Reticular Lesions Research Articles

Oral Lichen Planus: A Narrative Review Navigating Etiologies, Clinical Manifestations, Diagnostics, and Therapeutic Approaches.

Background/Objectives: Oral Lichen Planus (OLP) is a common immune-mediated inflammatory disorder affecting the oral mucosa, impacting 0.5% to 2% of the global population, primarily middle-aged women. Immunological dysregulation is a key factor in OLP's pathogenesis, involving CD4+ T helper and CD8+ T cytotoxic cells. The World Health Organization (WHO) classifies OLP as a potentially malignant disorder, with a risk of oral squamous cell carcinoma (OSCC) developing in up to 2% of lesions. This narrative review aims to provide a comprehensive overview of the etiopathogenesis, clinical manifestations, diagnostic criteria, and therapeutic strategies for OLP, informing clinical practice and guiding future research. Methods: A review of the literature from the PubMed and Google Scholar databases was conducted up to December 2023, focusing on studies addressing the etiopathogenesis, diagnosis, clinical manifestations, and treatment of OLP. Results: OLP's pathogenesis is driven by immune dysregulation, with CD4+ and CD8+ cells playing crucial roles. Clinically, OLP presents as reticular, erosive, bullous, and plaque-like lesions. Diagnosis relies on clinical examination, histopathology, and direct immunofluorescence. Recent advancements in diagnostic markers and imaging techniques have improved detection and monitoring. Treatment primarily involves corticosteroids, but novel therapies such as curcumin, retinoids, and laser therapy are increasingly used for their effectiveness and reduced side effects. These treatments show promise in symptom reduction and recurrence prevention, although long-term data are needed. Conclusions: Regular screenings and biopsies are essential due to OLP's likelihood of malignant transformation. This study urges further investigation into long-term results, improved diagnostic techniques, and evidence-based treatment regimens.

Extensive macular atrophy with pseudodrusen-like appearance: comprehensive review of the literature.

This review focuses on extensive macular atrophy with pseudodrusen-like appearance (EMAP), a recently described maculopathy presenting with pseudodrusen-like lesions and chorioretinal atrophy more pronounced in the vertical axis. Narrative review of the literature published until May 2024. The early onset age of EMAP (50-55 years) and its distinctive natural history, which includes night blindness followed by severe vision loss, differentiate it from atrophic age-related macular degeneration (AMD). A clear pathogenesis has not been determined, but risk factors include female gender and complement system abnormalities (altered levels of C3 and CH50). Moreover, lifelong exposure to pesticides has been suggested as risk factor for direct neuronal degeneration involving rods and cones. In the early phase of the disease, reticular pseudodrusen-like lesions appear in the superior perifovea and tend to coalescence horizontally into a flat, continuous, reflective material localized between the retinal pigmented epithelium and Bruch's membrane. Over time, EMAP causes profound RPE and outer retinal atrophy in the macular area, with a recent classification reporting a 3-stages evolution pattern. Blue autofluorescence showed rapidly evolving atrophy with either hyperautofluorescent or isoautofluorescent borders. Significant similarities between the diffuse-trickling phenotype of geographic atrophy and EMAP have been reported. Macular neovascularization is a possible complication. EMAP is specific form of early-onset atrophic macular degeneration with rapid evolution and no treatment. Further studies are needed to assess the best management.

Expression of epithelial growth factor receptor as a protein marker in oral reticular and erosive lichen planus

