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Michela D’Ascanio,1 Fausta Viccaro,1 Noemi Calabrò,1 Giulio Guerrieri,1 Claudia Salvucci,1 Dario Pizzirusso,1 Rita Mancini,1 Claudia De Vitis,1 Aldo Pezzuto,2 Alberto Ricci1 1Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy; 2Department of Cardiovascular and Respiratory Sciences, Sant’Andrea Hospital, Rome, ItalyCorrespondence: Michela D’Ascanio Via di Grottarossa 1035/1039, Roma 00189, RM, ItalyTel +390633776768Email dascaniomichela87@gmail.comPurpose: Lung hyperinflation is a feature of chronic obstructive pulmonary disease (COPD) and can determine pivotal consequence on symptoms, exercise tolerance and quality of life. Despite the relevance of assessing lung hyperinflation, there is still no single consensus as to what volume should be taken into account. We investigate which spirometric measurement is more reliable in assessing static lung hyperinflation and which is more related with impulse oscillometry system (IOS) measurements in COPD.Patients and Methods: Fifty-five COPD patients were enrolled. TLC, RV and RV:TLC ratio were obtained both with helium and plethysmography techniques. IOS measurements (X5, Fres and R5-R20) were performed. Pearson and Spearman correlation determined the relationships between the functional parameters that evaluate static hyperinflation (RV: TLC, TLC, RV) and IOS measurements.Results: As expected, we reported a statistically significant difference between these two techniques in terms of mean percentage values of TLC (7.57 ± 3.26 L; p= 0.02) and RV (15.24 ± 7.51 L; p=0.04), while RV:TLC measured with the two methods was similar (5.21 ± 4.69%; p=0.27). The correlation analysis showed that IOS parameters, such as difference in resistance between 5 Hz and 20 Hz (R(5– 20)) and resonant frequency (Fres), were positively correlated with RV:TLC ratio, while reactance at 5 Hz (X(5)) was negatively correlated with it. In particular, we pointed out a weak correlation between RV:TLC (%) (Pleth) and R(5– 20) (r=0.3, p=0.04), Fres (r=0.3; p=0.03), while X5 had a mild correlation with RV:TLC (%) (r=− 0.5;p< 0.0001). Moreover, we noticed a strong relationship between RV:TLC (%)(He) and X5 (r=− 0.7; p=0.0001) and a mild correlation between RV:TLC (%) (He) and Fres (r=0.4; p=0.003). Between R5-R20 and RV:TLC, there was a weak correlation (r=0.3; p=0.001). No correlation between TLC, RV (L,%) (both helium and Pleth derived) and IOS parameters (R(5– 20), X5, Fres) was found.Conclusion: RV:TLC can represent the most reliable parameter in the assessment of hyperinflation, considering the absence of significant difference in its measurement between the two techniques. IOS provides supplementary information in the assessment of static hyperinflation.Keywords: hyperinflation, COPD, IOS

Supplemental material, sj-pdf-1-hsm-10.1177_0951484820962293 for How to identify the drivers of patient inter-regional mobility in beveridgean systems? Critical review and assessment matrix for policy design & managerial interventions by Alberto Ricci, Elisabetta Barzan and Francesco Longo in Health Services Management Research

Additional file 2. Distribution in the chromosomes of the common non-synonymous variants.

Epithelial-to-mesenchymal transition (EMT) is a process in which cells undergo a developmental switch from epithelial to mesenchymal phenotype. This process has been related to embryologic morphogenesis but also to cancer progression and metastasis. The aim of the current study was to investigate the expression of EMT-related markers in adherent and spheroid cell cultures derived from malignant pleural effusions (MPEs) of patients affected by lung adenocarcinoma. On the basis of efficient in vitro propagation, six cases of MPEs were selected and analyzed by immunocytochemistry staining for EMT markers and by RT-PCR for transcription factors known to orchestrate EMT. EMT markers immunostaining showed in spheroids a statistically significant correlation between the loss of E-cadherin immunoreactivity and overexpression of N-cadherin (P0.001). Likewise loss of EpCAM epithelial marker was coincident with Vimentin overexpression (P0.001). RT-PCR analysis of transcription factors Snail, Slug, and Twist showed a highly variable expression, although a general trend to increase was observed. Importantly, in some selected cases it was possible to establish a precise relationship between spheroid formation, EMT switch and increased upregulation of the marker related to cancer stemness such as ALDH positivity. Therefore, MPE-derived cell cultures, while recapitulating the heterogeneity of lung cancer, are a suitable system to study the mechanisms at the basis of EMT and to understand its relationship with the generation of cancer stem cells.

Italian Journal of Anatomy and Embryology, Vol 115, No 1/2 (Supplement) 2010

Legionella pneumophyla is the agent responsible of Legionnaire's disease. It appears as a severe pneumonia and often requires admission in Intensive Care Unit. In literature, renal failure is reported to occur in 15 percent of Legionnaire disease and this event induce a mortality over 50% of these cases. The authors describe a case of Legionnaire's pneumonia with respiratory failure, rhabdomyolysis and acute renal failure. Patient was a female, 61 yrs old, admitted to our hospital because of fever (38 degrees-38.5 degrees C), severe respiratory failure (pH = 7.49, PaCO2 = 23.1 mmHg, PaO2 = 56.7 mmHg), oliguria (200 ml/24 h); chest x-rays and computed tomography (TC) showed a pneumonia at right lower lobe. Among other things, in blood analysis was noted the following values: BUN = 47 mg/dl, creatinine = 2.1 mg/dl, Na+ = 133 mmol/L, Cl- = 97 mmol/L, Ca+ = 7.2 mg/dl, K+ = 5.8 mmol/L, AST = 213 U/L, ALT = 45 U/L, LDH = 1817 U/L, CPK = 16738 U/L, CPK-MB = 229 U/L, myoglobin4300 ng/ml., leucocyte count = 17,500/mmc (N = 92%, L = 3%, M = 5%), positive anti Legionella IgG and IgM (IgG1:64, IgM1:96), evidence of Legionella soluble antigen in the urine analysis. Therapy with clarytromicyne (500 mg b.i.d i.v.) and rifampicin (600 mg/die i.v.) was begun; computed tomography showed after six days an improvement of pulmonary lesion but, in the following days, health status and blood analysis got worse. Patient went on antibiotics and underwent haemotherapy (Hb: 8 gr/dl), haemodialysis because of acute renal failure but healthy status worse furthermore and she died on 18th days after admission. This case point out rhabdomyolysis with acute renal failure is suggestive for Legionnaire's disease and is associated with high rate of mortality.