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Correlation of 68Gallium ventilation-perfusion PET/CT with pulmonary function test indices for assessing lung function.

68GalliumPulmonary function tests (PFT) are routinely used to assess lung function but they do not provide information about regional pulmonary dysfunction. We aimed to assess correlation of quantitative ventilation/perfusion (V/Q) PET/CT with PFT indices.

METHODS: 30 patients underwent V/Q PET/CT and PFT. Respiratory-gated images were acquired following inhalation of (68)Gallium-carbon nanoparticles and administration of (68)Gallium-macroaggregated albumin. Functional volumes were calculated by dividing the volume of normal ventilated and perfused (%NVQ), unmatched and matched defects from the total lung volume. These functional volumes were correlated with forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, and diffusing capacity for carbon monoxide (DLCO).

RESULTS: All functional volumes were significantly different in patients with chronic obstructive pulmonary disease (COPD) (p<0.05). FEV1/FVC and %NVQ had the highest correlation (r=0.82). FEV1 was also best correlated with %NVQ (r=0.64). DLCO was best correlated with the volume of unmatched defects (r=-0.55). Considering %NVQ only, a cut-off value of 90% correctly categorized 28/30 patients with or without significant pulmonary function impairment.

CONCLUSION: Our study demonstrates strong correlations between V/Q PET/CT functional volumes and PFT parameters. Since V/Q PET/CT is able to assess regional lung function, these data support the feasibility of its use in radiation therapy, preoperative planning and assessing pulmonary dysfunction in a variety of respiratory diseases.

Antimicrobial Proteins and Peptides in Human Lung Diseases: A Friend and Foe Partnership with Host Proteases.

Lung antimicrobial proteins and peptides (AMPs) are major sentinels of innate immunity by preventing microbial colonization and infection. Nevertheless bactericidal activity of AMPs against Gram-positive and Gram-negative bacteria is compromised in patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF) and asthma.

Evidence is accumulating that expression of harmful human serine proteases, matrix metalloproteases and cysteine cathepsins is markedely increased in these chronic lung diseases. The local imbalance between proteases and protease inhibitors compromises lung tissue integrity and function, by not only degrading extracellular matrix components, but also non-matrix proteins. Despite the fact that AMPs are somewhat resistant to proteolytic degradation, some human proteases cleave them efficiently and impair their antimicrobial potency. By contrast, certain AMPs may be effective as antiproteases. Host proteases participate in concert with bacterial proteases in the degradation of key innate immunity peptides/proteins and thus may play immunomodulatory activities during chronic lung diseases.

In this context, the present review highlights the current knowledge and recent discoveries on the ability of host enzymes to interact with AMPs, providing a better understanding of the role of human proteases in innate host defense.

Developments in the management and treatment of pulmonary embolism

Pulmonary embolism (PE) is a serious and costly disease for patients and healthcare systems. Guidelines emphasise the importance of differentiating between patients who are at high risk of mortality (those with shock and/or hypotension), who may be candidates for thrombolytic therapy or surgery, and those with less severe presentations. Recent clinical studies and guidelines have focused particularly on risk stratification of intermediate-risk patients. Although the use of thrombolysis has been investigated in these patients, anticoagulation remains the standard treatment approach. Individual risk stratification directs initial treatment. Rates of recurrence differ between subgroups of patients with PE; therefore, a review of provoking factors, along with the risks of morbidity and bleedin...

Cardiovascular comorbidities in hospitalised COPD patients: a determinant of future risk?

Cardiovascular disease (CVD), diabetes mellitus and arterial hypertension increase the risk of death and hospitalisations of chronic obstructive pulmonary disease (COPD) patients [1]. COPD patients with CVD are at increased risk of COPD-related hospitalisations [2]. Arterial hypertension is one of the most prevalent comorbidities, influencing 40–60% of COPD patients [1]. Diabetes mellitus is more prevalent in moderate to very severe COPD than in the general population [1] and hyperglycaemia during acute exacerbations of COPD (AECOPD) is associated with increased in-hospital mortality [3]. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has proposed a multidimensional classification for COPD management [4, 5] that includes symptoms and future risk of AECOPD, based on...

Current Pharmacological Treatment of Pulmonary Aspergillosis

Invasive aspergillosis (IA) is a severe condition with high mortality rates that typically occurs among immunocompromised patients, mostly those affected by hematological malignancies. In the past few years, an increasing number of cases have been reported among patients without classic risk factors. Although the current guidelines report voriconazole as the first-line therapy for IA, the increase in the rates of Aspergillus fumigatus resistant to azoles represents an emerging problem and requires the introduction of new therapeutic options. For these reasons, alternative antifungal therapies may be used in selected scenarios. The 2014 European Society of Clinical Microbiology and Infectious Disease guidelines recommend the use of isavuconazole, a new azole, as one of the first-line treatm...

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