BackgroundOral lichen planus (OLP) is a chronic inflammatory mucosal disease that is classified as a premalignant condition. Epithelial growth factor receptor (EGFR) is associated with tumorigenesis and tumor progression and is overexpressed in several oral malignant disorders. Despite the association of EGFR overexpression with oral potentially malignant lesions, few studies have analyzed its expression in OLP, showing controversial results. This study aimed to compare the expression of EGFR as a protein marker in Reticular and Erosive OLP.MethodsThis descriptive-analytical cross-sectional was conducted on 15 paraffin blocks of reticular lichen planus lesions, 16 paraffin blocks of erosive OLP lesions, and 8 paraffin blocks of inflammatory fibrous hyperplasia lesions as the control group (39 in total). After immunohistochemical staining for EGFR, samples were simultaneously observed by two maxillofacial pathologist, and the percentage of stained cells, intensity of staining, pattern of staining, and the location of stained cells were obtained.ResultsThe Mann-Whitney-U test showed that there was no significant difference in the mean percentage of stained cells between erosive OLP and reticular OLP (P-value = 0.213) and between reticular OLP and control group (P-value = 0.137), but there was a significant difference between erosive OLP and control group (P-value = 0.035). Fisher’s exact test showed that there was no significant difference between the frequency distribution of staining patterns in three types of lesions (P-value = 0.90). Kruskal-Wallis test showed that there was no significant difference between the intensity of staining in the three groups (P-value = 0.19) and also there was no significant difference between the location of stained cells in different layers of the epithelium in the three groups (P-value = 0.90).ConclusionsThe results of this study showed that in comparison of reticular OLP, erosive OLP, and the control group there was a significant difference just between erosive OLP and control group in the percentage of stained cells.

Oral lichen planus – an oral potentially malignant disorder (OPMD) of the oral cavity

Introduction. Oral lichen planus is a chronic inflammatory disease of unknown etiology, characterized by recurrent lesions, presenting as reticular lesions, sometimes accompanied by atrophic, erosive, and/or ulcerative areas. Despite being one of the most common conditions affecting the oral mucosa, oral lichen planus remains an ailment with undefined etiology and unclear pathogenesis, imprecise management, and uncertain premalignant potential. Materials and methods. A narrative literature review study was conducted. A bibliographic search was carried out in databases such as PubMed, Hinari, SpringerLink, the National Center of Biotechnology Information, and Medline. Articles published from 1990 to 2023 were selected using various combinations of keywords: “oral lichen planus,” and “epidemiology,” “etiology,” “pathogenesis,” “symptoms,” “management,” “histopathology,” and “malignant transformation.” After processing the data from these databases, 475 full articles were found. The final bibliography comprised 50 relevant sources, considered representative of the materials published on the topic of this synthesis article. Results. Oral lichen planus is an inflammatory condition associated with T-cell-mediated immune dysfunction. Triggers include autoimmune responses to local antigens, microorganisms, and stress. The disease results from a complex interplay of host factors, lifestyle, and environmental factors leading to T-cell-mediated immune dysregulation. Diagnosis of oral lichen planus is based on clinical features (multiple, bilateral, symmetrically distributed lesions, occurring most commonly on the buccal mucosa, dorsal tongue surface, and gingiva), histopathological findings (predominantly lymphocytic bandlike infiltrate in the lamina propria, presence of apoptotic cells in the basal cell layer, absence of epithelial dysplasia), and immune-related changes (deposition of fibrinogen along the basement membrane zone, presence of granular fluorescent deposits containing IgA, IgG, and IgM in colloid bodies). Conclusions. Oral lichen planus is a chronic inflammatory condition mediated by T-cells in response to various extrinsic antigens, modified autoantigens, or superantigens, with periods of remission and relapse and the potential for malignant transformation. The etiology and pathogenesis of this condition are complex, diagnosis relies on clinical features, histopathological findings, and immunological data, patient treatment is symptomatic, and the potential for malignant transformation varies. Nevertheless, prospective studies with large sample sizes, adequate treatment duration, and long-term follow-up are needed.

