Small Opacities Research Articles

Extracellular Histones Promote Pulmonary Fibrosis in Patients With Coal Workers’ Pneumoconiosis

This investigation assessed the profibrotic role that extracellular histones play in the pathogenesis of coal workers' pneumoconiosis (CWP). The correlation of extracellular histones with small opacity profusion (SOP) and transforming growth factor-β (TGF-β) was analyzed. The stimulating effect of extracellular histones on pulmonary fibroblast was assessed in vitro. The levels of extracellular histones in plasma were positively correlated with SOP and TGF-β in the coal miners investigated. Plasma collected from patients with CWP caused apparent lung fibroblast proliferation, while anti-H4 antibody antagonized the stimulating effect of the patient plasma by blocking histone H4. In vitro experiments showed that extracellular histones directly stimulated fibroblast proliferation. Consistent with our hypothesis, the concentrations of extracellular histones were indices of the severity of pulmonary fibrosis in simple CWP, and extracellular histones-targeted intervention could inhibit the proliferation of lung fibroblast.

A Pilot Study of Pulmonary Segmentectomy With Indocyanine Green Near-Infrared Angiography.

Video-assisted thoracoscopic surgery (VATS) pulmonary segmentectomy is commonly used in treating small ground-glass opacity (GGO) nodules in lung. The identification of the intersegmental plane is one of the challenges. In this pilot study, we aimed to evaluate the feasibility of indocyanine green (ICG) angiography in VATS segmentectomy. Nineteen GGO patients were enrolled, and VATS segmentectomy with ICG near-infrared angiography were performed between July 2017 and December 2017. Conventional 3-port VATS was used. ICG was injected intravenously after dominant arties were ligated. Intersegmental plane was identified and divided by stapler and electrocautery. All patients had perfect intersegmental plane visualization. The mean operation time was 140.8 minutes, and the mean blood loss was 23.7 mL. No complications due to ICG occurred. The mean chest tube duration was 4.6 days. No severe complications occurred in the perioperative period. The mean chest tube drainage duration was 4.6 days. Prolonged postoperative air leak (>5 days), which required no surgical intervention, occurred in 2 cases. There were no severe complications or in-hospital deaths. VATS segmentectomy with ICG near-infrared angiography is a reasonable treatment option to treat small GGO in lung, especially due to its good surgical view maintenance.

Hybrid operating room for the intraoperative CT-guided localization of pulmonary nodules.

Video-assisted thoracic surgery (VATS) requires preoperative computed tomography (CT)-guided localization of small pulmonary nodules or ground glass opacities (GGOs). However, this traditional two-stage approach is not devoid of potential complications, including wire dislodgement, pneumothorax, and/or hemothorax. With the advent of hybrid operating rooms (HORs), simultaneous single-stage localization and removal of such lesions has become possible. Here, we review the technical developments and the state-of-the-art in the field of intraoperative CT-guided localization and resection of small pulmonary nodules performed within a HOR.

A case report with osteopoicileosis and collagenoma: Buschke-Ollendorff syndrome

Buschke-Ollendorff syndrome is an inherited disease primarily affecting the skin and bones. It is characterized by small nodular opacities osteopoikilosis in bones and collagenoma and/or elastoma in the skin. In this case report, a 22-yearold male patient with pain complaints from his martial arts was presented with the findings of physical examination and X-ray examinations. Findings related to this syndrome were discussed in this case report.

The Burden of Silicosis in Michigan: 1988-2016.

