Granulomаtosis With Polyangiitis Affecting the Lung and Orbit

The paper describes a clinical case of pulmonary and right orbital injuries in granulomatosis with polyangiitis in a 38-year-old male. The case is of considerable interest due to the rarity of this pathology, especially because of the localization in the orbital region. The information provided in this paper can help in the early and accurate diagnosis of granulomatosis with polyangiitis, which, in turn, will improve the prognosis of the disease

КТ-признак «матовое стекло» при гранулематозе с полиангиитом и внебольничной пневмонии.

Granulomatosis with polyangiitis (GPA) is a rare systemic disease characterized by two parallel processes: necrotizing granulomatous inflammation and low-immune vasculitis predominantly affecting small vessels. Differential diagnosis of lung lesions on CT in patients with an established diagnosis of granulomatosis with polyangiitis can be very difficult.Purpose. Developing computed tomography criteria for the differential diagnosis of infiltrative changes in the lungs in patients with GPA and community-acquired bacterial pneumonia.Materials and methods. 67 CT examinations of the chest by 24 patients with verified GPA with infiltrative lung lesions and 36 CT examinations by 30 patients with bacterial pneumonia without concomitant pulmonary pathology, a comparative analysis of the following characteristics of ground glass opacity symptom was performed: “location", “craniocaudal distribution”, “uniformity”, “localization”, “quantity”, “association with consolidation”, “association with pleural effusion”. CT was performed natively on a Toshiba Aquilion Prime CT scanner according to a standard examination protocol with a slice thickness of 1 mm. Statistical processing of the obtained results was carried outusing the software application RStudio, version 1.3.1093 for mac OS (RStudio, PBC). To study the relationships between two categorical variables, the χ2 independence test and the principal component method for categoricalvariables were used.Results. GPA is characterized by multiple bilateral areas of ground glass opacity compaction, often with a central location, without a statistically significant craniocaudal dependence in the lung regions. In community-acquired pneumonia, this sign is more likely to be unilateral with a peripheral location in the lower lobes of the lung. Statistically significant differences in the degree of homogeneity, combination with consolidation, pleural effusion have not been established.Conclusion. CT reveals the characteristic features of the ground glass opacity CT sign in GPA and pneumonia, which, together with clinical and laboratory data, increase the accuracy of radiodiagnosis of these diseases.Гранулематоз с полиангиитом (ГПА) является редким системным заболеванием, которое характеризуется двумя параллельно протекающими процессами: некротизирующим гранулематозным воспалением и малоиммунным васкулитом с поражением преимущественно сосудов мелкого калибра. Дифференциальная диагностика поражения легких при КТ у пациентов с установленным диагнозом ГПА и инфильтративными изменениями легких представляет значительные трудности.Цель исследования: проанализировать КТ-проявления инфильтративных изменений в легких при ГПА и внебольничной бактериальной пневмонии и выявить возможности их дифференциальной диагностики.Материал и методы. На основании 67 КТ-исследований органов грудной клетки у 24 пациентов с верифицированным ГПА с поражением легких инфильтративного характера и 36 КТ-исследований у 30 пациентов с бактериальной пневмонией без сопутствующей легочной патологии проведен сравнительный анализ следующих характеристик симптома “матовое стекло”: “расположение”, “краниокаудальное распределение”, “однородность”, “локализация”, “количество”, “связь с консолидацией”, “связь с плевральным выпотом”. КТ выполнена на компьютерном томографе Toshiba Aquilion Prime нативно по стандартному протоколу исследования с толщиной среза 1 мм. Проведена статистическая обработка полученных результатов с помощью программного приложения RStudio, версия 1.3.1093 for mac OS (RStudio, PBC). Для изучениясвязей между двумя категориальными переменными применяли критерий независимости χ2 и метод глав-ных компонент для категориальных переменных.Результаты. Для ГПА характерны множественные двусторонние участки уплотнения по типу “матового стекла” чаще с центральным расположением, без статистически значимой краниокаудальной зависимости по отделам легких. При внебольничной пневмонии этот признак с большей вероятностью будет односторонним с периферическим расположением в нижних долях легкого. Статистически достоверных различий в степени однородности, сочетании с консолидацией, плевральным выпотом не установлено.Заключение. КТ позволяет выявить характерные особенности КТ-признака “матовое стекло” при ГПА и пневмонии, которые в совокупности с клинико-лабораторными данными повышают точность лучевой диагностики этих заболеваний

Современные представления о распространенности, патоморфологии и диагностике гранулематоза с полиангиитом с поражением легких (обзор литературы)