Screening, identification, and observation of infection process of a herbicidal fungal strain HY‐02

AbstractThis study clarified the herbicidal activity, crop safety, classification status, and infection process of herbicidal strain HY‐02, and laid a foundation for its development and utilization. Strain HY‐02 was isolated from the leaves of Rumex patientia L. by the tissue isolation method. The pathogenicity of the strain to six broadleaf weeds and the safety for four common crops were determined by spray inoculation. The taxonomic status of HY‐02 was determined by morphology and molecular biology, and the infection process was confirmed by scanning electron microscopy. In vitro leaf experiments showed that strain HY‐02 was pathogenic to six broadleaf weeds, Polygonum aviculare L., Elsholtzia densa Benth., Chenopodium album L., Polygonum lapathifolium L., Amaranthus retroflexus L., and Malva verticillata L. The pot experiment of weeds found that the pathogenicity rates for P. aviculare, E. densa, C. album, P. lapathifolium, A. retroflexus, and M. verticillata were 100.00%, 94.44%, 95.24%, 83.33%, 73.02%, and 40.00%, respectively. Strain HY‐02 seemed safe for four crops (Hordeum vulgare L., Triticum aestivum L., Vicia faba L., and Pisum sativum L.), but not for Brassica napus L. The strain was identified as Alternaria alternata (Fries) Keissler. Scanning electron microscope observations showed that hyphae invaded leaf tissues from the stomata by destroying epidermal cells. Hyphae rapidly grew and invaded living tissues by obtaining nutrients from the tissues, destroying the whole leaf tissues, and finally forming reticular lesions. Therefore, the HY‐02 strain has the potential to be developed into microbial biocontrol agents for weed control.

Predicting the Activity of Oral Lichen Planus with Glycolysis-related Molecules: A Scikit-learn-based Function.

Oral lichen planus (OLP) is one of the most common oral mucosa diseases, and is mainly mediated by T lymphocytes. The metabolic reprogramming of activated T cells has been shown to transform from oxidative phosphorylation to aerobic glycolysis. The present study investigated the serum levels of glycolysis-related molecules (lactate dehydrogenase, LDH; pyruvic acid, PA; lactic acid, LAC) in OLP, and the correlation with OLP activity was assessed using the reticular, atrophic and erosive lesion (RAE) scoring system. Univariate and multivariate linear regression functions based on scikit-learn were designed to predict the RAE scores in OLP patients, and the performance of these two machine learning functions was compared. The results revealed that the serum levels of PA and LAC were upregulated in erosive OLP (EOLP) patients, when compared to healthy volunteers. Furthermore, the LDH and LAC levels were significantly higher in the EOLP group than in the nonerosive OLP (NEOLP) group. All glycolysis-related molecules were positively correlated to the RAE scores. Among these, LAC had a strong correlation. The univariate function that involved the LAC level and the multivariate function that involved all glycolysis-related molecules presented comparable prediction accuracy and stability, but the latter was more time-consuming. It can be concluded that the serum LAC level can be a user-friendly biomarker to monitor the OLP activity, based on the univariate function developed in the present study. The intervention of the glycolytic pathway may provide a potential therapeutic strategy.

Anxiety and depression in keratotic oral lichen planus: a multicentric study from the SIPMO

ObjectivesOral lichen planus with exclusive keratotic reticular, papular, and/or plaque-like lesions (K-OLP) is a clinical pattern of OLP that may be associated with a complex symptomatology and psychological alteration. The aim of the study was to evaluate the prevalence of anxiety (A) and depression (D) in patients with K-OLP, analyzing the potential predictors which can affect mental health status.MethodsThree hundred K-OLP patients versus 300 healthy controls (HC) were recruited in 15 Italian universities. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), and Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A) were administered.ResultsThe K-OLP patients showed statistically higher scores in the NRS, T-PRI, HAM-D, and HAM-A compared with the HC (p-value < 0.001**). A and D were found in 158 (52.7%) and 148 (49.3%) K-OLP patients. Strong linear correlations were identified between HAM-A, HAM-D, NRS, T-PRI, and employment status and between HAM-D, HAM-A, NRS, T-PRI, employment status, and female gender. Multivariate logistic regression revealed that HAM-D and HAM-A showed the greatest increase in the R2 value for A and D in the K-OLP patients, respectively (DR2 = 55.5% p-value < 0.001**; DR2 = 56.5% p-value < 0.001**).ConclusionsThe prevalence of A and D is higher in the K-OLP patients compared with the HC, also found in K-OLP subjects without pain, suggesting that the processing of pain may be in a certain way independent of the processing of mood.Clinical relevanceMood disorders and pain assessment should be carefully performed in relation to K-OLP to obtain a complete analysis of the patients.