Exposure to respirable crystalline silica causes silicosis, a preventable, progressive occupational lung disease. A more rigorous occupational health standard for silica could help protect silica-exposed workers. To describe trends over 29 years of silicosis surveillance in Michigan. Michigan law requires the reporting of silicosis. We confirmed the diagnosis of silicosis in reported cases using medical questionnaires, review of medical records, and chest radiographs. The Michigan Occupational Safety and Health Administration (OSHA) conducted enforcement inspections at the workplaces of the silicosis cases, including air monitoring for silica and evaluation of workplace medical surveillance programs. The Michigan surveillance program identified 1,048 silicosis cases from 1988 to 2016, which decreased from 620 during 1988-1997, to 292 during 1998-2007, to 136 during 2008-2016. The cumulative incidence rate of silicosis decreased from 3.7 to 1.4 to 0.7 cases per 100,000 men 40 years of age and older in Michigan over the same three periods. African Americans had a higher cumulative incidence rate of silicosis, with 6.0 cases per 100,000 African American men 40 years of age and older in Michigan compared with 1.2 cases per 100,000 white men 40 years of age and older in Michigan. The cases identified had severe disease; 59% had progressive massive fibrosis or category 2 or 3 small opacities per B-reading classification of the chest radiograph. Seventeen percent reported ever having active tuberculosis. On spirometry, 76% of ever smokers and 72% of never smokers demonstrated either a restrictive or an obstructive pattern. Most (65%) had not applied for workers' compensation benefits; the percentage who applied for benefits decreased from 42% to 28-16% over the three periods. Thirty-four of 55 (62%) workplace inspections found exposures above the new OSHA 50 μg/m3 respirable crystalline silica permissible exposure limit, and only 11% of inspected companies screened their workers for silicosis. Adults with confirmed cases of silicosis have advanced disease and morbidity. Most are not using workers' compensation to pay for their care. The new OSHA silica standard, which lowers the permissible exposure limit for silica and requires medical monitoring to identify workers with silicosis, will help reduce the burden of silica exposure. It is critical for pulmonologists to be vigilant to recognize and manage this preventable occupational lung disease.

Exposure‒response relationships for silicosis and its progression in industrial sand workers.

Objectives This study aimed to characterize the relationship between radiographic silicosis and exposure to respirable quartz and determine how exposure affects disease progression. Methods Surveillance chest radiographs from a cohort of 1902 workers were examined to identify 67 cases of radiographic silicosis and 167 matched controls. Exposures were estimated by linking work histories to a job exposure matrix (JEM) based on samples collected by the participating companies and historical estimates. Conditional logistic regression was used to examine exposure‒response relationships. Sequential radiographs from silicosis cases were used to assess associations between exposure and disease progression. Results Risk of silicosis increased with cumulative exposure [odds ratio (OR) 1.43 per 1 mg/m 3years, 95% confidence interval (CI) 1.23-1.66], average exposure concentration (OR 1.30 per 0.10 mg/m 3, 95% CI 1.11-1.51) and net exposure duration (OR 1.10 per year, 95% CI 1.05-1.16). Multivariate analyses indicated that the risk associated with cumulative exposure varied depending on exposure duration and concentration. Analysis of the time worked at differing exposure levels indicated that exposures ≤0.05 mg/m 3were not significantly associated with silicosis risk after adjustment for years worked at higher concentrations. Disease progression was related to subsequent exposure concentration, with a yearly increase in small opacity profusion of 0.052 subcategory per each 0.10 mg/m 3increase in concentration. Conclusions Workers with longer exposure at lower concentrations were at higher risk for silicosis than those with the same cumulative exposure who worked for a shorter time at higher concentrations. The rate of silicosis progression was related to subsequent exposure concentration.

Smoking cessation sharply reduced lung cancer mortality in a historical cohort of 3185 Chinese silicotic workers from 1981 to 2014

BackgroundPopulation-based studies showed an over 50% decrease in lung cancer risk after quitting smoking for 5–6 years, but the beneficial effect in silicotics remains unknown. We aimed to rectify this knowledge gap using a large historical cohort of 3185 Chinese silicotics since 1981 and followed-up till 2014.MethodsBaseline information on workers’ socio-demographics, smoking habits, occupational history, and medical history was collected. Smoking status was reassessed during follow-up. Multiple Cox proportional hazards model was performed to evaluate the impact of smoking cessation on lung cancer mortality.ResultsOverall, 1942 deaths occurred and 188 lung cancer deaths were identified. Compared with never quitters, silicotics who were new quitters had almost halved their lung cancer risk [hazard ratio (HR) = 0.51, 95%CI: 0.34–0.76], while persistent quitters had a 53% risk reduction (HR = 0.47, 95%CI: 0.33–0.66). Lung cancer mortality approximately halved after quitting smoking for 10 years. While the risk kept decreasing with years since cessation, it did not reverse back to that of never smokers. Persistent quitters with small opacities tended to have higher beneficial effects than those with large opacities.ConclusionsSmoking cessation for 10 years halved lung cancer mortality among silicotics, while the beneficial effect was prominent for patients with small opacities.

The 13CO2 absorption spectrum by CRDS near 1.74 µm

The 1.74 µm spectral region corresponds to a very weak absorption interval of carbon dioxide (or “transparency window”) of particular importance to sound the deep atmosphere and the surface of Venus. In the present work, we extend the characterization of this spectral interval by the study of the 13CO2 isotopologues by high sensitivity cavity ring down spectroscopy (CRDS) with a highly enriched 13C sample. Indeed, in spite of their low natural abundances, the 13C minor isotopologues (in particular 16O13C18O with natural abundance less than 4.5 × 10−5) contribute importantly to the small residual opacity. In the studied 5694–5851 cm−1 spectral interval about 980 lines with intensity values as low as a few 10−30 cm/molecule at 296 K were detected. On the basis of the predictions of effective Hamiltonian models, the measured CO2 transitions were assigned to six isotopologues: 12C16O2, 13C16O2, 16O12C18O, 16O13C18O, 16O13C17O and 13C18O2. A total of 20 bands were assigned to the 13C isotopologues. Six of them are newly reported while the set of observed rotational transitions is enlarged for the others. The spectroscopic parameters of nineteen 13CO2 bands are determined from standard band-by-band analysis (typical rms deviations of the line positions are 8 × 10−4 cm−1).The new data show an overall good agreement with the Carbon Dioxide Spectroscopic Databank (CDSD-296), HITRAN2016 database and ab initio CO2 line lists. The previously identified issue related to the mixing of line intensities with CDSD or ab initio origins in the HITRAN database is illustrated by the 41104-00001 band of 13C16O2. A general discussion of the bands affected by this issue in the HITRAN2016 list is included.

Silicosis in underground miners in Lubumbashi, Democratic Republic of the Congo: 27 cases.

Silicosis is one of the most prevalent occupational lung diseases and a public health problem throughout the world. Underground miners of copper and cobalt are exposed to the dust of these minerals and thus to the risk of developing silicosis. The objective of this report was to describe a series of silicosis cases in miners exposed to mineral dusts at a mining company operating since the colonial era in Lubumbashi, Katanga province, in the Democratic Republic of the Congo (DRC). This descriptive retrospective study reviewed records at the occupational safety and health department of the mining company mentioned above and included 2500 underground miners who worked there between 1970 and 1995; it collected and analyzed their medical records. Chest radiographs of silicosis patients were classified according to the ILO International Classification of Radiographs of Pneumoconiosis. All miners were males (mean age: 48.5 ±12.5), had low literacy levels, and used no protective device (i.e., mask) against dust. Their mean number of working years in the underground mines was 25.07±7.39 years. Of the 2500 miners, 1.08% (27/2,500) had developed silicosis. The most common clinical manifestations were dyspnea and cough, and the most prevalent radiologic features large opacities (92.59%), small opacities (96.27%), and pleural thickening (25.92%). The fatality rate was 100%. This study revealed the absence of safety measures among Congolese underground miners from Lubumbashi, which might have contributed to the development of silicosis in some of them. It is thus necessary to implement occupational safety measures to reduce their risk of silicosis.

Confocal biomicroscopy in four patients with polychromatic corneal dystrophy

Abstract Introduction Polychromatic corneal dystrophy is an unusual pre-Descemet dystrophy, about which there are very few publications. The findings are presented in a case series of four patients with polychromatic corneal dystrophy, using a slit lamp, specular biomicroscopy, and confocal microcospy. Clinical cases Four women, between 36 and 72 year-old, with the diagnosis of polychromatic corneal dystrophy in routine reviews. None reported visual symptoms or ocular history of interest. Anterior biomicroscopy showed multiple and small multicolored brilliant opacities in the posterior area of the corneal stroma, with normal epithelium and anterior stroma. The opacities were bilateral and distributed throughout the entire cornea. Direct family members were examined, but none of them showed opacities. In the specular biomicroscopy, a normal endothelium, with pre-Descemet hypereflective particles, was observed. With confocal microscopy, there were no abnormalities in epithelium, Bowman layer, or sub-basal nervous plexus. In two cases, the anterior stroma showed hyper-reflective keratocytes and with small hypereflective particles among them. In the middle stroma, hyper-reflective keratocytes were seen in the four cases, two of them showed tiny hypereflective particles, and in the other two there were abnormal keratocytes with prominent cytoplasmic processes. Posterior stroma in the four cases showed a lot of hypereflective keratocytes and hypereflective particles of different sizes. These particles prevented examining the endothelium. Conclusions Polychromatic corneal dystrophy has typical signs that allow it to be diagnosed and characterized. Although the biomicroscopy image only seems to show alterations in the posterior stroma, confocal microscopy shows that the dystrophy affects the entire corneal stroma.

P1.16-36 Real-Time Ct Guided Video Assisted Thoracoscopic Partial Resection of Peripheral Small-Sized Lung Tumors

As pulmonary resection for small and grand-grass opacity (GGO) dominant pulmonary nodules have been increasing, various navigation systems to detect these nodules have been reported. The aim of this study is to evaluate feasibility of real-time CT guided pulmonary resection for impalpable small pulmonary nodules. From July to November in 2017, 11 patients were eligible for pulmonary resection for lung cancer or malignancy suspected lesions, which was expected to be difficult to detect during operation. These nodules were defined as GGO-dominant (>50%) tumor with a diameter of 3cm or lower (GGO-dominant type), and tumor with a diameter of 2cm or lower, which is located deeper than the diameter of the tumor from visceral pleura (deep solid type). First, we put several surgical clips as first marker on the visceral pleura of the tumor-located lobethrough 3-ports VATS approach. The tumor and the first markers were visualized by cone beam CT, then the second marker was put just on the tumor based on the image. Pulmonary resection was performed according to second marker guided by automated staplers. CT scanning was also performed for confirmation of the complete resection. These procedures were performed for 4 men and 7 women (mean age: 58 years (39-71)). Tumors were located in the right upper lobe/right lower lobe/left upper lobe/left lower lobe in 5/2/2/2 patients. Diameters of tumors were 1.5cm or less. Six tumors were GGO-dominant types whereas 5 were solid types located in the deep from the visceral pleura; therefore all tumors couldn’t be detected by video-scopic observation. The average number of cone beam CT scanning is 2.7 times. All patients accomplished macroscopic and microscopic complete resection with no adverse events during perioperative periods. This feasibility study suggested that cone beam CT was safe and useful guide forvideo assisted thoracoscopic partial resection for impalpable peripheral pulmonary nodules.

All things are created twice, but the surgeon only gets one chance: bronchoscopy marking may help the surgeon to perform sublobar resection.

We would like to thank Professor Sato for his interest and positive comments regarding our work. In an era of minimally invasive thoracic surgery [video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS)], minimally invasive sublobar resection (SLR) represents a serious challenge especially for small peripheral nodules (SPNs) or ground glass opacities (GGOs).

