-
Scientific Reports Oct 2021Pleural fibrosis (PF) is a chronic and progressive lung disease which affects approximately 30,000 people per year in the United States. Injury and sustained...
Pleural fibrosis (PF) is a chronic and progressive lung disease which affects approximately 30,000 people per year in the United States. Injury and sustained inflammation of the pleural space can result in PF, restricting lung expansion and impairing oxygen exchange. During the progression of pleural injury, normal pleural mesothelial cells (PMCs) undergo a transition, termed mesothelial mesenchymal transition (MesoMT). While multiple components of the fibrinolytic pathway have been investigated in pleural remodeling and PF, the role of the urokinase type plasminogen activator receptor (uPAR) is unknown. We found that uPAR is robustly expressed by pleural mesothelial cells in PF. Downregulation of uPAR by siRNA blocked TGF-β mediated MesoMT. TGF-β was also found to significantly induce uPA expression in PMCs undergoing MesoMT. Like uPAR, uPA downregulation blocked TGF-β mediated MesoMT. Further, uPAR is critical for uPA mediated MesoMT. LRP1 downregulation likewise blunted TGF-β mediated MesoMT. These findings are consistent with in vivo analyses, which showed that uPAR knockout mice were protected from S. pneumoniae-mediated decrements in lung function and restriction. Histological assessments of pleural fibrosis including pleural thickening and α-SMA expression were likewise reduced in uPAR knockout mice compared to WT mice. These studies strongly support the concept that uPAR targeting strategies could be beneficial for the treatment of PF.
Topics: Actins; Animals; Cells, Cultured; Epithelial-Mesenchymal Transition; Epithelium; Fibrosis; Humans; Mice; Mice, Inbred C57BL; Pleura; Pneumonia, Bacterial; Receptors, Urokinase Plasminogen Activator; Streptococcal Infections; Transforming Growth Factor beta; Urokinase-Type Plasminogen Activator
PubMed: 34707211
DOI: 10.1038/s41598-021-99520-5 -
Archives of Pathology & Laboratory... Aug 2016Described in Japan by Amitani et al in 1992, the entity of idiopathic upper lobe fibrosis was subsequently given the name pleuroparenchymal fibroelastosis (PPFE) in the... (Review)
Review
Described in Japan by Amitani et al in 1992, the entity of idiopathic upper lobe fibrosis was subsequently given the name pleuroparenchymal fibroelastosis (PPFE) in the English-speaking world. Pleuroparenchymal fibroelastosis is believed to be a rare disease characterized by a fibrosing process affecting the pleura and the subpleural lung parenchyma, with a predilection for the upper lobes. Uniquely, the fibrosing process is elastotic in nature, being associated with intra-alveolar fibrosis. The etiology of PPFE is unclear at this juncture, with many cases being considered as idiopathic forms of the disease. Conditions associated with PPFE include infections, bone marrow transplantation, and autoimmunity. In this review, we explore the clinical, radiologic, and pathologic features associated with PPFE in light of current understanding of the disease. Recent studies implicated that PPFE may not be as uncommon as claimed. The various differential diagnoses and implications of diagnosing PPFE are discussed.
Topics: Bone Marrow Transplantation; Diagnosis, Differential; Fibrosis; Humans; Infections; Lung; Pleura; Pneumonia; Pulmonary Fibrosis; Tomography, X-Ray Computed
PubMed: 27472241
DOI: 10.5858/arpa.2015-0166-RS -
BMC Infectious Diseases Aug 2019Due to the similar clinical, lung imaging, and pathological characteristics, talaromycosis is most commonly misdiagnosed as tuberculosis. This study aimed to identify... (Comparative Study)
Comparative Study
BACKGROUND
Due to the similar clinical, lung imaging, and pathological characteristics, talaromycosis is most commonly misdiagnosed as tuberculosis. This study aimed to identify the characteristics of talaromycosis pleural effusion (TMPE) and to distinguish TMPE from tuberculosis pleural effusion (TPE).
METHODS
We enrolled 19 cases each of TMPE and TPE from Guangxi, China. Patients' clinical records, pleural effusion tests, biomarker test results, and receiver operating characteristic curves were analyzed.
RESULTS
In total, 39.8% (65/163) of patients exhibited serous effusion, of whom 61 were non-human immunodeficiency virus (HIV)-infected patients; 68.85% of the non-HIV-infected patients (42/61) had TMPE. Thoracentesis was performed only in 19 patients, all of whom were misdiagnosed with tuberculosis and received long-term anti-tuberculosis treatment. In four of these patients, interleukin (IL)-23, IL-27, and interferon-gamma (IFN-γ) measurements were not performed since pleural effusion samples could not be collected because the effusion had been drained prior to the study. In the remaining 15 patients, pleural effusion samples were collected. Talaromyces marneffei was isolated from the pleural effusion and pleural nodules. Most TMPEs were characterized by yellowish fluid, with marked elevation of protein content and nucleated cell counts. However, neutrophils were predominantly found in TMPEs, and lymphocytes were predominantly found in TPEs (both p < 0.05). Adenosine deaminase (ADA) and IFN-γ levels in TMPEs were significantly lower than those in TPEs (all p < 0.05) and provided similar accuracies for distinguishing TMPEs from TPEs. IL-23 concentration in TMPEs was significantly higher than that in TPEs (p < 0.05), and it provided similar accuracy for diagnosing TMPEs. IL-27 concentrations in TMPEs were significantly lower than those in TPEs (all p < 0.05) but was not useful for distinguishing TMPE from TPE.
CONCLUSIONS
Talaromycosis can infringe on the pleural cavity via the translocation of T. marneffei into the pleural space. Nonetheless, this phenomenon is still commonly neglected by clinicians. TMPE is a yellowish fluid with exudative PEs and predominant neutrophils. Higher neutrophil counts and IL-23 may suggest talaromycosis. Higher lymphocyte counts, ADA activity, and IFN-γ concentration may suggest tuberculosis.
Topics: Adenosine Deaminase; Adolescent; Adult; Aged; Biomarkers; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Interferon-gamma; Interleukin-23 Subunit p19; Interleukins; Lymphocytes; Male; Middle Aged; Mycoses; Neutrophils; Pleural Effusion; ROC Curve; Talaromyces; Tuberculosis, Pleural
PubMed: 31455239
DOI: 10.1186/s12879-019-4376-6 -
BMC Infectious Diseases Apr 2022Amoebiasis is caused by the protozoan Entamoeba histolytica, which is a rare infectious disease in developed countries. If the trophozoites enter the blood, it can...
BACKGROUND
Amoebiasis is caused by the protozoan Entamoeba histolytica, which is a rare infectious disease in developed countries. If the trophozoites enter the blood, it can spread through the body, such as brain, and lungs. Cases of simultaneous infection of multiple organs are extremely rare.
CASE PRESENTATION
Here we report a case of simultaneous infection of amoeba in pulmonary pleura, urinary system and central nervous system. Although the patient received anti amoeba treatment, the prognosis of the patient was poor.
CONCLUSIONS
In this patient, multiple extraintestinal amebic infections in the absence of clinically confirmed intestinal amebiasis or amebic liver abscess are rare and pose diagnostic challenges. The disseminated amebiasis has significantly increased the mortality. Early diagnosis and appropriate treatment may reduce the mortality of disseminated amebiasis.
Topics: Amebiasis; Dysentery, Amebic; Entamoeba histolytica; Entamoebiasis; Humans; Liver Abscess, Amebic
PubMed: 35410146
DOI: 10.1186/s12879-022-07348-9 -
Internal Medicine (Tokyo, Japan) Jan 2020A 46-year-old Japanese man was admitted to our hospital with a 1-year history of dyspnea and persistent right-dominant bilateral pleural effusions. Chest and abdominal...
A 46-year-old Japanese man was admitted to our hospital with a 1-year history of dyspnea and persistent right-dominant bilateral pleural effusions. Chest and abdominal computed tomography (CT) revealed no notable findings apart from the bilateral pleural effusions. 2-deoxy-2-[F]-fluoro-D-glucose (FDG) positron emission tomography-CT showed no accumulation of FDG in the thorax and abdomen. Thoracoscopy revealed numerous small (approximately 2-3 mm in size), blister-like nodules on the left parietal pleura extending from the lower third of the chest wall to the diaphragm. A pathological examination revealed lymphocyte and plasma cell infiltrates with increasing numbers of IgG4-positive plasma cells in the fibrotic pleura, indicating IgG4-related pleuritis.
Topics: Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Lymphocytes; Male; Middle Aged; Plasma Cells; Pleura; Pleural Effusion; Pleurisy; Thoracoscopy
PubMed: 31554752
DOI: 10.2169/internalmedicine.3031-19 -
Contrast Media & Molecular Imaging 2022This study aims to investigate the diagnostic value of 18F-FDG PET/CT in tuberculous pleurisy (TBP) and the differential diagnostic value of 18F-FDG PET/CT between TBP...
The Value of 18F-FDG PET/CT in the Diagnosis of Tuberculous Pleurisy and in the Differential Diagnosis between Tuberculous Pleurisy and Pleural Metastasis from Lung Adenocarcinoma.
OBJECTIVES
This study aims to investigate the diagnostic value of 18F-FDG PET/CT in tuberculous pleurisy (TBP) and the differential diagnostic value of 18F-FDG PET/CT between TBP and pleural metastasis from lung adenocarcinoma (PMLAC).
MATERIALS AND METHODS
The features of pleura on PET and hybrid CT were retrospectively studied in 20 patients with TBP and 32 patients with PMLAC. The ROC curve was used to evaluate the diagnostic effectiveness of these indices for TBP and PMLAC, and binary logistic regression analysis was conducted to identify independent predictors of TBP and PMLAC.
RESULTS
There were significant differences in pleural 18F-FDG uptake pattern on PET (=0.001), pleural morphology pattern on CT (=0.002), the maximum diameter of the pleural nodule (=0.001), and interlobular fissure nodule (=0.001) between TBP and PMLAC groups. The diffused pleural FDG uptake type on PET (odds ratio (OR) = 6.0, 95% CI 2.216-16.248, =0.001) and the lamellar pleural thickening type on CT (OR = 4.4, 95% CI 2.536-7.635, =0.001) were independent predictors of TBP, with 60% and 55% sensitivity, 96.6% and 90.6% specificity, and 82.7% and 77.0% accuracy. The combined diagnostic sensitivity, specificity, and accuracy for TBP were 70%, 87.5%, and 80.8%. The mixed pleural FDG uptake type on PET (OR = 5.106, 95% CI 2.024-12.879, =0.001), the mixed pleural thickening type on CT (OR = 2.289, 95% CI 1.442-3.634, =0.001), and the maximum diameter of the pleural nodule (OR = 1.027, 95% CI 1.012-1.042, =0.001) were independent predictors of PMLAC, with 78.1%, 71.9%, and 87.5% sensitivity, 85%, 80%, and 85% specificity, and 80.8%, 75%, and 86.5% accuracy. The combined diagnostic sensitivity, specificity, and accuracy for PMLAC were 96.9%, 85%, and 90.4%.
CONCLUSIONS
18F-FDG PET/CT is of great clinical value in the diagnosis of TBP and in the differential diagnosis between TBP and PMLAC.
Topics: Adenocarcinoma of Lung; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Pleura; Positron Emission Tomography Computed Tomography; Retrospective Studies; Tuberculosis, Pleural
PubMed: 35965614
DOI: 10.1155/2022/4082291 -
Toxicology Letters Aug 2016Relationships between the physical properties of carbon nanotubes (CNTs) and their toxicities have been studied. However, little research has been conducted to...
Relationships between the physical properties of carbon nanotubes (CNTs) and their toxicities have been studied. However, little research has been conducted to investigate the pulmonary and pleural inflammation caused by short-fiber single-walled CNTs (SWCNTs) and multi-walled CNTs (MWCNTs). This study was performed to characterize differences in rat pulmonary and pleural inflammation caused by intratracheal instillation with doses of 0.15 or 1.5mg/kg of either short-sized SWCNTs or MWCNTs. Data from bronchoalveolar lavage fluid analysis, histopathological findings, and transcriptional profiling of rat lungs obtained over a 90-day period indicated that short SWCNTs caused persistent pulmonary inflammation. In addition, the short MWCNTs markedly impacted alveoli immediately after instillation, with the levels of pulmonary inflammation following MWCNT instillation being reduced in a time-dependent manner. MWCNT instillation induced greater levels of pleural inflammation than did short SWCNTs. SWCNTs and MWCNTs translocated in mediastinal lymph nodes were observed, suggesting that SWCNTs and MWCNTs underwent lymphatic drainage to the mediastinal lymph nodes after pleural penetration. Our results suggest that short SWCNTs and MWCNTs induced pulmonary and pleural inflammation and that they might be transported throughout the body after intratracheal instillation. The extent of changes in inflammation differed following SWCNT and MWCNT instillation in a time-dependent manner.
Topics: Animals; Cytokines; Gene Expression Profiling; Inflammation Mediators; Inhalation Exposure; Lung; Lymphatic System; Male; Nanotubes, Carbon; Pleura; Pleurisy; Pneumonia; Rats, Wistar; Time Factors
PubMed: 27259835
DOI: 10.1016/j.toxlet.2016.05.025 -
IEEE Transactions on Ultrasonics,... Nov 2020Recent works highlighted the significant potential of lung ultrasound (LUS) imaging in the management of subjects affected by COVID-19. In general, the development of...
Recent works highlighted the significant potential of lung ultrasound (LUS) imaging in the management of subjects affected by COVID-19. In general, the development of objective, fast, and accurate automatic methods for LUS data evaluation is still at an early stage. This is particularly true for COVID-19 diagnostic. In this article, we propose an automatic and unsupervised method for the detection and localization of the pleural line in LUS data based on the hidden Markov model and Viterbi Algorithm. The pleural line localization step is followed by a supervised classification procedure based on the support vector machine (SVM). The classifier evaluates the healthiness level of a patient and, if present, the severity of the pathology, i.e., the score value for each image of a given LUS acquisition. The experiments performed on a variety of LUS data acquired in Italian hospitals with both linear and convex probes highlight the effectiveness of the proposed method. The average overall accuracy in detecting the pleura is 84% and 94% for convex and linear probes, respectively. The accuracy of the SVM classification in correctly evaluating the severity of COVID-19 related pleural line alterations is about 88% and 94% for convex and linear probes, respectively. The results as well as the visualization of the detected pleural line and the predicted score chart, provide a significant support to medical staff for further evaluating the patient condition.
Topics: Algorithms; COVID-19; Coronavirus Infections; Humans; Image Interpretation, Computer-Assisted; Lung; Pandemics; Pleura; Pneumonia, Viral; Signal Processing, Computer-Assisted; Support Vector Machine; Ultrasonography
PubMed: 32746195
DOI: 10.1109/TUFFC.2020.3005512 -
BMC Medical Imaging Jun 2020We aimed to describe the chest CT findings in sixty-seven patients infected by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
BACKGROUND
We aimed to describe the chest CT findings in sixty-seven patients infected by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
METHODS
We retrospectively reviewed 67 patients hospitalized in Ruian People's Hospital. All the patients received the positive diagnosis of SARS-CoV-2 infection. The CT and clinical data were collected between January 23rd, 2020 and February 10th, 2020. The CT images were analyzed by the senior radiologists.
RESULTS
There are 54 patients with positive CT findings and 13 patients with negative CT findings. The typical CT findings in hospitalized patients with SARS-CoV-2 infection were ground glass opacities (42/54), lesions located in the peripheral area (50/54), multiple lesions (46/54), and lesions located in the lower lobes (42/54). There were less typical CT findings, including air bronchogram (18/54), pleural thickening or pleural effusion (14/54), consolidation (12/54), lesions in the upper lobes (12/54), interlobular septal thickening (11/54), reversed halo sign (9/54), single lesion (8/54), air cavities (4/54), bronchial wall thickening (3/54), and intrathoracic lymph node enlargement (2/54).
CONCLUSIONS
CT features can play an important role in the early diagnosis and follow-up of COVID-19 patients.
Topics: Adult; Aged; Betacoronavirus; COVID-19; China; Coronavirus Infections; Female; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral; Radiography, Thoracic; Retrospective Studies; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 32576224
DOI: 10.1186/s12880-020-00471-6 -
Scandinavian Journal of Surgery : SJS :... Jun 2018The development of pleural infection may imply a worse state of health and prognosis. The objective of this study was to ascertain the long-term survival and causes of...
BACKGROUND AND AIMS
The development of pleural infection may imply a worse state of health and prognosis. The objective of this study was to ascertain the long-term survival and causes of death after pleural infections and to compare them to those of matched controls.
MATERIAL AND METHODS
Altogether 191 patients treated for pleural infections at a single University Hospital between January 2000 and December 2008 and 1910 age- and gender-matched controls were included. Survival data and the causes of death for non-survivors were obtained from national databases and compared between the groups.
RESULTS
The etiology of pleural infection was pulmonary infection in 70%, procedural complication in 9%, trauma in 5%, malignancy in 4%, other in 7%, and unknown in 5% of patients. The course of treatment was surgical in 82%, drainage only in 12%, and conservative in 5% of included patients. The median follow-up time was 11 years. Mortality rates were 8.4% versus 0.8% during the first 90 days, p < 0.001, and 46.6% versus 24.5% overall, p < 0.001, in patients and controls, respectively. Mortality was significantly higher in patients with pulmonary infection, procedural complication, or malignancy as the etiology of pleural infection. In multivariable analysis, advanced age, previous malignancies, institutional care, alcoholism, and malignant etiology for the infection were associated with inferior survival. Deaths caused by malignancies, respiratory diseases, and digestive diseases were significantly more common in patients than in controls.
CONCLUSION
Long-term survival in patients with pleural infections is significantly inferior to that of age and gender-matched controls.
Topics: Adult; Aged; Case-Control Studies; Cause of Death; Empyema, Pleural; Female; Humans; Male; Middle Aged; Pleurisy; Prognosis; Survival Rate
PubMed: 29121816
DOI: 10.1177/1457496917738868