Observational findings of transbronchial lung biopsy in patients with interstitial lung disease: a retrospective study in Aleppo University Hospital.

This retrospective cohort research was done between 1 January 2020 and 18 April 2022 at the pulmonary department of Aleppo University Hospital, Syria, using patient records. In our study, 174 patients were examined. We included patients over the age of 18 who were referred or admitted to our department at Aleppo University Hospital after being diagnosed with diffuse parenchymal lung disease based on high-resolution computed tomography and clinical symptoms, while excluding other respiratory diseases such as tuberculosis and coronavirus disease 2019. Patients in the research were 53±7.1 years old on average. Cough and dyspnea were the most common clinical complaints among the patients, which accounted for 79.12 and 78.16%, respectively. A significant fraction of ground-glass opacity was detected on the high-resolution computed tomography, amounting to 102 (58.62%) and 74 (42.53%) for the reticular lesions, respectively. As a complication there were 40 patients with bleeding, of whom 24 had moderate bleeding, and 11 had major bleeding. We also had three patients with pneumothorax. The diagnostic yield of the TBLB in our ILD patients was 66.66%. An adequate diagnostic accuracy (66.66%) was detected in the TBLB in confirming the diagnosis of ILD; in addition, the bleeding was the most prevalent complication of this procedure. More interventional studies are needed to compare the diagnostic accuracy of this procedure with other invasive and noninvasive diagnostic methodologies of ILD.

Current and Emerging Knowledge in COVID-19.

COVID-19 has emerged as a pandemic leading to a global public health crisis of unprecedented morbidity. A comprehensive insight into the imaging of COVID-19 has enabled early diagnosis, stratification of disease severity, and identification of potential sequelae. The evolution of COVID-19 can be divided into early infectious, pulmonary, and hyperinflammatory phases. Clinical features, imaging features, and management are different among the three phases. In the early stage, peripheral ground-glass opacities are predominant CT findings, and therapy directly targeting SARS-CoV-2 is effective. In the later stage, organizing pneumonia or diffuse alveolar damage pattern are predominant CT findings and anti-inflammatory therapies are more beneficial. The risk of severe disease or hospitalization is lower in breakthrough or Omicron variant infection compared with nonimmunized or Delta variant infections. The protection rates of the fourth dose of mRNA vaccination were 34% and 67% against overall infection and hospitalizations for severe illness, respectively. After acute COVID-19 pneumonia, most residual CT abnormalities gradually decreased in extent, but they may remain as linear or multifocal reticular or cystic lesions. Advanced insights into the pathophysiologic and imaging features of COVID-19 along with vaccine benefits have improved patient care, but emerging knowledge of post-COVID-19 condition, or long COVID, also presents radiology with new challenges.

NLP and oral health information.

NLP and oral health information.

Paeoniflorin drives the immunomodulatory effects of mesenchymal stem cells by regulating Th1/Th2 cytokines in oral lichen planus

Lichen planus (LP) is a chronic inflammatory disease. Oral lichen planus (OLP) mainly appears as oral mucosal reticular or ulcerative lesions with an unknown etiology. We aimed to explore the immunomodulatory effect of paeoniflorin (PF) in mesenchymal stem cells (MSCs) and the potential involvement of Th1/Th2 cytokines in OLP. The effects of paeoniflorin on the proliferation and migration of MSCs were detected by Cell Counting Kit-8 (CCK8) and Transwell assays. MSCs were subjected to osteogenic, adipogenic and neurogenic induction followed by Alizarin red, oil red O, real-time PCR and immunofluorescence assays. We found that paeoniflorin promoted the proliferation, migration and multilineage differentiation of MSCs from OLP lesions (OLP-MSCs) in vitro. Paeoniflorin pretreatment increased the inhibitory effect of OLP-MSCs on peripheral blood mononuclear cells. Furthermore, paeoniflorin-pretreated OLP-MSCs simultaneously decreased Th1 cytokine levels and increased Th2 cytokine levels in T lymphocyte cocultures. Finally, paeoniflorin-pretreated OLP-MSCs also promoted the Th1/Th2 balance both in vitro and in the serum of mice that received skin allografts. In conclusion, paeoniflorin enhanced MSC immunomodulation and changed the inflammatory microenvironment via T lymphocytes, suggesting that the improvement of OLP-MSCs is a promising therapeutic approach for OLP.