Granulomatosis with polyangiitis (GPA) (Wegener's granulomatosis) is a rare systemic autoimmune disease from the group of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCAs). GPA is proceeding with granulomatous inflammation, mainly of the upper and lower respiratory tract and low-immune necrotizing vasculitis that affects small- and medium-size vessels in lungs, kidneys, skin. The disease is an extremely rare long-term systemic disorder, is rarely the object of research, the literature data are few and unsystematic.Purpose. The purpose of the literature review was to study the published materials, analyze the received information and define tasks for further study of this pathology, primarily from the standpoint of radiation diagnostics.Materials and methods. The search was carried out in bibliographic databases MedLine, PubMed, if necessary, links to external full-text sources were used. 36 of the most significant publications were selected and worked out, including 8 domestic and 28 foreign. One of the selection criteria for articles was the availability of information about the radiological diagnosis of GPA in them.Results. Most authors focus their attention on clinical manifestations and features of treatment, not paying sufficient attention to diagnostic methods. Many studies have been carried out on a small sample of patients or are limited to individual clinical observations; there is practically no information on changes in the computed tomographic picture of the lungs in GPA in dynamics. The most complete semiotics of lung damage according to CT data is presented in the article by F. Martinez et al. (2012).Conclusions. It was found that in case of lung lesions by GPA, nodules, nodes and masses are more often determined, in half of cases – with cavities of decay, less often areas of ground-glass opacity and consolidation are detected. However, at present there is no unified approach to the interpretation of the radiological semiotics of the disease and the determination of the diagnostic value of individual computed tomographic patterns of lung damage. This requires their further detailed study for the correct and timely diagnosis of such a rare, but complex and potentially life-threatening disease.Гранулематоз с полиангиитом (ГПА) (гранулематоз Вегенера) – это редкое системное аутоиммунное заболевание из группы васкулитов, ассоциированное с антителами к цитоплазме нейтрофилов (АНЦА) и протекающее с гранулематозным воспалением преимущественно верхних и нижних дыхательных путей и малоиммунным некротизирующим васкулитом чаще сосудов мелкого и среднего калибра почек, легких, кожи. Заболевание относится к орфанным, редко является объектом исследования, литературные данные о нем немногочисленны и разрозненны.Цель исследования: изучение опубликованных материалов, анализ полученной информации и определение задач для дальнейшего изучения этой патологии, в первую очередь с позиции лучевой диагностики.Материал и методы. Поиск производился в библиографических базах данных MedLine, PubMed, при необходимости использовались ссылки на внешние полнотекстовые источники. Отобрано и проработано 36 наиболее значимых публикаций, из них 8 отечественных и 28 зарубежных. Одним из критериев отбора статей было наличие в них сведений о лучевой диагностике ГПА.Результаты. Большинство авторов акцентируют свое внимание на клинических проявлениях и особенностях лечения, не уделяя достаточного внимания диагностическим методам. Многие исследования проведены на небольшой выборке пациентов или ограничены отдельными клиническими наблюдениями, практически отсутствует информация об изменении компьютерно-томографической картины легких при ГПА в динамике. Наиболее полно семиотика поражения легких по данным КТ изложена в статье F. Martinez и соавт. (2012).Заключение. Установлено, что при поражении легких при ГПА чаще определяются очаги и образования округлой формы, в половине случаев – с полостями распада, реже выявляются участки уплотнения легочной ткани по типу “матового стекла” и консолидации. Однако в настоящее время не существует единого подхода к трактовке рентгенологической семиотики заболевания и определению диагностического значения отдельных компьютерно-томографических паттернов поражения легких. Это требует их дальнейшего детального изучения для правильной и своевременной диагностики такого редкого, но сложного и потенциально опасного для жизни заболевания

Роль ПЭТ/КТ в онкогинекологии (обзор литературы)

Purpose: to consider the modern possibilities of positron emission tomography combined with computed tomography (PET/CT) with FDG in the diagnosis of oncological formations in gynecology.Materials and methods. Search, selection and evaluation of existing foreign and domestic research included in the peer-reviewed E-library, PubMed, GoogleScholar, Scopus.Results. This article summarizes the existing evidence base to establish the clinical relevance and new possibilities for the use of FDG PET/CT in common gynecological malignancies.Conclusion. The use of FDG PET/CT can have a significant impact on patient management by improving cancer staging, influencing patient choice for treatment, and detecting early disease recurrence.Цель исследования: рассмотреть современные возможности позитронно-эмиссионной томографии, совмещенной с компьютерной томографией (ПЭТ/КТ) с фтордезоксиглюкозой (ФДГ), в диагностике онкологических образований в гинекологии.Материал и методы. Поиск, отбор и оценка существующих зарубежных и отечественных исследований, включенных в рецензируемые базы E-library, PubMed, GoogleScholar, Scopus.Результаты. В статье обобщается существующая доказательная база для установления клинического значения и новых возможностей применения ПЭТ/КТ с ФДГ при распространенных гинекологических злокачественных новообразованиях.Заключение. Использование ПЭТ/КТ с ФДГ может оказать значительное влияние на ведение пациентов за счет улучшения стадирования рака, влияния на выбор пациентов для лечения и выявления раннего рецидива заболевания

