Evolution Of Lesions Research Articles

Matrix Metalloproteinase-9 Levels are Associated with Brain Lesion and Persistent Venous Occlusion in Patients with Cerebral Venous Thrombosis.

Elucidating mechanisms of brain damage in cerebral venous thrombosis (CVT) would be instrumental to develop targeted therapies and improve prognosis prediction. Matrix metalloproteinase-9 (MMP-9), a gelatinase that degrades major components of the basal lamina, has been associated to blood-brain barrier disruption. We aimed to assess, in patients with CVT, the temporal change in serum concentrations of MMP-9 and its association with key imaging and clinical outcomes. Pathophysiology of Venous Infarction-PRediction of InfarctiOn and RecanalIzaTion in CVT (PRIORITy-CVT) was a multicenter prospective cohort study of patients with newly diagnosed CVT. Serial collection of peripheral blood samples performed on day 1, 3, and 8, and standardized magnetic resonance imaging on day 1, 8, and 90. MMP-9 was quantified using enzyme-linked immunosorbent assay in 59 patients and 22 healthy controls. Primary outcomes were parenchymal brain lesion, early evolution of brain lesion, early recanalization, and functional outcome on day 90. CVT patients with parenchymal brain lesion had higher baseline concentrations of MMP-9 compared with controls (adjusted p = 0.001). The area under receiver operating characteristic curve value for MMP-9 for predicting brain lesion was 0.71 (95% confidence interval [CI]: 0.57-0.85, p = 0.009). Patients with venous recanalization showed early decline of circulating MMP-9 and significantly lower levels on day 8 (p = 0.021). Higher MMP-9 on day 8 was associated with persistent venous occlusion (odds ratio: 1.20 [per 20 ng/mL], 95% CI: 1.02-1.43, p = 0.030). We report a novel relationship among MMP-9, parenchymal brain damage, and early venous recanalization, suggesting that circulating MMP-9 is a dynamic marker of brain tissue damage in patients with CVT.

ThOracic Ultrasound in Idiopathic Pulmonary Fibrosis Evolution (TOUPIE): research protocol of a multicentric prospective study

IntroductionIdiopathic pulmonary fibrosis (IPF) is the most common and severe interstitial lung disease (ILD). It is a progressive disease that requires a regular follow-up: clinical examination, pulmonary function testing (PFT)...

Histopathological features in fatal COVID-19 acute respiratory distress syndrome.

BackgroundCOVID-19 acute respiratory distress syndrome (ARDS) shares the common histological hallmarks with other forms of ARDS. However, the chronology of the histological lesions has not been well established.ObjectiveTo describe the chronological histopathological alterations in the lungs of patients with COVID-19 related ARDS.DesignA prospective cohort study was carried out.SettingIntensive Care Unit of a tertiary hospital.PatientsThe first 22 consecutive COVID-19 deaths.MeasurementsLung biopsies and histopathological analyses were performed in deceased patients with COVID-19 related ARDS. Clinical data and patient course were evaluated.ResultsThe median patient age was 66 [63–74] years; 73% were males. The median duration of mechanical ventilation was 17 [8–24] days. COVID-19 induced pulmonary injury was characterized by an exudative phase in the first week of the disease, followed by a proliferative/organizing phase in the second and third weeks, and finally an end-stage fibrosis phase after the third week. Viral RNA and proteins were detected in pneumocytes and macrophages in a very early stage of the disease, and were no longer detected after the second week.LimitationLimited sample size.ConclusionsThe chronological evolution of COVID-19 lung histopathological lesions seems to be similar to that seen in other forms of ARDS. In particular, lung lesions consistent with potentially corticosteroid-sensitive lesions are seen.

Ameloblastic fibro-odontoma in a child patient: case report and literature review

The ameloblastic fibro-odontoma (AFO) is a mixed odontogenic tumor, with characteristics of ameloblastic fibroma, presenting enamel and dentin, which occurs more frequently in individuals aged 5 to 17 years. This paper reports na extensive case of ameloblastic fibro-odontoma in the mandible of a 3-year-old patient, discussed in comparison to cases selected from a brief literature review on the clinical characteristics, Evolution and therapeutic options for this lesion. In the last years, there was no consensus in the literature concerning its etiopathogenesis and classification, yet recently the AFO was classified as a developing odontoma. This case is in accordance with the 7 cases reported in the literature of AFO in the mandible of children aged 10 years or younger, especially concerning the lesion pattern and evolution and treatment adopted. The patient did not present relapse and exhibited local bone regeneration at the 3-year follow-up.