ORAL LICHEN PLANUS AND LICHENOID LESIONS: CLINICAL FEATURES FROM A BRAZILIAN POPULATION

<h3>Objectives</h3> Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are close conditions that show a considerable overlap in diagnostic criteria. The aim of this study is to evaluate and describe the clinical features from a series of histologic specimens compatible with OLP and OLL diagnosed in Brazilian patients in a 15-year period. <h3>Study Design</h3> All cases histologically diagnosed as OLP and OLL and with histological reports compatible with OLP were retrieved. <h3>Results</h3> The final sample included 221 patients, including 160 females and 61 males, with a mean age of 54 years. The most common affected anatomic site was the buccal mucosa (71%), followed by the tongue (45%) and the gingiva (20%). Gingival involvement in OLL was an unusual finding. The reticular form alone was the most common clinical presentation (53%), followed by the association of reticular and atrophic/erosive/ulcerated lesions (42%). Symptoms were more frequently reported in the presence of atrophic/erosive/ulcerated lesions. <h3>Conclusions</h3> This retrospective study showed that OLP was more commonly observed as reticular lesions in the buccal mucosa of middle-aged women and that OLL was mostly characterized by the association of reticular and atrophic/erosive/ulcerated lesions.

Correction to: Prodromal neuroinvasion of pathological α-synuclein in brainstem reticular nuclei and white matter lesions in a model of α-synucleinopathy

[This corrects the article DOI: 10.1093/braincomms/fcab104.].

Serum vitamin D level in healthy individuals versus patients with symptomatic and asymptomatic oral lichen planus.

The aetiology of oral lichen planus (OLP) is multifactorial, having variable triggers. A role for vitamin D related to the immune system has been established. Vitamin D modulating effect is on the adaptive and innate immune responses. Our study aimed to compare serum levels of vitamin D in patients having different clinical symptoms of OLP (symptomatic or asymptomatic) with healthy individuals. Also, in this study, for further evaluation, the expression level of interleukin-17A and interleukin-6 (IL-17A and IL-6) was evaluated because the presence of active vitamin D reduces the expression of these pro-inflammatory factors.This study was included three groups with 30 volunteers in each. The first group included asymptomatic oral lichen planus patients (reticular or plaque-like lesions). The second group consisted of symptomatic oral lichen planus patients (atrophic or bullous-erosive lesions). In contrast, the third group consisted of healthy control subjects. The serum 25-hydroxyvitamin D was measured between the three groups and then correlated with clinical manifestation of oral lichen planus, either symptomatic or non-symptomatic. The Real-Time PCR technique was used to evaluate the expression of IL-17A and IL-6. Patients with symptomatic OLP (second group) had statistically significantly lower Vitamin D levels than asymptomatic OLP patients (first group). Healthy Controls (third group) exhibited statistically significantly higher vitamin D levels than OLP groups. The results of IL-17A and IL-6 genes expression showed that the presence of vitamin D had a statistically significant effect on reducing the expression of these two pro-inflammatory cytokines among symptomatic and asymptomatic OLP patients. Also, the results showed that there was a statistically significant difference between OLP patients (group I and II) and the control group (group III). In general, the current study results showed that lack of vitamin D had an important role in initiating or increasing the OLP's severity.

Chest CT Patterns from Diagnosis to 1 Year of Follow-up in Patients with COVID-19.

