Sex Disparity in Severity of Lung Lesions in Newly Identified Tuberculosis Is Age-Associated.

Background: The age-associated characteristic of computed tomography (CT) images of tuberculosis (TB) and the reason for male bias in TB are still not clear. Methods: We compared the CT images, clinical inflammatory indices and sputum bacterial counts between 594 non-smoking men and women with newly diagnosed TB with matched large span of ages from 15 to 92 years old. Logistic regression analyses were used to identify the cavity-associated factors of men and women, separately and in combination. Results: Sputum bacterial counts, ratio of cavities, lung injury scores, and level of C reactive protein were significantly higher in men than in women with ages from 15 to 74, but not in cases older than 75. In CT images, thick walled cavity, cicatricial emphysema and parenchymal bands were present in men at ages of 15-74 more than matched women. Ratios of cases with lobular emphysema and pleural effusion were higher in men after age of 56. While ratios of cases with parenchymal bands, calcification, pleural effusion, pleural thickening, lobular emphysema and bronchovascular distortion increased with aging, those of centrilobular nodules, micronodules and tree in bud decreased with aging in men. Erythrocyte sedimentation rate (ESR) increased with aging, but no differences were found between men and women in ESR or T-SPOT TB tests. Higher complement C4 and lower body mass index in men and positive result in anti-TB antibody test in women were strongly associated with the presence of cavity. Conclusions: The sex bias in TB is age-associated. TB prevention, treatment and research should take differences of sex and age into account.

The Association Between Imaging Features of TSCT and the Expression of PD-L1 in Patients With Surgical Resection of Lung Adenocarcinoma.

OBJECTIVES: Programmed death-ligand 1 (PD-L1) expression might serve as a predictive biomarker for immune checkpoint inhibitors in lung cancer. However, the relationship between PD-L1 expression and imaging features of lung cancer has not been fully understood. PATIENTS AND METHODS: A total of 350 patients with pathologically confirmed adenocarcinoma who received surgical treatment and had preoperative thin section computed tomography (CT) examination were included. Quantitative CT features including the mean CT value and tumor mass were measured on multiplanar reconstructed images. PD-L1-positive tumor was defined as the tumor proportion score > 5%. RESULTS: Seventy-four of 350 (21.1%) specimens were detected as PD-L1-positive tumors. PD-L1 expression was adversely associated with epidermal growth factor receptor mutation status (P < .001) and was significantly associated with invasive adenocarcinomas rather than preinvasive lesions and minimally invasive adenocarcinomas (P < .001). Multivariate analysis identified absence of surrounding ground glass opacity (P = .022), shape (P = .008), pleural indentation (P = .007), tumor mean CT value (P = .004), and the ratio of consolidation mass to tumor mass (P = .003) as being significantly associated with the expression of PD-L1. To improve the diagnostic accuracy, a joint model that combined 5 imaging traits was conducted. The area under the curve of the joint model was 0.783, with a sensitivity of 81.1% and specificity of 64.1%, respectively. CONCLUSION: PD-L1 expression was associated with pathologic invasiveness of adenocarcinomas and CT features, which suggested the possibility of predicting PD-L1 expression status via imaging features.

Sex influences the association between haemostasis and the extent of lung lesions in tuberculosis.

BACKGROUND: Worldwide tuberculosis (TB) reports show a male bias in morbidity; however, the differences in pathogenesis between men and women with TB, as well as the mechanisms associated with such differences, are poorly investigated. We hypothesized that comparison of the degree of lung injury and clinical indices of well-matched men and women with newly diagnosed TB, and statistical analysis of the correlation between these indices and the extent of lung lesions, can provide insights into the mechanism of gender bias in TB. METHODS: We evaluated the acid-fast bacilli grading of sputum samples and compiled computed tomography (CT) data of the age-matched, newly diagnosed male and female TB patients without history of smoking or comorbidities. Inflammatory biomarker levels and routine haematological and coagulation-associated parameters were compared. Binary logistic regression analysis was used to define the association between the indices and lung lesions, and the influence of sex adjustment. RESULTS: Women with TB have a longer delay in seeking healthcare than men after onset of the TB-associated symptoms. Men with TB have significantly more severe lung lesions (cavities and healing-associated features) and higher bacterial counts compared to women with TB. Scoring of the CT images before and after anti-TB treatment showed a faster response to therapy in women than in men. Coagulation- and platelet-associated indices were in models from multivariate regression analysis with groups of males or females with TB or in combination. In univariate regression analysis, lower lymphocyte counts were associated with both cavity and more bacterial counts, independent of sex, age and BMI. The association of international normalized ratios (INR), prothrombin times (PTs), mean platelet volumes (MPVs) and fibrinogen (FIB) level with lung lesions was mostly influenced by sex adjustment. CONCLUSIONS: Sex influences the association between haemostasis and extent of TB lung lesions, which may be one mechanism involved in sex bias in TB pathogenesis.

Hemostasis and Lipoprotein Indices Signify Exacerbated Lung Injury in TB With Diabetes Comorbidity.

BACKGROUND: Exacerbated immunopathology is a frequent consequence of TB that is complicated by diabetes mellitus (DM); however, the underlying mechanisms are still poorly defined. METHODS: In the two groups of age- and sex-matched patients with TB and DM (DM-TB) and with TB and without DM, we microscopically evaluated the areas of caseous necrosis and graded the extent of perinecrotic fibrosis in lung biopsies from the sputum smear-negative (SN) patients. We scored acid-fast bacilli in sputum smear-positive (SP) patients and compiled CT scan data from both the SN and SP patients. We compared inflammatory biomarkers and routine hematologic and biochemical parameters. Binary logistic regression analyses were applied to define the indices associated with the extent of lung injury. RESULTS: Enlarged caseous necrotic areas with exacerbated fibrotic encapsulations were found in SN patients with DM-TB, consistent with the higher ratio of thick-walled cavities and more bacilli in the sputum from SP patients with DM-TB. Larger necrotic foci were detected in men compared with women within the SN TB groups. Significantly higher fibrinogen and lower high-density lipoprotein cholesterol (HDL-C) were observed in SN patients with DM-TB. Regression analyses revealed that diabetes, activation of the coagulation pathway (shown by increased platelet distribution width, decreased mean platelet volume, and shortened prothrombin time), and dyslipidemia (shown by decreased low-density lipoprotein cholesterol, HDL-C, and apolipoprotein A) are risk factors for severe lung lesions in both SN and SP patients with TB. CONCLUSIONS: Hemostasis and dyslipidemia are associated with granuloma necrosis and fibroplasia leading to exacerbated lung damage in TB, especially in patients with DM-TB.

Air bronchogram: A potential indicator of epidermal growth factor receptor mutation in pulmonary subsolid nodules.

OBJECTIVES: Evaluation of pulmonary subsolid nodule is a longstanding clinical problem. We aimed to validate the computed tomography (CT) features correlating with pathological invasiveness and to explore any imaging findings associated with epidermal growth factor receptor (EGFR) mutation in lung adenocarcinoma. METHODS: A total of 204 patients with pathologically proven stage IA adenocarcinoma who had preoperative CT and data on EGFR status were enrolled in this retrospective study. Quantitative CT features including tumor size and solid volume proportion (SVP) were measured on multiplanar reconstructed images. Pathological analysis was stratified into adenocarcinoma in situ and minimally invasive adenocarcinoma (AIS/MIA), and invasive adenocarcinomas (IAs). RESULTS: There were 93 AIS/MIA and 111 IAs. EGFR mutation was detected in 109 (53.4%) cases. In radiopathological analysis, IAs were significantly in larger tumor size (15.8mm vs. 10.9mm), higher SVP (18.3% vs. 1.1%) and more likely to present air bronchogram, vascular invasion, lobulated/irregular shape, non-smooth margin and pleural tag than AIS/MIA. The multivariate logistic regression indicated that tumor size (OR=1.337) and SVP (OR=1.198) were significant differentiating factors of IAs from AIS/MIA. In radiogenomic analysis, EGFR status differed in tumor size, air bronchogram and margin. The multivariate logistic regression disclosed that the presence of an air bronchogram (OR=3.451) was significantly associated with EGFR mutation after adjustment for age, gender and smoking status. CONCLUSIONS: In subsolid nodules, tumor size and SVP were significant predictors of pathological invasiveness. In addition, the presence of air bronchogram was suggestive of activated EGFR mutation.

Sexual dimorphism in finger length ratios and sex determination - A study in Indo-Mauritian population.

Many studies have shown that the finger length ratios might be characteristic for sexual dimorphism. The aim of the study was to determine sexual dimorphism in finger length ratios among the representatives of the Indo-Mauritian population. The study group comprised of 200 healthy Indo-Mauritian people (100 male and 100 female) of the age ranged from 19 to 25 years. The lengths of second (2D), third (3D), forth (4D) and fifth (5D) finger of both hands were measured by using a vernier caliper. Our results indicate that all finger length ratios have significant sex differences (p-value < 0.05) except 2D:5D and 3D:5D. To conclude, 2D:4D ratio is the most decisive ratio (predictive accuracy = 0.61) which can demarcate between male and female.