Sarcoidosis: challenging diagnostic aspects of an old disease.

Over the past few years, there have been substantial advances in our understanding of sarcoidosis immunopathogenesis. Conversely, the etiology of the disease remains obscure for a number of reasons, including heterogeneity of clinical manifestations, often overlapping with other disorders, and insensitive and nonspecific diagnostic tests. While no cause has been definitely confirmed, there is increasing evidence that one or more infectious agents may cause the disease, although the organism may no longer be viable. Here we present 2 cases, in which sarcoidosis preceded tuberculosis and non-Hodgkin lymphoma. Development of new lesions in a patient with chronic/remitting sarcoidosis should be looked at with suspicion and promptly investigated in order to rule out an alternative/concomitant diagnosis. In such cases, tissue confirmation from the most accessible site, and bone marrow biopsy-if lymphoma is in the differential diagnosis-should be performed. In conclusion, we strongly advise that physicians be ready to reconsider the diagnosis of sarcoidosis in the presence of atypical manifestations or persistent/progressive disease despite conventional therapy

Diagnosis of occult tuberculosis in hematological malignancy by enumeration of antigen-specific T cells.

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Evaluation of carcass quality, body and pulmonary lesions detected at the abattoir in heavy pigs subjected or not to tail docking

BackgroundNowadays, body and tail lesions and respiratory disease are some of the greatest problems affecting the health and welfare of pigs. The aim of the study was to measure the prevalence of pleurisy, bronchopneumonia (enzootic pneumonia like lesions) and lesions on tail and body of heavy pigs subjected or not to tail docking through the inspection in Italian abattoirs. Additionally, the effect of tail docking and season was investigated on carcass quality (weight, % of lean meat, and Protected Designation of Origin (PDO) classification). For this purpose, a total 17.256 carcasses belonging to 171 batches from 103 farms were inspected in an Italian abattoir between 2019 and 2022. Enzootic pneumonia (EP) like lesions were scored according to the Madec and Derrien method, while pleurisy was scored using the Italian Slaughterhouse pleuritic evaluation system (SPES). For the tail and body, the lesions were scored according to Welfare Quality. The lesion score index (LSI) was calculated for each area. Data were analysed using a general linear model (GLM) including tail caudectomy, season and distance of the farm from the abattoir.ResultsThe warm season increased the percentage of lesions in carcasses in all parts of the body observed (P < 0.0001). The presence of undocked tail increased the LSI of the tail (P < 0.0001). The percentage of limbs lesions with score 2 and limbs LSI increase with increasing duration of transport (coef. = 0.003, P < 0.001; coef. = 0.008, P < 0.001; respectively). The hot carcass weight and the percentage of carcasses included in the PDO were higher in batches with docked tails (P = 0.027; P < 0.001, respectively), while the percentage of lean meat was higher in batches with undocked tails (P < 0.001). There was a negative correlation between the percentage of carcasses included in PDO and the LSI of tail (r = - 0.422; P < 0.001).ConclusionsIn conclusion, the presence of the undocked tail and the warm season can be considered risk factors for the prevalence of tail lesions, while long transport can increase limb lesions. Furthermore, the carcass weight and meat quality were negatively influenced by tail lesions

Epidemiology and management of interstitial lung disease in ANCA-associated vasculitis

Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a group of systemic vasculitides that predominantly affect small vessels, including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Pulmonary involvement is frequently observed in AAV patients, with various possible phenotypes in the different diseases. In the last years, among the possible types of lung involvement, a growing interest has been addressed to the interstitial lung disease (ILD). Prevalence of ILD is higher in MPA than in GPA; in fact, ILD has been reported in up to 45% of MPA patients and in 23% of GPA. Anti-MPO antibodies are the main ANCA subtype associated to ILD, in about 46-71% of cases, while anti-PR3 antibodies are reported in 0-29% of patients. High resolution computed tomography (HRCT) frequently detects interstitial lung abnormalities in AAV, up to 66% of patients with MPA, even if with an unclear clinical relevance, specifically in asymptomatic patients. Ground glass opacities, mainly consistent with diffuse alveolar hemorrhage (DAH), are the most frequent finding in MPA patients, but reticulations, interlobular septal thickening and honeycombing are also reported. ILD significantly affects quality of life and survival, with mortality increased 2 to 4 times, particularly higher in MPA patients with pulmonary fibrosis. Currently, immunosuppressive therapy is considered also as a possible treatment of ILD. However, a careful evaluation of progression and severity of lung involvement, should guide the treatment decision in the single patient. In this review, we discuss the available evidence on clinical features, diagnostic work-up, prognosis and management of AAV-ILD

Spectrally and temporally resolved estimation of neural signal diversity

Quantifying the complexity of neural activity has provided fundamental insights into cognition, consciousness, and clinical conditions. However, the most widely used approach to estimate the complexity of neural dynamics, Lempel-Ziv complexity (LZ), has fundamental limitations that substantially restrict its domain of applicability. In this article we leverage the information-theoretic foundations of LZ to overcome these limitations by introducing a complexity estimator based on state-space models — which we dub Complexity via State-space Entropy Rate (CSER). While having a performance equivalent to LZ in discriminating states of consciousness, CSER boasts two crucial advantages: 1) CSER offers a principled decomposition into spectral components, which allows us to rigorously investigate the relationship between complexity and spectral power; and 2) CSER provides a temporal resolution two orders of magnitude better than LZ, which allows complexity analyses of e.g. event-locked neural signals. As a proof of principle, we use MEG, EEG and ECoG datasets of humans and monkeys to show that CSER identifies the gamma band as the main driver of complexity changes across states of consciousness; and reveals early entropy increases that precede the standard ERP in an auditory mismatch negativity paradigm by approximately 20ms. Overall, by overcoming the main limitations of LZ and substantially extending its range of applicability, CSER opens the door to novel investigations on the fine-grained spectral and temporal structure of the signal complexity associated with cognitive processes and conscious states

Sensitive detection of circulating breast cancer cells by reverse-transcriptase polymerase chain reaction of maspin gene

Background: Maspin, a recently identified protein related to the family of serpins, is believed to play a role in human breast cancer. In an effort to improve the present methods of detection, we have developed a reverse-transcriptase polymerase chain reaction (RT-PCR) assay for maspin transcript to identify small numbers of mammary carcinoma cells in the peripheral blood and bone marrow of patients with breast cancer. Patients and methods: Five non-neoplastic mammary tissue samples, 13 breast cancer specimens as well as 17 peripheral blood and 4 bone marrow samples from normal subjects were screened for the presence of maspin mRNA by RT-PCR. The same assay was applied to peripheral blood or bone marrow samples obtained from 29 patients with stages I to IV breast cancer. Results: By RT-PCR it was possible to amplify maspin mRNA in all of the primary and metastatic breast cancer specimens, but in none of the normal hemopoietic samples from healthy donors. Thus, detection of maspin transcript in the peripheral blood or marrow of a patient known to have breast cancer is indicative of the presence of mammary carcinoma cells. In reconstitution experiments, maspin RT-PCR reliably detected 10 mammary carcinoma cells in 1 million normal peripheral-blood mononuclear cells (PBMCs). None of the 9 patients with stages I, II, or III breast cancer had maspin transcript in peripheral blood. Of note, 3 of 9 patients with stage TV breast cancer receiving systemic therapy at the time of sample collection, but only I of 11 patients with stage IV not receiving therapy, had detectable maspin transcript in peripheral blood. Moreover, 3 marrow specimens from stage TV patients tested positive by this assay. Conclusions: This pilot study suggests that maspin RT-PCR assay is a sensitive, specific and sufficiently rapid method for detection of small numbers of circulating cells and marrow micrometastases in breast cancer patients. The possibility of applying this assay in the detection of tumor cell contamination of both marrow and stem-cell apheresis harvests of breast cancer patients merits further investigation

Immunity to Polyomavirus BK Infection: Immune Monitoring to Regulate the Balance between Risk of BKV Nephropathy and Induction of Alloimmunity.

Polyomavirus BK-associated nephropathy (PyVAN) is the main infectious cause of allograft damage after kidney transplantation. A number of studies revealed an association between the presence of BKV-specific cellular immunity and BK viral clearance, with patients failing to recover specific T cells progressing to PyVAN. Evolution to allograft dysfunction can be prevented by restoration of BKV-specific immunity through a stepwise reduction of maintenance immunosuppressive drugs. Prospective monitoring of BK viral load and specific immunity, together with B-cell alloimmune surveillance, may allow a targeted modification/reduction of immunosuppression, with the aim of obtaining viral clearance while preventing graft injury due to deposition of de novo donor-specific HLA antibodies and late/chronic antibody-mediated allograft injury. Innovative, immune-based therapies may further contribute to BKV infection prevention and control

Interstitial pneumonia with autoimmune features: Why rheumatologist–pulmonologist collaboration is essential

