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Background: Vascular remodeling and inflammation contribute to the pathogenesis and/or development of pulmonary hypertension. Bone marrow-derived cells (BMCs) include mesenchymal stem cells and progenitor cells play critical role in tissue repair as well as anti-inflammatory effects. Aim of this study was to investigate the effect of intratracheal delivered BMCs on monocrotaline (MCT)-induced muscuralization and inflammation in rat lung.METHODS: BMCs were isolated and cultured for 3 weeks. Seven days following MCT (60 mg/kg) treatment, DiI labeled autologous BMCs were intratracheally delivered to male Sprague-Dawley rats. Twenty-eight days following the MCT treatment, rats had hemodynamic studies. Hearts and lungs were removed to evaluate right ventricular (RV) hypertrophy and lung pathologies.Results: MCT treated rats had increased RV systolic pressure (RVSP), RV weight as well as wall thickness of small pulmonary arteries and alveolar septum thickness than those of placebo-treated control rats (all p values <0.01). Intratracheal delivery of autologous BMCs (1x106) 7 days after MCT prevented the increase in RVSP at 4 weeks compared with MCT alone (45.1 ± 2.23 versus 35.0 ± 3.84 mmHg, respectively; p<0.05). Furthermore, the intratracheal delivery of BMCs significantly attenuated the pulmonary vessel wall thickness (54.4 % ± 2.25 versus 17.8 % ± 2.69, p<0.01), and alveolar septum thickening (155.1 % ± 1.56 versus 114.2 % ± 1.16, p<0.01) accompanied with decreased numbers of inflammatory cells in perivascular areas and expression of proinflammatory cytokines compared with MCT alone. Immunohistochemical studies showed monocyte-like shaped DiI positive cells distributed in alveolar areas in BMCs delivered lungs, and some of those DiI positive cells expressed CD 68 and alpha smooth muscle cell actin.Conclusion: Intratracheal delivery of autologous BMCs prevented MCT-induced pulmonary hypertension by attenuation of vascular muscularization and inflammation in rat lung. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses mondor disease which causes chest pain.

Introduction: Individuals with tuberculosis (TB) who are being treated with anti-tumor necrosis factor α (anti-TNFα) for coexisting conditions may experience unexpected exacerbations of TB after the initiation of antituberculous therapy, so-called anti-TNFα-induced TB-immune reconstitution inflammatory syndrome (anti-TNFα-induced TB-IRIS). Anti-TNFα-induced TB-IRIS is often treated empirically with corticosteroids; however, the evidence of the effectiveness of corticosteroids is lacking and the management can be a challenge., Patient Concerns: A 32-year-old man on long-term infliximab therapy for Crohn disease visited a clinic complaining of persistent fever and cough that had started 1 week previously. His most recent infliximab injection had been administered 14 days before the visit. A chest X-ray revealed a left pleural effusion, and he was admitted to a local hospital., Diagnosis: A chest computed tomography (CT) scan revealed miliary pulmonary nodules; acid-fast bacilli were found in a sputum smear and a urine sediment sample; and polymerase chain reaction confirmed the presence of Mycobacterium tuberculosis in both his sputum and the pleural effusion. He was diagnosed with miliary TB., Interventions: Antituberculous therapy was started and he was transferred to our hospital for further management. His symptoms initially improved after the initiation of antituberculous therapy, but 2 weeks later, his symptoms recurred and shadows on chest X-ray worsened. A repeat chest CT scan revealed enlarged miliary pulmonary nodules, extensive ground-glass opacities, and an increased volume of his pleural effusion. This paradoxical exacerbation was diagnosed as TB-IRIS associated with infliximab. A moderate-dose of systemic corticosteroid was initiated [prednisolone 25 mg/day (0.5 mg/kg/day)]., Outcomes: After starting corticosteroid treatment, his radiological findings improved immediately, and his fever and cough disappeared within a few days. After discharge, prednisolone was tapered off over the course of 10 weeks, and he completed a 9-month course of antituberculous therapy uneventfully. He had not restarted infliximab at his most recent follow-up 14 months later., Conclusion: We successfully managed a patient with anti-TNFα-induced TB-IRIS using moderate-dose corticosteroids. Due to the limited evidence currently available, physicians should consider the necessity, dosage, and duration of corticosteroids for each case of anti-TNFα-induced TB-IRIS on an individual patient-by-patient basis.

Aims: Hyaline membrane (HM) in diffuse alveolar damage (DAD) pattern is frequently detected in the acute stage of interstitial pneumonia (IP). To determine the exact nature of HM, we investigated immunohistochemically 25 cases of HM-containing IP., Methods: The cases examined using various kinds of antibodies were four cases associated with rheumatoid arthritis, five with usual interstitial pneumonia, two with dermatomyositis, five with viral infection, one case with progressive systemic sclerosis and eight cases caused by other agents., Results: HM mostly reacted with antibodies to PE10 (SP-A), Factor VIII, KL-6 and EMA and, interestingly, stained for AE1/AE3, CK19, and Hup-1 in some cases, but was negative for PTAH staining. However, the immunoreactivities of HM varied even within the same disease or section., Conclusions: The immunohistochemical heterogeneity of HM suggests that HM may be formed by different mechanisms in various types of IP. Our findings also suggest that the main components of HM are derived from alveolar epithelial cells and their proteins, some including cytoplasmic element of CK19, and also from serum factors, but not fibrin. The immunohistochemical characteristics of HM in DAD pattern will aid understanding of the significance of HM formation in IP.

A case of multilobar bronchioloalveolar carcinoma (BAC) is reported. To investigate the clonality of BAC, immunohistochemical staining as well as genetic analysis were performed. To investigate point mutations of the p53 gene, we used the polymerase chain reaction and fluorescence-based single strand conformation polymorphism analysis method. The BAC tissues of the right upper lobe, right lower lobe, and the other lobes were considered to be multiclonal. This case suggests that multilobar BAC might occur with multiclonality.