Time-Course Changes of Extracellular Matrix Encoding Genes Expression Level in the Spinal Cord Following Contusion Injury-A Data-Driven Approach.

The involvement of the extracellular matrix (ECM) in lesion evolution and functional outcome is well recognized in spinal cord injury. Most attention has been dedicated to the “core” area of the lesion and scar formation, while only scattered reports consider ECM modification based on the temporal evolution and the segments adjacent to the lesion. In this study, we investigated the expression profile of 100 genes encoding for ECM proteins at 1, 8 and 45 days post-injury, in the spinal cord segments rostral and caudal to the lesion and in the scar segment, in a rat model. During both the active lesion phases and the lesion stabilization, we observed an asymmetric gene expression induced by the injury, with a higher regulation in the rostral segment of genes involved in ECM remodeling, adhesion and cell migration. Using bioinformatic approaches, the metalloproteases inhibitor Timp1 and the hyaluronan receptor Cd44 emerged as the hub genes at all post-lesion times. Results from the bioinformatic gene expression analysis were then confirmed at protein level by tissue analysis and by cell culture using primary astrocytes. These results indicated that ECM regulation also takes place outside of the lesion area in spinal cord injury.

Functional and structural evolution of paracentral acute middle maculopathy

A 22-year-old healthy man awoke with a new paracentral scotoma affecting his left eye. On examination, visual acuity was 20/20 in the left eye. Microperimetry (MP) showed reduced retinal sensitivity co-localized to a characteristic band of inner nuclear layer (INL) hyperreflectivity on optical coherence tomography representing paracentral acute middle maculopathy (PAMM) (Fig. 1, upper row). Weekly assessments documented the evolution of the PAMM lesion (Fig. 1). The scotoma persisted despite some improvement in the size with MP while sequential tracked optical coherence tomography B-scans illustrated a progressive decrease in reflectivity and thickness of the corresponding INL.

In Situ Studies of Fibrillar Polymorphs in Alzheimer's Disease

Aggregates of Aβ peptides and tau protein are defining features of Alzheimer's disease (AD) but the contribution of these structures to the etiology of disease remains uncertain. High resolution structures of fibrillar polymorphs have provided a basis for studies of disease, but fall short of defining the molecular mechanisms underlying disease progression. Evidence is accumulating that the peptide conformation within fibrils correlates with disease subtype and suggests that protofilament conformation represents the physical embodiment of a ‘strain’ of AD. Within a single strain the fold of peptides may be invariant. But the fibrils are capable of polymorphism that includes variation in the packing of protofilaments into fibrils; the pitch of the resultant fibrils and the higher order organization of plaques into which they aggregate. These intra-strain polymorphisms are divided by low-energy barriers allowing multiple configurations to coexist within a single preparation or tissue. Clinical presentation of different strains may be determined by variation in the way different protofilament structures generate relevant toxic species, be they monomers, oligomers or higher order structures. To better understand their role in disease, in situ studies of fibril structure have been carried out on histological thin sections of human brain tissue. Scanning x-ray microdiffraction is providing information on the variation of fibrillar polymorphism at sub-cellular length scales and makes possible mapping the distribution of polymorphs within tissue. Scattering in the wide-angle regime produces information on fibrillar twist. Scattering in the small-angle regime can be used to generate the cross-sectional shape of fibrils. Mapping the variation of these structural parameters across and among plaques and tangles in different regions of the brain provides insight into the development and evolution of neurodegenerative lesions.

Long-term evolution of multiple sclerosis iron rim lesions in 7 T MRI.

Recent data suggest that multiple sclerosis white matter lesions surrounded by a rim of iron containing microglia, termed iron rim lesions, signify patients with more severe disease course and a propensity to develop progressive multiple sclerosis. So far, however, little is known regarding the dynamics of iron rim lesions over long-time follow-up. In a prospective longitudinal cohort study in 33 patients (17 females; 30 relapsing-remitting, three secondary progressive multiple sclerosis; median age 36.6 years (18.6-62.6), we characterized the evolution of iron rim lesions by MRI at 7 T with annual scanning. The longest follow-up was 7 years in a subgroup of eight patients. Median and mean observation period were 1 (0-7) and 2.9 (±2.6) years, respectively. Images were acquired using a fluid-attenuated inversion recovery sequence fused with iron-sensitive MRI phase data, termed FLAIR-SWI, as well as a magnetization prepared two rapid acquisition gradient echoes, termed MP2RAGE. Volumes and T1 relaxation times of lesions with and without iron rims were assessed by manual segmentation. The pathological substrates of periplaque signal changes outside the iron rims were corroborated by targeted histological analysis on 17 post-mortem cases (10 females; two relapsing-remitting, 13 secondary progressive and two primary progressive multiple sclerosis; median age 66 years (34-88), four of them with available post-mortem 7 T MRI data. We observed 16 nascent iron rim lesions, which mainly formed in relapsing-remitting multiple sclerosis. Iron rim lesion fraction was significantly higher in relapsing-remitting than progressive disease (17.8 versus 7.2%; P < 0.001). In secondary progressive multiple sclerosis only, iron rim lesions showed significantly different volume dynamics (P < 0.034) compared with non-rim lesions, which significantly shrank with time in both relapsing-remitting (P < 0.001) and secondary progressive multiple sclerosis (P < 0.004). The iron rims themselves gradually diminished with time (P < 0.008). Compared with relapsing-remitting multiple sclerosis, iron rim lesions in secondary progressive multiple sclerosis were significantly more destructive than non-iron rim lesions (P < 0.001), reflected by prolonged lesional T1 relaxation times and by progressively increasing changes ascribed to secondary axonal degeneration in the periplaque white matter. Our study for the first time shows that chronic active lesions in multiple sclerosis patients evolve over many years after their initial formation. The dynamics of iron rim lesions thus provide one explanation for progressive brain damage and disability accrual in patients. Their systematic recording might become useful as a tool for predicting disease progression and monitoring treatment in progressive multiple sclerosis.

Effect of early sleep apnoea treatment with adaptive servo-ventilation in acute stroke patients on cerebral lesion evolution and neurological outcomes: study protocol for a multicentre, randomized controlled, rater-blinded, clinical trial (eSATIS: early Sleep Apnoea Treatment in Stroke)

BackgroundSleep-disordered breathing (SDB) is highly prevalent in acute ischaemic stroke and is associated with worse functional outcome and increased risk of recurrence. Recent meta-analyses suggest the possibility of beneficial effects of nocturnal ventilatory treatments (continuous positive airway pressure (CPAP) or adaptive servo-ventilation (ASV)) in stroke patients with SDB. The evidence for a favourable effect of early SDB treatment in acute stroke patients remains, however, uncertain.MethodseSATIS is an open-label, multicentre (6 centres in 4 countries), interventional, randomized controlled trial in patients with acute ischaemic stroke and significant SDB. Primary outcome of the study is the impact of immediate SDB treatment with non-invasive ASV on infarct progression measured with magnetic resonance imaging in the first 3 months after stroke. Secondary outcomes are the effects of immediate SDB treatment vs non-treatment on clinical outcome (independence in daily functioning, new cardio-/cerebrovascular events including death, cognition) and physiological parameters (blood pressure, endothelial functioning/arterial stiffness). After respiratory polygraphy in the first night after stroke, patients are classified as having significant SDB (apnoea-hypopnoea index (AHI) > 20/h) or no SDB (AHI < 5/h). Patients with significant SDB are randomized to treatment (ASV+ group) or no treatment (ASV− group) from the second night after stroke. In all patients, clinical, physiological and magnetic resonance imaging studies are performed between day 1 (visit 1) and days 4–7 (visit 4) and repeated at day 90 ± 7 (visit 6) after stroke.DiscussionThe trial will give information on the feasibility and efficacy of ASV treatment in patients with acute stroke and SDB and allows assessing the impact of SDB on stroke outcome. Diagnosing and treating SDB during the acute phase of stroke is not yet current medical practice. Evidence in favour of ASV treatment from a randomized multicentre trial may lead to a change in stroke care and to improved outcomes.Trial registrationClinicalTrials.gov NCT02554487, retrospectively registered on 16 September 2015 (actual study start date, 13 August 2015), and www.kofam.ch (SNCTP000001521).

Unbiased examination of genome-wide human endogenous retrovirus transcripts in MS brain lesions

Background: Human endogenous retrovirus (HERV) expression in multiple sclerosis (MS) brain lesions may contribute to chronic inflammation, but expression of genome-wide HERVs in different MS lesions is unknown. Objective: We examined the HERV expression landscape in different MS lesions compared to control brains. Methods: Transcripts from 71 MS brain samples and 25 control WM were obtained by next-generation RNA sequencing and mapped against HERV transcripts across the human genome. Differential expression of mapped HERV-W and HERV-H reads between MS lesion types and controls was analysed. Results: Out of 6.38 billion high-quality paired end reads, 174 million reads (2.73%) mapped to HERV transcripts. There was no difference in HERVs expression level between MS and control brains, but HERV-W transcripts were significantly reduced in chronic active lesions. Of the four HERV-W transcripts exclusively present in MS, ERV3633503 located on chromosome 7q21.13 close to the MS genetic risk locus had the highest number of reads. In the HERV-H family, 75% of transcripts located to nearby 7q21-22 were overrepresented in MS, and ERV3643914 was expressed more than 16 times in MS compared to control brains. Conclusion: Novel HERV-W and HERV-H transcripts located at chromosome 7 regions were uniquely expressed in MS lesions, indicating their potential role in brain lesion evolution.

Does echocardiography help us to refine risk stratification of patients with infective endocarditis?

Infective endocarditis (IE) is a severe condition with persistent high mortality risk. The aim of this study was to evaluate, in addition to clinical characteristics, the role of valvular lesions natural history based on repeated echocardiograms during in-hospital follow-up. Patients hospitalised for IE with repeated echocardiography (defined by at least 2 in-hospital echocardiograms) at follow-up (FU) were retrospectively analysed. Sixty-eight patients with a mean age of 65 ± 17 years old were studied. Only Staphylococcus aureus was associated with a higher mortality in multivariate analysis (P = 0.038). In patients medically treated (n = 19), the global evolution of vegetation size was the following: increase in 15.8%, stability in 26.3%, decrease in 21.1%, and disappearance in 36.8%. There was a significant difference in survival at 1 year between the group with decrease or vegetation disappearance and the group with stability or increased size of the vegetation (respectively 100% versus 37.5%; P = 0.0021; Fig. 1). In patients with surgical treatment (n = 11), there was no significant difference regarding survival at 1 year according to preoperative evolution of vegetation size. Mortality risk of IE was determined by the presence of Staphylococcus aureus infection. The echocardiographic evolution of valvular lesions in non-surgical patients impacts the prognosis but our preliminary series does not allow to draw definite conclusions.

Asymptomatic SARS-CoV-2 infection and CT lung lesions: how reliable is the hypothesised association?

Asymptomatic SARS-CoV-2 infection and CT lung lesions: how reliable is the hypothesised association?

Radiološka slika KOVID-19 pneumonije

Interstitial pneumonia is the main manifestation of the COVID-19 disease. The aim of this paper is to present the spectrum of typical radiological findings (CT - computed tomography, and radiographic) in COVID-19 pneumonia, the different CT examination techniques, the types and evolution of inflammatory lesions in the lungs, the criteria for assessing the probability of COVID-19 pneumonia in comparison to other types of interstitial pneumonia, and the scoring systems for determining the extent of COVID-19 pneumonia, based on CT findings and radiography. The standard CT examination protocol is a native CT examination of the chest, and, due to high sensitivity of low-dose CT protocols for detecting lung lesions, this imaging technique has become widely used in radiological practice during the COVID-19 pandemic. Bilateral, multiple, round or confluent zones of ground-glass density, predominantly localized subpleurally, peripherally and posteriorly, usually most extensive in the lower lobes, represent a typical CT presentation of COVID-19 pneumonia. Consolidations may develop at a later stage. A chest X-ray shows homogeneously reduced transparency in the lateral pulmonary fields, circular and irregular cloudlike shadows, and confluent patchy shadows, usually most extensive basally and laterally. RSNA and CO-RADS criteria are used to assess the probability of COVID-19 pneumonia, based on the criteria of a typical/atypical CT finding. Four stages of COVID-19 pneumonia have been defined, based on the dynamics of inflammatory lung lesion presentation: early, progressive, the phase of consolidation and the phase of organization. To assess the extent and severity of pneumonia, various scoring systems have been proposed, the most widely accepted one being the CT severity scoring system, based on visual semiquantitative assessment of the percentage of lung parenchyma inflammation lesions involvement of each of the five lobes, on a scale of 1 (&lt;5%) to 5 (&gt;75%), whereby the maximum score can be 25.

Ecthyma Gangrenosum in 5-Month-Old Long-Term Ventilated Infant: A Case Report

Rationale: Ecthyma gangrenosum (EG) is an aggressive cutaneous disease caused by local or systemic infection with Pseudomonas aeruginosa. EG is characterized by cutaneous manifestations ranging from nodule and papule to necrotic ulceration with surrounding erythema, especially with black eschar or central crust. EG presents with characteristic skin lesions which is important to establish diagnosis of sepsis caused by P aeruginosa, a serious condition that can be treated efficiently if diagnosed early. Patient concerns: A 5-month-old male infant, case of Severe HIE, Ventilatory dependent with Tracheostomy, NGT feeding, Epilepsy and dystonia admitted to Cambridge Medical and rehabilitation Center (CMRC)–AUH -UAE. Developed characteristic skin lesions of EG and developed sepsis. Diagnoses: Ecthyma gangrenosum and sepsis caused by Pseudomonas aeruginosa. Interventions: Meropenem was used in combination with Vancomycin at first and then continued only with Meropenem. Outcomes: Cure. Lessons: Early recognition of EG plays an important role in providing appropriate empiric antibiotic treatment at early stage and improves the prognosis. Close clinical follow up on skin lesion evolution is an alternative to possible invasive management.

Return of Thoroughbred Racing Horses to the Races after Treating Slab Fractures of the Third Carpal Bone with PRP and Stem Cells

Background: Despite the fact that slab fracture of the third carpal bone is an event of great worldwide relevance in racehorses, the third carpal fracture doesn’t have data on treatments and return to racing in Brazil. The search for efficient treatments and which provide recovery providing horses return to racing is an objective of sports equine medicine. Regenerative therapies like Platelet Rich Plasma (PRP) and Stem Cells (MSc) have demonstrated a great potential in the treatment of several injuries. For the treatment of three Thoroughbred racing horses at Brazilian Jockey Club, with sagittal plane slab fractures of the third carpal bone, we used the association of PRP and Stem Cells for reduction of the rest and good return to conditions athletics of these horses.Cases: Three Thoroughbred racing horses, males, 4 and 5 years old, showed slab fracture third carpal bone in different moments of their activity at Brazilian Jockey Club. Usually, the treatment for this type of fracture is the arthroscopic repair and the conservative management. We performed after initial radiographic evaluation dorsoproximal-dorsodistal oblique (DPr-DDiO) “skyline”, intra-articular applications of PRP and MSCs. The treatments were performed according to the radiographic follow-up of the lesion evolution. No other treatment was performed concomitantly with cell therapy in the 3 treated patients. Three treatments were performed in the first patient and 2 in the second and third patients. Before each treatment for all patients, we performed radiography dorsoproximal-dorsodistal oblique (DPr-DDiO) ‘skyline’ of the carpus. After this step, the animal was sedated with 10% xylazine hydrochloride at a dose of 0.5 mg/kg intravenously. Antisepsis of the carpus was performed and applied with radiographic monitoring of the needle positioning, first the PRP in the volume of 2 mL and in sequence, 20 million cells MSCs suspended in autologous plasma from the cell bank of the Cellen veterinary stem cell laboratory, totalizing 4 mL. The 3 horses returned to their training routines and continued to be monitored by clinical examinations and radiography, there were no post-treatment complications and all ran again in the median time of 253 days after the first application of PRP and stem cells. Everyone won the first race after treatment.Discussion: The 3 patients suffered the fractures after running at the Brazilian Jockey Club. All fractures were simple- no comminuted slab fractures of the third carpal. In our study, we chose to carry out the treatments with PRP and MSCs by intra-articular application. The regenerative medicine occupies a prominent place in recovery from injuries and the association of PRP and MSCs have played an important role in the treatment of athlete horses in tendons, bones and joint injuries and our work, the treatment was effective, without complications, helped to reduce local inflammation, perceptually reducing the pain observed before the application and the animals started running again with a quality equivalent to that observed before the occurrence of injuries. This way, our results demonstrated that the association PRP and MSCs was effective in recovering the 3 patients, all of them ran after injury. The median time for racing was 253 days and the horses won their first races after fractures occurred. These results encourage the use of the association of PRP and MSCs also for no comminuted sagittal plane slab fractures of the third carpal in Thoroughbred Racing horses.

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) – a case report and a review of the latest scientific reports

The paper presents a case of a 61-year-old patient with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS), along with a detailed description of the diagnostic and therapeutic process, as well as radiological records reflecting the evolution of lesions depending on the steroid therapy used. We also refer to the latest literature reports on the aetiology, pathogenesis, diagnosis and treatment of this clinical entity, including its potential relationship with lymphoproliferative and lymphohistiocytic processes. Furthermore, we present a spectrum of diseases that can clinically and radiologically mimic CLIPPERS (CLIPPERS-mimics), along with the proposed differential diagnosis. Finally, the paper presents the recommended treatment strategy for both acute disease and a maintenance therapy, with particular emphasis on the role of steroid therapy.

Patrones de derivación estomatológica y demora en el diagnóstico. Estudio descriptivo

Objective: The aim of this study is to analyze and describe the referral patterns of two groups of patients who consulted the Oral Medicine Department “A”, FOUNC during the year 2019. Materials and methods: A retrospective descriptive study of the analysis of clinical records of two groups of patients of the Oral Medicine Department “A” (2019). Four students, supervised by two professors, carried out the examination. There were registered the following variables: gender, age, type of referral (spontaneous demand, by students, by dentists, by other professionals), pre-referral treatments, evolution (from first symptoms at the time of the stomatological consultation), and kind of lesion (cancer / pre-cancer and other injuries) and prescription of biopsies. Results: 67 clinical records were registered. The average age was 49 years (48 years for men and 50 for women). The stomatological referral by dentists was the most frequent. In 56% of the registered clinical records, the patient consulted with inefficient previous treatments (without a diagnosis) and in the remaining 44%, referrals were made without the prescription of previous treatments, noting a difference of 3 months in the average evolution of the lesions in both situations. 66% of the cases required biopsies. Discussion: When the referral is not appropriate, delays of oral lesions diagnosis are generated. Regarding these cases, the initial clinical scenario is modified, and therefore, the treatment and prognosis of the lesions. Practices must be carried out for postgraduate professional training in Oral Medicine, the promotion of early referral and awareness of self-medication risks.

Lesion Evolution and Neurodegeneration in RVCL-S: A Monogenic Microvasculopathy.

In the article “Lesion Evolution and Neurodegeneration in RVCL-S: A Monogenic Microvasculopathy” by Ford et al.,1 the following sentence was omitted from the Study Funding statement: “This work was supported by Clayco Foundation, Energy 4A Cure Foundation, Cure CRV Research and The Foundation for Barnes Jewish Hospital (MB, MKL, DH, JJM, JPA).” The authors regret the omission.

Immune Escape Mechanisms in Non Small Cell Lung Cancer.

Simple SummaryImmune escape mechanisms have been identified in every step of lung tumorigenesis. A heterogeneous ensemble of immune evasion processes shapes the evolution of precursor lesions towards the invasive phase, contributes to fostering progression from early stage to metastatic disease and defines the main immunological features of specific lung cancer molecular subsets. By disabling distinct phases of the cancer immunity cycle, from antigen presentation to activation of T cell-mediated immunity, and from antigen-specific T cell recruitment to tumor recognition, immune escape in non small cell lung cancer (NSCLC) represents one of the major hurdles to be overcome to improve clinical outcome in patients treated with immunotherapy targeting immune checkpoints.Development of strong immune evasion has been traditionally associated with the late stages of solid tumor progression, since advanced cancers are more likely to have reached the third phase of the immunoediting process. However, by integrating a variety of approaches, evidence for active immune escape mechanisms has been found even in the pre-invasive lesions that later progress to the main NSCLC histotypes. Pre-invasive lesions of adenocarcinoma (LUAD) and of squamous cell carcinoma (LUSC) can show impaired antigen presentation, loss of heterozygosity at the Human Leukocyte Antigen (HLA) region, neoantigen silencing, activation of immune checkpoints, altered TH1/TH2 cytokine ratios, and immune contexture evolution. Analysis of large panels of LUAD vs. LUSC, of early stage NSCLC vs. normal lung tissue, of specific molecular subsets of NSCLC, and of distinct regions within the same tumor, indicates that all these processes of immune escape continue to evolve in the invasive stage of NSCLC, are associated with inter- and intra-tumor heterogeneity, and contribute to resistance to therapy by immune checkpoint blockade (ICB). In this review, we will discuss the most recent evidence on immune escape mechanisms developing from the precursor to invasive stage in NSCLC, and the contribution of immune evasion to resistance to ICB in lung cancer.

Post-COVID-19 infections and evolution of pulmonary and cardiac lesions – the battle has just started

Abstract Talking only about the acute phase of COVID-19 infection is not enough. A multitude of complications has arisen after viremia, which has been generating problems for experts. Of these, lung and heart lesions remain important, and interventions, and their prevalence pose real problems for practitioners. The authors analyze these post-COVID-19 complications as well as appropriate recommendations for diagnostic and therapeutic interventions