In 2015 the European Respiratory Society (ERS) and the American Thoracic Society (ATS) “Task Force on Undifferentiated Forms of Connective Tissue Disease-associ-ated Interstitial Lung Disease” proposed classification criteria for a new research category defined as “Interstitial Pneumonia with Autoimmune Features” (IPAF), to uniformly de-fine patients with interstitial lung disease (ILD) and features of autoimmunity, without a definite connective tissue disease. These classification criteria were based on a variable combination of features obtained from three domains: a clinical domain consisting of extra-thoracic features, a serologic domain with specific autoantibodies, and a morphologic domain with imaging patterns, histopathological findings, or multicompartment in-volvement. Features suggesting a systemic vasculitis were excluded. Since publication of ERS/ATS IPAF research criteria, various retrospective studies have been published focusing on prevalence; clinical, morphological, and serological features; and prognosis of these patients showing a broad heterogeneity in the results. Recently, two prospective, cohort studies were performed, confirming the existence of some peculiarities for this clinical entity and the possible progression of IPAF to a defined connective tissue disease (CTD) in about 15% of cases. Moreover, a non-specific interstitial pneumonia pattern, an anti-nuclear antibody positivity, and a Raynaud phenomenon were the most common findings. In comparison with idiopathic pulmonary fibrosis (IPF), IPAF patients showed a better performance in pulmonary function tests and less necessity of oxygen delivery. However, at this stage of our knowledge, we believe that further prospective studies, possibly derived from multicenter cohorts and through randomized control trials, to further validate the proposed classification criteria are needed

Antifibrotic treatment response and prognostic predictors in patients with idiopathic pulmonary fibrosis and exposed to occupational dust

BACKGROUND: Idiopathic Pulmonary Fibrosis (IPF) is an aggressive interstitial lung disease with an unpredictable course. Occupational dust exposure may contribute to IPF onset, but its impact on antifibrotic treatment and disease prognosis is still unknown. We evaluated clinical characteristics, respiratory function and prognostic predictors at diagnosis and at 12 month treatment of pirfenidone or nintedanib in IPF patients according to occupational dust exposure. METHODS: A total of 115 IPF patients were recruited. At diagnosis, we collected demographic, clinical characteristics, occupational history. Pulmonary function tests were performed and two prognostic indices [Gender, Age, Physiology (GAP) and Composite Physiologic Index (CPI)] calculated, both at diagnosis and after the 12 month treatment. The date of long-term oxygen therapy (LTOT) initiation was recorded during the entire follow-up (mean = 37.85, range 12-60 months). RESULTS: At baseline, patients exposed to occupational dust [≥ 10 years (n = 62)] showed a lower percentage of graduates (19.3% vs 54.7%; p = 0.04) and a higher percentage of asbestos exposure (46.8% vs 18.9%; p 0.002) than patients not exposed [< 10 years (n = 53)]. Both at diagnosis and after 12 months of antifibrotics, no significant differences for respiratory function and prognostic predictors were found. The multivariate analysis confirmed that occupational dust exposure did not affect neither FVC and DLCO after 12 month therapy nor the timing of LTOT initiation. CONCLUSION: Occupational dust exposure lasting 10 years or more does not seem to influence the therapeutic effects of antifibrotics and the prognostic predictors in patients with IPF

Changes of the digestive tract of Golden Retriever dogs affected by muscular dystrophy

O modelo experimental canino Golden Retriever portador da Distrofia Muscular (GRMD) é o melhor substituto entre os modelos animais para estudar a Distrofia Muscular de Duchenne. Além da musculatura estriada, a doença pode afetar a musculatura estriada cardíaca e a musculatura lisa, e desta forma, o funcionamento do trato digestório, já que o músculo liso é o elemento primário dos órgãos tubulares. Através de estudo morfológico descritivo, o objetivo deste trabalho foi verificar se a distrofia muscular afeta a arquitetura geral do trato digestório e como se dispõe sua estrutura muscular em animais afetados. Foram realizadas avaliações descritivas macro e microscópicas com colorações de Hematoxilina-Eosina, Tricrômio de Masson e Picrosirius. Entre os resultados apresentados, verificou-se que o esôfago e o fígado dos animais afetados encontraram-se alterados, assim como o estômago não ocupava seu lugar habitual. O músculo diafragma apresentava-se atrofiado e diferenças histológicas foram encontradas na camada muscular do sistema gastrointestinal, em geral. Outras estruturas do tubo digestório de GRMDs apresentaram-se de maneira similar a de um animal normal.The experimental canine model Golden Retriever carrier of Muscular Dystrophy (GRMD) is the best substitute of animal models to study Duchenne Muscular Dystrophy. Above striated muscle, the disease can affect the heart and smooth muscle, so the functioning of the digestive tract, as the smooth muscle is the primary element of tubular organs. Through morphological description, the purpose of this study was to determine whether the muscular dystrophy affects the overall architecture of the digestive tract and how is willing this muscular structure. Were evaluated macroscopic and microscopic optical description staining with hematoxylin-eosin, Masson's trichrome and Sirius. The esophagus and liver of affected animals were altered. The stomach of the animals did not occupy the usual space. The diaphragm muscle had atrophied. The general histological structure of the digestive tract presented in a manner similar to a normal animal. Changes and histological differences were found in the muscle layer.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq