Levels of circulating endothelial cells are low in idiopathic pulmonary fibrosis and are further reduced by anti-fibrotic treatments

Background: It has been suggested that circulating fibrocytes and endothelial cells actively participate in the intense remodelling of the pulmonary vasculature in patients with idiopathic pulmonary fibrosis (IPF). Indeed, fibrotic areas exist that have fewer blood vessels, whereas adjacent non-fibrotic tissue is highly vascularized. The number of circulating endothelial cells (CEC) and endothelial progenitor cells (EPC) might reflect the balance between vascular injury and repair. Thus, fibrocytes as well as endothelial cells could potentially be used as biomarkers of disease progression and treatment outcome. Methods: Peripheral blood samples were collected from 67 patients with a multidisciplinary diagnosis of IPF and from 45 age-matched and sex-matched healthy volunteers. Buffy coat was isolated according to standard procedures and at least 20 million cells were stained with different monoclonal antibodies for the detection of CEC, EPC and circulating fibrocytes. For the detection of CEC and EPC, cells were stained with anti-CD45, anti-CD34, anti-CD133, anti-CD14, anti-CD309 and with the viability probe Far-Red LIVE/DEAD. For the detection of circulating fibrocytes, cells were first stained with LIVE/DEAD and the following monoclonal antibodies: anti-CD3, anti-CD19, anti-CD45, anti-CD34 and anti-CD14, then cells were fixed, permeabilized and stained with fluorochrome-conjugated anti-collagen I monoclonal antibodies. Results: Patients with IPF displayed almost undetectable levels of circulating fibrocytes, low levels of CEC, and normal levels of EPC. Patients treated with nintedanib displayed higher levels of CEC, but lower levels of endothelial cells expressing CD309 (the type II receptor for vascular endothelial growth factor). Treatment with both nintedanib and pirfenidone reduced the percentage of CEC and circulating fibrocytes. Conclusions: Levels of CEC were reduced in patients with IPF as compared to healthy individuals. The anti-fibrotic treatments nintedanib and pirfenidone further reduced CEC levels. These findings might help explain the mechanism of action of these drugs and should be explored as predictive biomarkers in IPF

Evaluation of membranes for the treatment of oilfield-produced water

Large quantities of water are generated during oil extraction. Reinjection of this effluent is frequently the most suitable option for environmental considerations. For this purpose, the water produced must have characteristics that will prevent the plugging of the reservoir rocks, i.e., suspended solids and oil and grease content must be lower than 5 mg L-1. This work evaluated the performance of membranes for water treatment, based upon long-term experiments with real effluent, evaluating the permeate flux over time and the effluent characteristics. The results indicated that it is possible to obtain a permeate flux with suspended solids content with less than 1 mg L-1 oil and a grease concentration in the range of 1 to 3 mg L-1 using membranes with a pore size of 0,1 m. After 50 hours of permeation, the permeate fluxes obtained with the polymeric and ceramic membranes were equal to 50 and 300 L h-1 m-2, respectively. With a chemical regeneration procedure, it was possible to recover 95% of the ceramic membrane’s original permeability and 30% of the polymeric membrane’s permeability. Considering the permeate quality, the regeneration efficiency of the membrane and the fluxes achieved, it is possible to point out the use of ceramic membranes as a potential technology for treating oilfield-produced water, and it has the advantage of being a compact and robust process

An Unusual Cause Of Alveolar Accumulation Of Foamy Macrophages In Adults

A 33-year-old non-smoking female presented with a 6-months history of mild dyspnea and cough. Physiologic testing showed a moderate restrictive ventilatory impairment, whereas high-resolution CT revealed bilateral ground-glass opacities and thickening of interlobular septa. A videothoracoscopic biopsy was performed. Microscopically, the pulmonary architecture was preserved, with only a minimal interstitial fibrosis. The alveolar and the bronchiolar spaces were filled by finely vacuolated macrophages, whereas Pas-positive macrophages expanded the pleural and the interlobular connective tissues. The bronchiolar epithelium had a peculiar clear cytoplasm. Three months after the biopsy, the patient presented with abdominal pain, hepatosplenomegaly and thrombocytopenia. A bone marrow biopsy showed a \u201csea-blue histiocytosis\u201d. The sphingomyelinase activity, evaluated in cultured fibroblasts, was markedly reduced and a diagnosis of Niemann-Pick disease type B was performed. In the lung: 1) the evaluation of both morphology and localization of the macrophages may provide useful diagnostic clues to the pathologist; 2) although rare, the possibility of a metabolic disease must be considered also in adults; and 3) a diffuse alveolar accumulation of foamy macrophages without a significant fibrosis/inflammation, particularly when associated with a clarification of the bronchiolar epithelium, is characteristic of pulmonary involvement in Niemann-Pick disease

“Neurologist's contribution to the diagnosis of sine materia respiratory insufficiency: case report”

Abstract Background Right-to-left shunt (RLS) may be the cause of marked hypoxemia, a respiratory insufficiency which is usually difficult to diagnose by respiratory physicians as it develops in the absence of an intrinsic lung disease. Case presentation We report a case of RLS in a patient with a hepatopulmonary syndrome caused by chronic autoimmune cholangitis. RLS was suspected clinically by physical examination and by standard CT imaging and MIP reconstruction of the pulmonary vascular bed. Repeated previous transthoracic echocardiography (TTE) studies did not reveal shunts or any cardiac defect. The final diagnosis was made by means of a minimally invasive transcranial Doppler examination with the use of saline agitated with 0.5 ml of patient’s blood as contrast solution. Conclusions Transcranial Colour-Coded Duplex Sonography (TCCS) with saline contrast medium injection is described to have a higher sensitivity than TTE and comparable to transesophageal echocardiography (TEE) in RLS diagnosis. The collaboration of neurologists in diagnosing respiratory insufficiency is very important as the examination is simple, well tolerated in comparison with the discomfort associated with transesophageal echocardiography, and minimally invasive in comparison with angiography, which is the last diagnostic procedure in this clinical scenario. In order to confirm RLS, TCCS with blood-saline contrast medium injection should be performed for the diagnosis of chronic hypoxemia for which causes are not detected with routine clinical examinations.</p

A “Galactic” Chest X-ray

Clinical manifestations accompanying respiratory failure with insidious and rapidly progressive onset are often non-specific. Symptoms such as a cough, dyspnea, and fever are common to a large number of inflammatory, infectious, or neoplastic diseases. During the COVID-19 pandemic it is essential to limit the use of hospital services and inappropriate diagnostic techniques. A particular radiological pattern can orient the clinical and laboratory scenario and guide the diagnostic workup. A 58-year-old woman was admitted to our COVID-19 unit for suspected coronavirus infection. She was complaining of worsening dyspnea, tachycardia, and low grade fever. A chest X-ray showed diffuse, alveolar, and interstitial lung involvement with micronodules tending to coalescence. This radiographic pattern known as “galaxy sign”, consistent with diffuse, coalescing nodular miliary pulmonary involvement, simulating a non-specific alveolar opacification of the lungs is typical of a few pneumological differential diagnoses, represented by sarcoidosis, tuberculosis, pneumoconiosis, and metastatic lesions, and virtually excludes an interstitial viral pneumonitis. The use of endoscopic techniques can, in such cases, confirm the clinical suspicion for initiating appropriate targeted therapies

Clinical and pharmacoeconomic aspects of omalizumab: a 4-year follow-up

Objectives: The aim of this study was to assess the stability of the effectiveness of omalizumab as add-on treatment in 11 patients with severe persistent allergic asthma followed for 4 years. Secondary outcomes were safety and economic impact, in terms of use of healthcare resources. Methods: This retrospective study was designed to analyse a series of patients with severe allergic asthma treated with omalizumab. Patients were initially enrolled as part of the CIGE025A2425 international multicentre clinical trial. At the end (week 32), 11 responsive patients went on to complete the study and continued omalizumab treatment until June 2010. The monitoring visits coincided with the timescales planned for administering the drug and for the follow up. To estimate the economic impact, the PRE–POST treatment comparison was obtained by comparing the annual pretreatment costs with an annual average of the 4-year posttreatment period costs Results: After 4 years, 81.8% of patients showed a good/excellent Global Evaluation of Treatment Effectiveness scale score and 81.2% showed an excellent increase (>1.5) in the Asthma Quality of Life Questionnaire score. The average forced expiratory volume in one second (FEV 1 ) at 4 years was 75.3% compared with the predicted normal value for each patient, with a net increase ( p = 0.009) compared with baseline FEV 1 values (58.6%). The frequency of serious exacerbations dropped by 94.7% compared with the pretreatment period, while mild–moderate exacerbations fell by 41.8%. A reduction in costs was observed for hospital admissions (97.3%), visits to emergency department (ED) (97.5%) and mild–moderate exacerbations (84%). The average cost reduction of concomitant drugs remained at 36%. Conclusions: This study confirms the effectiveness and reliability of omalizumab over the long term, while providing an excellent safety profile. The additional cost due the use of omalizumab was offset by the medium- and long-term savings associated with the reduction in hospital admissions and access to ED