BackgroundThe chest CT manifestations of COVID-19 from hospitalization to convalescence after 1 year are unknown.PurposeTo assess chest CT manifestations of COVID-19 up to 1 year after symptom onset.Materials and MethodsPatients were enrolled if they were admitted to the hospital because of COVID-19 and underwent CT during hospitalization at two isolation centers between January 27, 2020, and March 31, 2020. In a prospective study, three serial chest CT scans were obtained at approximately 3, 7, and 12 months after symptom onset and were longitudinally analyzed. The total CT score of pulmonary lobe involvement, ranging from 0 to 25, was assessed (score of 1–5 for each lobe). Univariable and multivariable logistic regression analyses were performed to explore independent risk factors for residual CT abnormalities after 1 year.ResultsA total of 209 study participants (mean age, 49 years ± 13 [standard deviation]; 116 women) were evaluated. CT abnormalities had resolved in 61% of participants (128 of 209) at 3 months and in 75% of participants (156 of 209) at 12 months. Among participants with chest CT abnormalities that had not resolved, there were residual linear opacities in 25 of the 209 participants (12%) and multifocal reticular or cystic lesions in 28 of the 209 participants (13%). Age 50 years or older, lymphopenia, and severe or aggravation of acute respiratory distress syndrome were independent risk factors for residual CT abnormalities at 1 year (odds ratios = 15.9, 18.9, and 43.9, respectively; P < .001 for each comparison). In 53 participants with residual CT abnormalities at 12 months, reticular lesions (41 of 53 participants [77%]) and bronchial dilation (39 of 53 participants [74%]) were observed at discharge and were persistent in 28 (53%) and 24 (45%) of the 53 participants, respectively.ConclusionOne year after COVID-19 diagnosis, chest CT scans showed abnormal findings in 53 of the 209 study participants (25%), with 28 of the 209 participants (13%) showing subpleural reticular or cystic lesions. Older participants with severe COVID-19 or acute respiratory distress syndrome were more likely to develop lung sequelae that persisted at 1 year.© RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Lee and Wi et al in this issue.

Microvascular Skin Manifestations Caused by COVID-19.

Hypercoagulability and vascular injury, which characterize morbidity in COVID-19 disease, are frequently observed in the skin. Several pathomechanisms, such as inflammation caused by angiotensin-converting enzyme 2-mediated uptake into endothelial cells or SARS-CoV-2-initiated host immune responses, contribute to microthrombus formation and the appearance of vascular skin lesions. Besides pathophysiologic mechanisms observed in the skin, this review describes the clinical appearance of cutaneous vascular lesions and their association with COVID-19 disease, including acro-ischemia, reticular lesions, and cutaneous small vessel vasculitis. Clinicians need to be aware that skin manifestations may be the only symptom in SARS-CoV-2 infection, and that inflammatory and thrombotic SARS-CoV-2-driven processes observed in multiple organs and tissues appear identically in the skin as well.

SYNCHRONICITY OF ORAL LICHEN PLANUS AND MUCOEPIDERMOID CARCINOMA OF MINOR SALIVARY GLAND. CASE REPORT

Background Oral lichen planus is a disease of unknown origin, although its etiology associated with immune disorders is favored. It is difficult to control and has distinctive clinical characteristics that mainly affect vestibular mucosa among other oral mucosa sites. On the other hand, mucoepidermoid carcinoma is the most common malignant neoplasm of minor salivary glands, appearing mainly on the palate. In labial mucosa it can appear as nodules of slow growth, asymptomatic and with blue coloration. A case is reported where both entities are diagnosed in the same patient. Case Presentation A 53-year-old female patient presented with reticular lesions and white plaques with erosive areas distributed in almost all oral mucosa and vermilion borders, with 1 year of evolution that has worsened over time without diminishing over various treatments. On examination, a mobile firm nodule, 1.0 cm in diameter, was distinguished in the submucosal aspect of the lower left labial mucosa. Upon interrogation, the patient was referred for a surgical procedure a year and a half ago without obtaining a histopathologic diagnosis. Biopsies were indicated in both processes. Oral lichen planus and CM of the labial lesion were corroborated by microscopy. Treatment with topical steroids and monitoring of the surgical site of labial mucosa was indicated. After 1-year follow-up, there was control of oral lichen planus and no recurrence of CM. Conclusions The importance of extra- and intraoral examination is based on the various clinical diagnoses found in patients because they can be unique and multiple, with the latter independent or dependent on each other with better treatment and prognosis opportunities.