Лучевая диагностика спонтанной межреберной легочной грыжи (клиническое наблюдение)

Pulmonary or intercostal hernia appears as a bulge lung tissue result in the subcutaneous fat through a natural orifice or pathologically caused defects of the chest wall. Difficulties of diagnosis of the true pulmonary hernia owing to extremely infrequent occurrence of this pathology are, as a rule, bound to poor knowledge of doctors and quite often lead to inaccurate medical tactics. In the diagnosis of lung hernia along with clinical and laboratory data are used such research methods as x-ray, ultrasound, CT, among which, CT is a highly informative investigation method that allows to evaluate the status of lung tissue in the hernia sac and in other parts of the lungs, just to visualize the structures of the mediastinum, as well as the condition of the pleural cavity and chest wall, determining its proper treatment.Легочная или межреберная грыжа возникает как результат выпячивания ткани легкого в подкожно-жировую клетчатку через естественные отверстия или патологически возникшие дефекты грудной стенки. Трудности диагностики истинной легочной грыжи в силу крайне редкой встречаемости данной патологии, как правило, связаны с недостаточной информированностью врачей и нередко приводят к ошибочной лечебной тактике. При диагностике легочной грыжи наряду с клинико-лабораторными данными используют такие методы исследования, как рентген, УЗИ, КТ, среди которых КТ является методом, позволяющим детально оценить состояние легочной ткани в грыжевом мешке и в остальных отделах легких, точно дифференцировать структуры средостения, а также состояние плевральных полостей и грудной стенки, определяя выбор адекватной лечебной тактики. Статья посвящена описанию случая диагностики и лечения истинной легочной грыжи

Cell-type specific RNA-Seq reveals novel roles and regulatory programs for terminally differentiated Dictyostelium cells

Abstract Background A major hallmark of multicellular evolution is increasing complexity by the evolution of new specialized cell types. During Dictyostelid evolution novel specialization occurred within taxon group 4. We here aim to retrace the nature and ancestry of the novel “cup” cells by comparing their transcriptome to that of other cell types. Results RNA-Seq was performed on purified mature spore, stalk and cup cells and on vegetative amoebas. Clustering and phylogenetic analyses showed that cup cells were most similar to stalk cells, suggesting that they share a common ancestor. The affinity between cup and stalk cells was also evident from promoter-reporter studies of newly identified cell-type genes, which revealed late expression in cups of many stalk genes. However, GO enrichment analysis reveal the unexpected prominence of GTPase mediated signalling in cup cells, in contrast to enrichment of autophagy and cell wall synthesis related transcripts in stalk cells. Combining the cell type RNA-Seq data with developmental expression profiles revealed complex expression dynamics in each cell type as well as genes exclusively expressed during terminal differentiation. Most notable were nine related hssA-like genes that were highly and exclusively expressed in cup cells. Conclusions This study reveals the unique transcriptomes of the mature cup, stalk and spore cells of D. discoideum and provides insight into the ancestry of cup cells and roles in signalling that were not previously realized. The data presented in this study will serve as an important resource for future studies into the regulation and evolution of cell type specialization

Health sector spending and spending on HIV/AIDS, tuberculosis, and malaria, and development assistance for health: progress towards Sustainable Development Goal 3

Background: Sustainable Development Goal (SDG) 3 aims to “ensure healthy lives and promote well-being for all at all ages”. While a substantial effort has been made to quantify progress towards SDG3, less research has focused on tracking spending towards this goal. We used spending estimates to measure progress in financing the priority areas of SDG3, examine the association between outcomes and financing, and identify where resource gains are most needed to achieve the SDG3 indicators for which data are available. Methods: We estimated domestic health spending, disaggregated by source (government, out-of-pocket, and prepaid private) from 1995 to 2017 for 195 countries and territories. For disease-specific health spending, we estimated spending for HIV/AIDS and tuberculosis for 135 low-income and middle-income countries, and malaria in 106 malaria-endemic countries, from 2000 to 2017. We also estimated development assistance for health (DAH) from 1990 to 2019, by source, disbursing development agency, recipient, and health focus area, including DAH for pandemic preparedness. Finally, we estimated future health spending for 195 countries and territories from 2018 until 2030. We report all spending estimates in inflation-adjusted 2019 US$, unless otherwise stated. Findings: Since the development and implementation of the SDGs in 2015, global health spending has increased, reaching$7·9 trillion (95% uncertainty interval 7·8–8·0) in 2017 and is expected to increase to $11·0 trillion (10·7–11·2) by 2030. In 2017, in low-income and middle-income countries spending on HIV/AIDS was$20·2 billion (17·0–25·0) and on tuberculosis it was $10·9 billion (10·3–11·8), and in malaria-endemic countries spending on malaria was$5·1 billion (4·9–5·4). Development assistance for health was $40·6 billion in 2019 and HIV/AIDS has been the health focus area to receive the highest contribution since 2004. In 2019,$374 million of DAH was provided for pandemic preparedness, less than 1% of DAH. Although spending has increased across HIV/AIDS, tuberculosis, and malaria since 2015, spending has not increased in all countries, and outcomes in terms of prevalence, incidence, and per-capita spending have been mixed. The proportion of health spending from pooled sources is expected to increase from 81·6% (81·6–81·7) in 2015 to 83·1% (82·8–83·3) in 2030. Interpretation: Health spending on SDG3 priority areas has increased, but not in all countries, and progress towards meeting the SDG3 targets has been mixed and has varied by country and by target. The evidence on the scale-up of spending and improvements in health outcomes suggest a nuanced relationship, such that increases in spending do not always results in improvements in outcomes. Although countries will probably need more resources to achieve SDG3, other constraints in the broader health system such as inefficient allocation of resources across interventions and populations, weak governance systems, human resource shortages, and drug shortages, will also need to be addressed. Funding: The Bill & Melinda Gates Foundatio

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)-giving infants only breast-milk for the first 6 months of life-is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization's Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030.This work was primarily supported by grant no. OPP1132415 from the Bill & Melinda Gates Foundation. Co-authors used by the Bill & Melinda Gates Foundation (E.G.P. and R.R.3) provided feedback on initial maps and drafts of this manuscript. L.G.A. has received support from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES), Código de Financiamento 001 and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (grant nos. 404710/2018-2 and 310797/2019-5). O.O.Adetokunboh acknowledges the National Research Foundation, Department of Science and Innovation and South African Centre for Epidemiological Modelling and Analysis. M.Ausloos, A.Pana and C.H. are partially supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project no. PN-III-P4-ID-PCCF-2016-0084. P.C.B. would like to acknowledge the support of F. Alam and A. Hussain. T.W.B. was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. K.Deribe is supported by the Wellcome Trust (grant no. 201900/Z/16/Z) as part of his international intermediate fellowship. C.H. and A.Pana are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project no. PN-III-P2-2.1-SOL-2020-2-0351. B.Hwang is partially supported by China Medical University (CMU109-MF-63), Taichung, Taiwan. M.Khan acknowledges Jatiya Kabi Kazi Nazrul Islam University for their support. A.M.K. acknowledges the other collaborators and the corresponding author. Y.K. was supported by the Research Management Centre, Xiamen University Malaysia (grant no. XMUMRF/2020-C6/ITM/0004). K.Krishan is supported by a DST PURSE grant and UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. M.Kumar would like to acknowledge FIC/NIH K43 TW010716-03. I.L. is a member of the Sistema Nacional de Investigación (SNI), which is supported by the Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT), Panamá. M.L. was supported by China Medical University, Taiwan (CMU109-N-22 and CMU109-MF-118). W.M. is currently a programme analyst in Population and Development at the United Nations Population Fund (UNFPA) Country Office in Peru, which does not necessarily endorses this study. D.E.N. acknowledges Cochrane South Africa, South African Medical Research Council. G.C.P. is supported by an NHMRC research fellowship. P.Rathi acknowledges support from Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India. Ramu Rawat acknowledges the support of the GBD Secretariat for supporting the reviewing and collaboration of this paper. B.R. acknowledges support from Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal. A.Ribeiro was supported by National Funds through FCT, under the programme of ‘Stimulus of Scientific Employment—Individual Support’ within the contract no. info:eu-repo/grantAgreement/FCT/CEEC IND 2018/CEECIND/02386/2018/CP1538/CT0001/PT. S.Sajadi acknowledges colleagues at Global Burden of Diseases and Local Burden of Disease. A.M.S. acknowledges the support from the Egyptian Fulbright Mission Program. F.S. was supported by the Shenzhen Science and Technology Program (grant no. KQTD20190929172835662). A.Sheikh is supported by Health Data Research UK. B.K.S. acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for all the academic support. B.U. acknowledges support from Manipal Academy of Higher Education, Manipal. C.S.W. is supported by the South African Medical Research Council. Y.Z. was supported by Science and Technology Research Project of Hubei Provincial Department of Education (grant no. Q20201104) and Outstanding Young and Middle-aged Technology Innovation Team Project of Hubei Provincial Department of Education (grant no. T2020003). The funders of the study had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. All maps presented in this study are generated by the authors and no permissions are required to publish them

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P &lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P &lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk