Background: Osteopontin (OPN) is a glycoprotein that has been associated with inflammation and fibrosis. Recently published data supports that OPN is up-regulated in surgical lung tissue samples of patients with COPD (Schneider F et al FASEB 2010).
Aim: The aim of this study was to determine the levels of OPN in sputum supernatants of patients with COPD, and compare them with healthy subjects and to investigate their possible association with mediators and cells involved in the inflammatory and remodeling process as well as with the extension of emphysema as defined by HRCT.
Methods: Seventy-seven patients with COPD and 40 healthy subjects (20 smokers) were studied. All subjects underwent lung function tests, sputum induction for cell count identification and OPN, TGF-β1, MMP-2, IL-8, LTB4 measurement in sputum supernatants. A HRCT was performed for quantification of emphysema
Measurements and Main results: OPN levels [median (interquartile range) pg/ml] were significantly higher in patients with COPD compared to both healthy smokers and non-smokers [1340 (601-6227) vs 101(77-109) vs 69 (50-89) respectively, p<0.001]. Regression analysis showed a significant association between OPN and sputum neutrophils, IL-8, MMP-2 and the extent of emphysema. The above associations were not observed in healthy subjects.
Conclusions: Our results indicate that OPN levels are higher in patients with COPD compared to both smoking and non-smoking healthy subjects. Moreover, the association of OPN with sputum neutrophils, IL-8 and MMP-2 indicates a role of OPN in neutrophilic inflammation while its association with the extent of emphysema shows a role in the pathogenesis of this particular COPD phenotype.
Objectives In Sarcoidosis joints-muscles-bones (JMBs) localizations are of the least common. 18F-FDG-PET/CT imaging revolutionized detection of JMBs involvement by adding metabolic activity information and allowing for a comprehensive, whole-body mapping of the disease.Aim and methods This study investigated prevalence, distribution, and clinical significance of JMBs sarcoidosis in 195 consecutive patients that underwent 18F-FDG PET/CT examination.Results Joint and bone involvement were encountered in 15% of patients with a mean of the maximum-standardized-uptake-value (SUVmax) of 6.1. Most common location was the axial skeleton. Hypercalciuria was significantly more frequent in patients with osseous involvement (p = 0.003). Muscle activity (SUVmax = 2.4) was encountered in 20% of the patients, most frequently in treatment-naïve (p = 0.02). The muscles of the lower extremities were affected the most. Muscle and bone localization coexist in 50% of the cases. JMBs disease was almost asymptomatic, not related to chronicity but to pulmonary, nodal, and systemic disease. Long-term follow-up and treatment response of affected patients confirmed sarcoidosis.Conclusion 18F-FDG-PET/CT revealed JMBs localizations and coexistence with other organ sites supporting the concept that sarcoidosis is a systemic disease. By allowing an integrative interpretation of multi-organ involvement in the context of a pattern highly suggestive of sarcoidosis, it strongly keeps-off the diagnosis of malignancy.
Sputum and blood eosinophils are proposed as candidate biomarkers for the identification of chronic obstructive pulmonary disease (COPD) patients at risk for exacerbation and treatment response. In this study, we evaluated the associations of eosinophils with the presence of emphysema in COPD patients. Induced sputum and blood eosinophil measurements were performed in consecutive COPD patients. Patients underwent lung function testing and high resolution computed tomography (HRCT) of the chest and the presence of emphysema was quantified. Patients with emphysematous lesions in ≥15% of the pulmonary parenchyma were considered having significant emphysema. Ninety-eight patients were included in the study. Patients with significant emphysema had lower blood eosinophil counts compared to patients without emphysema [median (IQR) 34.6 (0.0, 63.0) vs. 169.0 (110.0, 260.0) cells/µL, p < 0.001]; similar results were observed for the percentage (%) of blood eosinophils, but no difference was observed for sputum eosinophils. The differences were evident in frequent and non-frequent exacerbators and irrespective of the use of inhaled corticosteroids (ICS). Patients with significant emphysema in HRCT present lower levels of blood eosinophils and these differences were present irrespective of the frequent exacerbator history or the use of ICS. Blood eosinophils may not represent a clinically relevant biomarker in the presence of emphysema.
Rationale: CPFE is a disease entity for which clinical management and therapeutic approaches are not clearly defined. Pulmonary rehabilitation (PR) is known to be an effective intervention for COPD patients, however its impact as a therapeutic option for CPFE is still unknown. Methods: We evaluated patients with a CPFE diagnosis based on chest HRCT. All patients underwent pulmonary function tests, cardiopulmonary exercise testing, echocardiography and evaluation of health-related quality of life (HRQoL) measured using the Saint George's Respiratory Questionnaire. Patients participated in a PR program (3 times/week for 3 consecutive months), and all tests were repeated after the end of this program. Results: Seven male patients completed the program (mean age 65.3±5.9years). No difference was observed before and after PR in the level of dyspnea according to the mMRC scale, in echocardiographic measurements or in pulmonary function tests, with the exception of a deterioration in DLCO %pred (median(IQR) [40.0(31.9, 53.7) vs 38.1(25.0, 55.0) p=0.043]. However, patients showed an improvement in HRQoL [31.7(16.9, 47.0) vs 25.5(15.6, 34.5), p=0.043]. Patients showed significant improvements in cardiopulmonary exercise testing parameters, including maximum work(%pred) [46(30, 51) vs 55(36, 73), p=0.018], peakVO2(ml/kg/min) [16.5(13.9, 19.8) vs 19.9(14.6, 25.8), p=0.018], O2 pulse(%pred) [75.0(68.3, 88.8) vs 94.0(80.0, 111.5), p=0.043].and a decrease in end-tidal CO2 [27.3(20.9, 32.5) vs 26.1(19.5, 35.8), p=0.043]. Conclusion: Despite the absence of improvement in lung function and echocardiographic parameters, PR seems to improve HRQoL and exercise capacity in CPFE patients.
Although modern treatment of asthma improves asthma control, some patients still experience exacerbations. The aim of the present study was to detect predictors of asthmatic exacerbations Methods: We included patients with asthma followed up in asthma clinics of 2 tertiary University hospitals. Demographic and functional characteristics, levels of exhaled NO, and inflammatory biomarkers (IL-13, ΕCP και IL-8) and cell counts in induced sputum were recorded at baseline. Measurements were performed with the patients in stability and were considered as their personal best. Patients received optimal treatment with good compliance and were followed up for 1 year for asthma exacerbations occurrence. Evaluation of the effect of recorded parameters on asthma exacerbations was performed with univariate and multivariate Poisson regression analysis.171 patients (118 female) with bronchial asthma (mean age 51.6 ± 13.2 years) were included in the study. The mean number of exacerbations in 1 year of follow up was 0.4 ± 0.8 while the majority of patients (71.9%) did not experience any exacerbation. In multivariate Poisson Regression analysis only 3 characteristics were predictors of future exacerbations: FEV1 [IRR(95% CI)], [0.970(0.954-0.987)], p = 0.001, high BMI [1.078(1.030-1.129)], p = 0.001, and the need for permanent treatment with oral corticosteroids for asthma control maintenance [2.542(1.083-5.964)], p = 0.032 CONCLUSION: Optimal guideline-based asthma management results in minimal occurrence of exacerbations in the majority of patients. Predictors of exacerbations are low FEV1 levels in stability, high BMI and the need for permanent treatment with oral corticosteroids.
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Background: There is growing evidence that supports the use of chest ultrasound (CUS) versus conventional chest X-ray (CXR) in order to diagnose postoperative complications. However, data regarding its use after thoracic surgery are scarce and contradictory. The aim of this study was to conduct a systematic review to evaluate the accuracy of CUS after thoracic surgery. Methods: An electronic search in MEDLINE (via PubMed), complemented by manual searches in article references, was conducted to identify eligible studies. Results: Six studies with a total of 789 patients were included in this meta-analysis. Performing CXR decreased in up to 61.6% of cases, with the main reasons for performing CXR being massive subcutaneous emphysema or complex hydrothorax. Agreement between CUS and routine-based therapeutic options was, in some studies, up to 97%. Conclusions: The selectively postoperative use of CUS may reduce the number of routinely performed CXR. However, if CUS findings are inconclusive, further radiological examinations are obligatory.