HIGH DOSE CORTICOSTEROIDS IN ACUTE MANAGEMENT OF ACUTE INTERSTITIAL PNEUMONIA

SESSION TITLE: Critical Care 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Little advancements have been made in the management of acute interstitial pneumonia (AIP) since its discovery. This case report describes the use of high dose corticosteroids in the resolution of presumed AIP. CASE PRESENTATION: The patient is a middle aged, African American, nonsmoking female with a past medical history of morbid obesity and obstructive sleep apnea complicated by noncompliance with nightly CPAP who presented with a combination of fevers, chills and emesis. She was initially treated with vancomycin and pipercillin-tazobactam. Her hospital course was rapidly complicated by fluid refractory hypotension, which required ICU transfer for vasopressor therapy. At the time of transfer, the patient was found to be profoundly hypoxemic requiring the initiation of high flow nasal cannula at a rate of 55 liters per minute and 100% FiO2. Plain chest film at that time was notable for hypoinflation without other abnormalities. Chest CT completed shortly thereafter revealed a few small ground glass opacities in the bilateral apices, small pleural effusions and dependent compressive atelectasis of the lower lobes. Within 24 hours, the patient developed diffuse airspace disease on plain film chest imaging. When she failed to respond to aggressive diuresis, concern for a potential noninfectious, inflammatory process was considered. This diagnosis was furthered when repeat chest CT imaging demonstrated multilobar, diffuse ground glass opacities with septal thickening and consolidations in the setting of a sedimentation rate greater than 100. She was then started on high dose steroids (methylprednisolone 500mg IV every 6 hours) for presumed acute interstitial pneumonia. Repeat CT chest completed four days into the course of corticosteroid therapy revealed near complete resolution of the radiographic abnormalities. The patient was also weaned off supplemental oxygen over the same time period and was ultimately discharged on a prolonged prednisone taper. DISCUSSION: AIP is often defined as a rapidly progressive respiratory failure in the setting of bilateral radiographic infiltrates and an absence of a known, underlying inciting cause. While the diagnosis of AIP requires a surgical lung biopsy demonstrating organizing diffuse alveolar damage, it too often is a diagnosis of exclusion given the severity of most patients' illness. Corticosteroids have been shown to inhibit proinflammatory mediators and limit the fibrotic response seen in the pathogenesis of AIP. Patients are believed to require deliberate steroid tapers to prevent reoccurrence. CONCLUSIONS: This case report reaffirms the notion that high dose corticosteroid therapy can be useful in the acute management of AIP. There are currently limited treatment options for AIP, and given the high mortality associated with AIP more advanced therapies need to be investigated. Reference #1: Avnon LS, Pikovsky O, Sion-vardy N, Almog Y. Acute interstitial pneumonia-Hamman-Rich syndrome: clinical characteristics and diagnostic and therapeutic considerations. Anesth Analg. 2009;108(1):232-7. Reference #2: Suh GY, Kang EH, Chung MP, et al. Early intervention can improve clinical outcome of acute interstitial pneumonia. Chest. 2006;129(3):753-61. Reference #3: Vourlekis JS. Acute interstitial pneumonia. Clin Chest Med. 2004;25(4):739-47, vii. DISCLOSURES: No relevant relationships by Seth Brant, source=Web Response No relevant relationships by Jared Dyer, source=Web Response

Continued Increase in Prevalence of Coal Workers' Pneumoconiosis in the United States, 1970-2017.

To update prevalence estimates for coal workers' pneumoconiosis (CWP) among working underground coal miners in the United States. We conducted a prevalence study using radiographs collected from 1970 to 2017. We classified each radiograph using international standards. We defined CWP as the presence of small opacities, with profusion greater than or equal to subcategory 1/0, or the presence of a large opacity larger than 1 centimeter. Following a low point in the late 1990s, the national prevalence of CWP in miners with 25 years or more of tenure now exceeds 10%. In central Appalachia (Kentucky, Virginia, West Virginia), 20.6% of long-tenured miners have CWP. When we excluded miners from central Appalachia, the prevalence for the remainder of the United States was lower, but an increase since 2000 remains evident. The national prevalence of CWP among working coal miners is increasing. This increase is most pronounced in central Appalachia. Current CWP prevalence estimates will likely be reflected in future trends for severe and disabling disease, including progressive massive fibrosis. Public Health Implications. Recently enacted protections to prevent coal mine dust exposure and identify CWP at its early stage remain essential to protect US coal miners.

Biomicroscopia confocal en 4 pacientes con distrofia corneal policromática

IntroductionPolychromatic corneal dystrophy is an unusual pre-descemet dystrophy, about which there are very few publications. The findings are presented in a case series of four patients with polychromatic corneal dystrophy, using a slit lamp, specular biomicroscopy, and confocal microcospy. Clinical casesFour women, between 36 and 72 year-old, with the diagnosis of polychromatic corneal dystrophy in routine reviews. None reported visual symptoms or ocular history of interest. Anterior biomicroscopy showed multiple and small multicoloured brilliant opacities in the posterior area of the corneal stroma, with normal epithelium and anterior stroma. The opacities were bilateral and distributed throughout the entire cornea. Direct family members were examined, but none of them showed opacities. In the specular biomicroscopy, a normal endothelium, with pre-descemet hypereflective particles, was observed. With confocal microscopy, there were no abnormalities in epithelium, Bowman layer, or sub-basal nervous plexus. In two cases, the anterior stroma showed hyper-reflective keratocytes and with small hypereflective particles among them. In the middle stroma, hyper-reflective keratocytes were seen in the four cases, two of them showed tiny hypereflective particles, and in the other two there were abnormal keratocytes with prominent cytoplasmic processes. Posterior stroma in the four cases showed a lot of hypereflective keratocytes and hypereflective particles of different sizes. These particles prevented examining the endothelium. ConclusionsPolychromatic corneal dystrophy has typical signs that allow it to be diagnosed and characterised. Although the biomicroscopy image only seems to show alterations in the posterior stroma, confocal microscopy shows that the dystrophy affects the entire corneal stroma.

Potential asbestos exposure among patients with primary lung cancer in Japan.

Objective: To investigate the extent of asbestos exposure among patients with primary lung cancer in Japan. Methods: A retrospective estimation of potential asbestos-exposed individuals, as determined by the presence of pleural plaques identified on chest computed tomography (CT), was conducted on 885 pathologically confirmed primary lung cancer patients (mean age 71.3 years, 641 males). All patients were diagnosed at 29 hospitals across Japan between 2006 and 2007. Since these hospitals belong to the Japan Federation of Democratic Medical Institutions (MIN-IREN), an organization of medical institutions for workers, the study subjects may contain a higher proportion of workers than the general population. Results: Pleural plaques were identified in 12.8% of subjects (15.8% in males and 4.9% in females), consisting exclusively of cases older than 50 years. They were found most frequently on the chest wall pleura (96.5%), followed by the diaphragm (23.9%) and mediastinum (9.7%). Calcifications were seen in 47 cases (41.6%). The highest prevalence of pleural plaques was seen among workers from construction-related fields (37.7%). No distinct lung cancer histology was observed in patients with pleural plaques. Coexistence of pleural plaques and small irregular opacities was observed in 2.5% of subjects. Conclusion: In a Japanese population representing more workers than general Japanese, 12.8% of patients with primary lung cancer may have experienced asbestos exposure at some time in the past. Special medical attention should be paid to individuals with a history of employment in construction-related occupations, as workers in this sector showed the highest prevalence of pleural plaques.

Elliptic flow from Coulomb interaction and low density elastic scattering

In high energy heavy ion collisions and interacting cold atom systems, large elliptic flow anisotropies have been observed. For the large opacity ($\rho\sigma L\sim 10^{3}$) of the latter hydrodynamics is a natural consequence, but for the small opacity ($\rho\sigma L\sim 1$) of the former hydrodynamic description is questionable. To shed light onto the situation, we simulate the expansion of a low density Argon ion (or atom) system, initially trapped in an elliptical region, under the Coulomb interaction (or elastic scattering). Significant elliptic anisotropy is found in both cases, and the anisotropy depends on the initial spatial eccentricity and the density of the system. The results may provide insights into the physics of anisotropic flow in high energy heavy ion collisions and its role in the study of quantum chromodynamics.

Radiological signs associated with pulmonary multi-drug resistant tuberculosis: an analysis of published evidences.

Despite that confirmative diagnosis of pulmonary drug-sensitive tuberculosis (DS-TB) and multidrug resistant tuberculosis (MDR-TB) is determined by microbiological testing, early suspicions of MDR-TB by chest imaging are highly desirable in order to guide diagnostic process. We aim to perform an analysis of currently available literatures on radiological signs associated with pulmonary MDR-TB. A literature search was performed using PubMed on January 29, 2018. The search words combination was "((extensive* drug resistant tuberculosis) OR (multidrug-resistant tuberculosis)) AND (CT or radiograph or imaging or X-ray or computed tomography)". We analyzed English language articles reported sufficient information of radiological signs of DS-TB vs. MDR-TB. Seventeen articles were found to be sufficiently relevant and included for analysis. The reported pulmonary MDR-TB cases were grouped into four categories: (I) previously treated (or 'secondary', or 'acquired') MDR-TB in HIV negative (-) adults; (II) new (or 'primary') MDR-TB in HIV(-) adults; (III) MDR-TB in HIV positive (+) adults; and (IV) MDR-TB in child patients. The common radiological findings of pulmonary MDR-TB included centrilobular small nodules, branching linear and nodular opacities (tree-in-bud sign), patchy or lobular areas of consolidation, cavitation, and bronchiectasis. While overall MDR-TB cases tended to have more extensive disease, more likely to be bilateral, to have pleural involvement, to have bronchiectasis, and to have lung volume loss; these signs alone were not sufficient for differential diagnosis of MDR-TB. Current literatures suggest that the radiological sign which may offer good specificity for pulmonary MDR-TB diagnosis, though maybe at the cost of low sensitivity, would be thick-walled multiple cavities, particularly if the cavity number is ≥3. For adult HIV(-) patients, new MDR-TB appear to show similar prevalence of cavity lesion, which was estimated to be around 70%, compared with previously treated MDR-TB. Thick-walled multiple cavity lesions present the most promising radiological sign for MDR-TB diagnosis. For future studies cavity lesion characteristics should be quantified in details.

Hereditary cataracts in Russian Blue cats.

The purpose of this study was to investigate the prevalence of cataracts in the Russian Blue breed of cats in Sweden, and to describe the clinical appearance of this presumed inherited form of cataract. A total of 66 Russian Blue cats were examined in Sweden, between March and October 2014, using standard examination techniques. The examined cats were between 3 months and 14 years of age. Pedigrees were collected from all examined cats for genetic studies. Mild-to-severe forms of mainly bilateral cataracts were observed in 22/66 examined Russian Blue cats of both sexes. Two affected cats were <1 year of age. The most frequently observed appearance of a cataract was a small triangular, Y-shaped or circular opacity at the border of the posterior nucleus and the anterior part of the posterior cortex, which caused no observable visual impairment. More extended forms were observed in 6/22 cats, with involvement of both the nucleus and either the entire cortex or parts of the posterior and/or anterior cortex. Visual impairment or blindness was observed in the latter six cases. Pedigree analyses indicated a simple autosomal recessive mode of inheritance for the defect, although a dominant mode with incomplete penetrance could not be excluded. This study indicates that the Russian Blue breed of cat is affected by hereditary cataracts. The high prevalence in young cats and the characteristic location of the most frequently observed defect in the study suggest an early onset type of cataract. The breeders should be aware of this defect and have their cats examined by a veterinary ophthalmologist before breeding of an individual Russian Blue cat is considered.

Dental Technicians' Pneumoconiosis; Illness Behind a Healthy Smile - Case Series of a Reference Center in Turkey.

Background:Dental laboratories include many hazards and risks. Dental technicians working in an unfavorable work environment in Turkey and other parts of the world may develop pneumoconiosis as a result of exposure to dust, depending on exposure time. In this study, we aimed to investigate the clinical and laboratory findings of dental technicians.Materials and Methods:The study consists of a case series. Between 2013 and 2016, a total of 70 who were working as a dental technician and referred to our clinic with suspicion of occupational disease were evaluated. Comprehensive work-history, physical examination complaints, functional status, chest X-ray, and high-resolution computed lung tomography (HRCT) findings were evaluated.Results:In all, 46 (65.7%) of the 70 dental technicians were diagnosed with pneumoconiosis. About 45 (97.8%) subjects were male and 1 (2.2%) was female. The mean age of starting to work was 15.89 ± 2.79 (11-23) years. The mix dust exposure time was 176.13 ± 73.97 (18-384) months. Small round opacities were most common finding. In 16 patients, high profusion being 2/3 and above were identified, and large opacity was detected in 11 patients. The radiological profusion had a weak negative correlation with FEV 1 and FVC (correlation coefficient − 0.18, P = 0.210 and − 0.058, P = 0704) and moderate negative correlation between radiological profusion and FEV1/FVC (correlation coefficient − 0.377, P = 0.010). In addition, no correlation was observed between the age at start of work and the duration of exposure.Conclusion:The presence of pneumoconiosis continues in dental technicians in Turkey, especially because there is an early childhood apprenticeship culture and almost all workers in this period have the history of sandblasting.