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BackgroundThe British Thoracic Society guidelines (2015) on the investigation and management of pulmonary nodules recommend the use of two risk prediction tools to assess the likelihood of malignancy in solid pulmonary nodules (Brock model following initial CT and the model described by Herder et al. following PET-CT). Management strategies are suggested on the basis of these risk assessments. The aim of this study was to assess the performance of this algorithm in patients with solid pulmonary nodules recruited from a UK teaching hospital.MethodPatients with solid pulmonary nodules (4–30 mm) were retrospectively identified from the lung cancer MDT and a nodule follow-up clinic (n = 221). All patients had a final diagnosis confirmed by histology or radiological stability on 2-year follow up.ResultsThe median age was 69 years. The prevalence of malignancy was 37.1% (29.9% primary lung cancer, 7.2% metastatic disease). 25 patients where PET-CT was recommended by the guideline but did not occur were excluded from subsequent analysis.Ten patients had nodules <5 mm and therefore would have been immediately discharged. All these nodules were benign.CT surveillance was recommended for 106 patients (37 with nodule <8 mm, 45 with malignant risk of <10% following initial CT, and 24 with malignant risk of <10% following PET-CT). 94% of these 106 patients had benign disease, 2% had primary lung cancer and 4% had metastatic disease.Surgical/non-surgical treatment was recommended for 58 patients where the malignant risk was >70% following PET-CT. 81% of these patients had primary lung cancer, 10% had metastatic disease and 9% were benign.For nodules with a malignant risk of between 10 and 70% following PET-CT, the guidelines recommend consideration of biopsy with alternatives of CT surveillance or surgical resection depending on patient preference and fitness. Of the 22 patients with nodules in this range, 36% were benign, 55% primary lung cancer and 9% metastatic disease.ConclusionThe solid nodule algorithm from the BTS guidelines shows good accuracy in discriminating benign from malignant nodules, recommending appropriate management in a high proportion of cases. Further studies should evaluate this and the other management algorithms with prospectively collected data.

The US National Lung Screening Trial (NLST) identified persons for lung cancer screening by age (55–74 yrs) and smoking history, but a subsequent analysis of the US SEER database showed that only 26.7% of lung cancer cases would have been eligible for screening according to these criteria.Strategies to increase the proportion of lung cancer patients who might qualify for screening include increasing the upper age limit to 80 years (endorsed by the US Preventative Services Task Force – USPSTF), and using composite lung cancer risk prediction tools. The UK Lung Screening pilot (UKLS) used the Liverpool Lung Project score (LLP) to identify patients for screening. In a validation cohort from the US Prostate, Lung, Colorectal and Ovarian study, a threshold based on the PLCOM2012 score identified more cancers than the NLST criteria. We prospectively compared these criteria for the first time in patients presenting with lung cancer in Yorkshire.MethodsWe audited the proportion of patients presenting with lung cancer through fast-track clinics at 4 Yorkshire centres who would have been eligible for screening according to the following criteria: NLST criteria, UKLS criteria, USPSTF criteria, LLP ≥5% 55–80 yrs, and PLCO ≥1.51% 55–80 yrs.ResultsData was collected for 206 patients presenting between January and July 2016 (Leeds 131, Halifax 26, Bradford 12, Mid-Yorkshire 37). Median age was 72 years and the proportion of cases by age cohort was as follows: <55 yrs 9.2%, 55–60 yrs 9.7%, 61–65 yrs 12.1%, 66–70 yrs 13.6%, 71–75 yrs 18.4%, 76–80 yrs 17.0%, >80 yrs 19.9%. Smoking status was: current smoker 89 (43.2%), ex-smoker 106 (51.5%) and never smoker 11 (5.3%). The number of patients eligible by the various criteria are shown in Table 1.ConclusionThe proportion of lung cancer patients who would have been eligible for screening differs considerably between the various criteria. Only approximately one third of patients would have been eligible according to the criteria used in NLST and UKLS. Increasing the upper age limit for screening to 80yrs substantially increases the proportion of cases that would be eligible. A threshold of 1.51% by the PLCOM2012 score included the largest number of lung cancer patients of the criteria assessed.Abstract S129 Table 1The numbers and proportions of lung cancer patients who would have been eligible for CT screening according to various inclusion criteriaCriteriaDescriptorNumber of eligible patientsProportion of all lung cancer patientsProportion of 55–80yrs ever-smoking patientsNLSTAge 55–74, ≥30 pack years smoking, quit time <15 years7134.5%51.1%USPSTFAge 55–80, ≥30 pack years smoking, quit time <15 years8943.2%64.0%UKLSAge 50–75, ≥5% lung cancer risk by LLPv.26732.5%48.2%PLCO ≥1.51%Age 55–80, ≥1.51% lung cancer risk by PLCOM201211153.9%79.9%LLP ≥5%Age 55–80, ≥5% lung cancer risk by LLPv.29445.6%67.6%

Innate immunity plays a central role in the pathogenesis of severe asthma, and it is closely linked to elevated IgE and Toll-like receptor 4 (TLR-4) levels. However, there is a scarcity of information about the association of the TLR-4 receptor polymorphism in the pathogenesis of severe asthma. This study highlights the level of gene expression of different alleles in asthmatic patients compared to healthy control individuals. This was a randomized control trial, which included 150 patients with asthma (with high serum levels of IgE) with a matching 150 healthy control individuals. Participants had a series of blood tests to measure various immune parameters: interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), intercellular adhesion molecule-1 (ICAM1) and detect allele type and gene expression of the TLR-4 gene. Patients with asthma had significantly higher levels of IL-8 when compared to the healthy control participants. In addition, in the rs91 genotyping, there were significant differences in the levels of IL-8 and TNF between CC and TT genotyping. While in rs90 TLR-4, TNF levels were significantly higher in AA vs. AG and GG genotypes among the asthmatic patients when compared to the control group. The results showed that in TLR-4, rs4986791 were significantly associated with asthma risk. Polymorphisms in TLRs play essential roles in asthma.

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Objective In chronic kidney disease (CKD), there is primary deficiency of erythropoietin, thereby leading to anemia. In addition, chronic immune activation and the inflammatory process could be involved in the pathophysiology of anemia in patients with (CKD). However, anemia and inflammation are present in earlier stages of renal impairment. The objective of this study was to evaluate the possible association of some of the markers of inflammation with anemia in patients with CKD with and without dialysis treatment. Methods The markers of inflammation such as white blood cell (WBC) count, granulocytes % and C-reactive protein (CRP) were determined. Similarly, serum albumin, platelets count and hemoglobin level were measured in blood samples from 61 patients with CKD attending Nephrology Unit at Al-Hussein Medical City and 20 healthy controls. The selected patients were stratified into two subgroups; 31 patients without hemodialysis (HD) and other 30 patients on HD. Results A significantly lower hemoglobin level, serum albumin and platelets count were observed in patients with CKD on hemodialysis therapy compared to controls, (P value = 0.0001). There was a significant correlation between WBC count and granulocytes % with regard to the low hemoglobin level in patients with CKD especially those on hemodialysis HD, (P value < 0.05). Conclusion Renal failure anemia was found to be strongly associated with high WBC count and gronulocytes percentage which are known markers of inflammatory status.

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