της μη-ειδικής ανοσίας στην Iδιοπαθή Πνευμονική Ίνωση (ΙΠΙ), στη Κρυπτογενή Οργανούμενη Πνευμονία (ΚΟΠ), στη Ρευματοειδή Αρθρίτιδα με Συνήθη Διάμεση Πνευμονία (ΡΑ-ΣΔΠ) και στη Ρευματοειδή Αρθρίτιδα με Μη Ειδική Διάμεση Πνευμονία (ΡΑ-ΜΕΔΠ). Μέθοδος: Στη μελέτη εισήχθηκαν 23 ασθενείς με ΙΠΙ, 9 ασθενείς με ΚΟΠ, 5 ασθενείς με ΡΑ-ΣΔΠ και 8 ασθενείς με ΡΑ-ΜΕΔΠ. 10 ασθενείς με άλλα νοσήματα αποκλείστηκαν από τη μελέτη, ενώ 19 υγϊή άτομα επιλέχθηκαν ως μάρτυρες. Λήφθηκε περιφερικό αίμα και Βρογχοκυψελιδικό Έκπλυμα (ΒΚΕ). Εξετάσθηκαν τα κύτταρα φυσικοί φονείς (ΝΚ) και τα ΝΚΤ κύτταρα του αίματος, η απόπτωση των ΝΚ κυττάρων και η έκφραση του ενεργοποιητικού υποδοχέα επί των μυελοειδών κυττάρων τύπου 1 (TREM-1). Μετρήθηκε η συγκέντρωση του παράγοντα νέκρωσης των όγκων (TNF-α) στο ΒΚΕ και η παραγωγή του σε κυτταρο-καλλιέργειες μετά από διέγερσή τους είτε με λιπο-πολυσακχαριδική ενδοτοξίνη (LPS) είτε με Pam3CysSK3. Μελετήθηκε επίσης η έκφραση των υποδοχέων TLR 2 και 4 στην επιφάνεια των μονοκυττάρων και των ΝΚ κυττάρων του περιφερικού αίματος.Αποτελέσματα: Οι ασθενείς με ΡΑ-ΜΕΔΠ είχαν μειωμένα ΝΚ κύτταρα στο αίμα, οριακά στατιστικώς μη σημαντικά (p=0.07), τα οποία εμφάνισαν και πτωχή παραγωγή TNF-α μετά από διέγερση με LPS. Η έκφραση των TLR υποδοχέων επί των ΝΚ κυττάρων ήταν αδιάφορη μεταξύ ασθενών και μαρτύρων. Τα μονοκύτταρα των ασθενών με ΙΠΙ ανέδειξαν χαμηλή παραγωγή TNF-α μετά από διέγερση με LPS, αλλά φυσιολογική μετά από διέγερση με Pam3CysSK3, ενώ η έκφραση του TLR4 επί των μονοκυττάρων ανευρέθηκε φυσιολογική. Αντίθετα, η έκφραση του TLR2 επί των μονοκυττάρων ανευρέθηκε αυξημένη στην ΙΠΙ, και κυρίως στις ΚΟΠ, ΡΑ-ΣΔΠ και ΡΑ-ΜΕΔΠ (p=0.015). Τα μονοκύτταρα και τα ουδετερόφιλα ασθενών με ΚΟΠ παρουσίασαν έντονη έκφραση TREM-1. Ασθενότερη έκφραση ανευρέθηκε στα μονοκύτταρα ασθενών με ΡΑ-ΜΕΔΠ (p=0.07). Τέλος, στο ΒΚΕ των ομάδων με ΙΠΙ και ΡΑ-ΣΔΠ ανευρέθηκε μειωμένη συγκέντρωση TNF-α.Συμπέρασμα: H μη-ειδική ανοσία στους πνεύμονες και στη συστηματική κυκλοφορία έχει παρόμοια ινοποιά χαρακτηριστικά στις IΠΙ και ΡA-ΣΔΠ απ`ότι η ΡA-ΜΕΔΠ, η οποία διακρίνεται από εξάντληση στην περιφέρεια μη λειτουργικών ΝΚ κυττάρων. Οι υποδοχείς TREM-1 και οι TLR πιθανότατα επηρεάζουν τη φλεγμονή στις διάχυτες παρεγχυματικές πνευμονοπάθειες