Evaluation of Salivary Interleukin-12, Interleukin-23 Levels in Patients with Oral Lichen Planus and Squamous Cell Carcinoma

Abstract Objectives The present study aimed to evaluate interleukin-12 (IL-12) and IL-23 in the saliva of patients with oral lichen planus (OLP) and oral squamous cell carcinoma (SCC). Materials and Methods Thirty cases with clinical and histopathological OLP (bilateral lesions, papular and reticular lesions, and Wickham lines) (Group A), 30 with oral SCCs (OSCCs) (Group B), and 30 with no history of oral cancer, other lesions, or lichen planus (Group C) were enrolled at the Department of Oral Medicine School of Dentistry, Zahedan, Iran. The whole unstimulated saliva was collected and the salivary concentration of IL-12 and IL-23 was measured using an enzyme-linked immunosorbent assay in the laboratory. Statistical Analysis Data were analyzed using Kruskal–Wallis, Mann–Whitney tests, and Pearson's correlation coefficients. Results In the present study, salivary IL-12 and IL-23 levels were higher in OSCC patients than in OLP and healthy individuals. Conclusions The results show that although IL-23 and IL-12 cytokines have an important role in the pathogenesis of chronic immunity and inflammatory diseases, further studies are required to assess matrix metalloproteinase links with tumor invasion.

Clinical impact of direct-acting antiviral treatment on patients with hepatitis C virus–related oral lichen planus

<h3>Objectives</h3> Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disease. It has been related to hepatitis C virus (HCV) infection as one of the extrahepatic pathologic manifestations. The current treatment for HCV infection with direct-acting antivirals (DAAs) is highly effective and safe. This study aimed to evaluate the impact of HCV eradication on OLP clinical manifestations. <h3>Methods</h3> Patients with a histologic diagnosis of OLP and HCV chronic infection were recruited from the oral medicine and internal medicine units of the University of Campania "Luigi Vanvitelli." All patients received DAA treatment and were monitored at baseline and during and after treatment for liver function and antiviral response. Patients underwent an oral clinical examination before receiving DAAs (T0) and 8 weeks after the end of treatment (T1), and they were observed periodically in follow-up (FU). Statistical analysis was performed using Mann-Whitney and Wilcoxon tests, chi-square tests, and Fisher exact tests. <h3>Results</h3> Eighteen patients (13 females and 5 males; median age, 75 years) with chronic HCV infection of different genotypes were enrolled. All patients cleared HCV RNA with a sustained virologic response at FU. No adverse events were reported. The median FU was 92 weeks at T2. At T0, 5 patients presented with reticular and bilateral white lesions; 7 patients presented with erosive OLP; and 6 patients presented with a mixed form. The mean percentages of oral sites involved were 30% (±13.9) at T0, 20.8% (±12.9) at T1, and 16.2% (±15.2) at T2, showing improvement from T0 to T1 (<i>P</i> = .007) and T2 (<i>P</i> = .005). One patient developed oral cancer during the treatment and was excluded. Oral lesions have improved in 9 cases (52.9%) at T1 and in 10 cases (55.6%) at FU (T2); among these, 6 (60%) showed complete remission. However, statistical analysis did not reveal a significant correlation between oral improvement and HCV genotype (<i>P</i> = .64), viral load (<i>P</i> = .27), liver status (<i>P</i> = .60), isolated HBcAb positivity (<i>P</i> = .633), and type of DAA received (<i>P</i> = .103). <h3>Conclusions</h3> DAA treatment leading to HCV eradication can improve OLP symptoms. However, a causative relationship between HCV infection and OLP pathogenesis is difficult to establish. Further studies are necessary.

Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort

BackgroundMore than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear.Research QuestionWhat are the major long-term pulmonary sequelae in critical patients who survive COVID-19?Study Design and MethodsConsecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging.ResultsOne hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay.InterpretationThree months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.