Inova Health Care Services

Prostate cancer is one of the most frequently diagnosed cancers in men. Prostate tumor staging and disease aggressiveness are evaluated based on the Gleason scoring system, which is further used to direct clinical intervention. The Gleason scoring system provides an estimate of tumor aggressiveness through quantitation of the serum level of prostate specific antigen (PSA) and histologic assessment of Grade Group, determined by the Gleason Grade of the tumor specimen.

To improve our understanding of the proteomic characteristics differentiating low- versus high-grade prostate cancer tumors, we performed a deep proteomic characterization of laser microdissected epithelial and stromal subpopulations from surgically resected tissue specimens from patients with Gleason 6 (n = 23 specimens from n = 15 patients) and Gleason 9 (n = 15 specimens from n = 15 patients) prostate cancer via quantitative high-resolution liquid chromatography-tandem mass spectrometry analysis.

In total, 789 and 295 grade-specific significantly altered proteins were quantified in the tumor epithelium and tumor-involved stroma, respectively. Benign epithelial and stromal populations were not inherently different between Gleason 6 versus Gleason 9 specimens. Notably, 598 proteins were exclusively significantly altered between Gleason 9 (but not Gleason 6) tumor-involved stroma and benign stroma, including several proteins involved in cholesterol biosynthesis and nucleotide metabolism.

Proteomic alterations between Gleason 6 versus Gleason 9 were exclusive to the disease microenvironment, observed in both the tumor epithelium and tumor-involved stroma. Further, the molecular alterations measured in the tumor-involved stroma from Gleason 9 cases relative to the benign stroma have unique significance in disease aggressiveness, development, and/or progression. Our data provide supportive evidence of a need for further investigations into targeting stromal reservoirs of cholesterol and/or deoxynucleoside triphosphates in PCa tumors and further highlight the necessity for independent examination of the TME epithelial and stromal compartments.

Pulmonary hypertension (PH) is associated with morbidity and mortality in patients with interstitial lung disease (ILD). Several prediction models have been proposed to predict PH in ILD patients. We sought to discern how previously described prediction models perform in predicting PH in patients with ILD.

Patients with ILD who completed a baseline right heart catheterization, from Inova Fairfax Hospital, Northwestern Memorial Hospital, and Asan Medical Center in Korea were enrolled. The performance of various prediction models (FORD model, the FORD calculator, the PH-ILD Detection tool, and the mean pulmonary artery pressure prediction model) were assessed using receiver operating characteristic (ROC) curves and area under the receiver operating characteristic curve (AUROC). There were four definitions of pulmonary hypertension against which the models were evaluated.

There were a total of 192 patients with ILD, of whom 32.8% (n = 63/192) met the modified 5th world symposium on PH definition of precapillary PH. Among the models assessed, the FORD calculator had an AUROC (0.733) that was marginally highest. Subgroup analysis revealed that the FORD index had the highest AUROC (0.817) in patients with idiopathic pulmonary fibrosis, while the FORD calculator had the highest AUROC (0.751) in patients with non-IPF ILD.

The FORD model can be used to predict group 3 PH in both IPF patients and non-IPF ILD patients. It could serve as a tool for ILD patient selection for right heart catheterization as well as an enrichment tool for clinical trials targeting the pulmonary vasculature.

This retrospective analysis describes a single institution's incidence of post-BLVR pneumothorax stratified by target lobe. Clinical outcomes, chest tube days, homogeneous versus heterogeneous disease, and need for EBV removal due to unresolving PAL are also described. Data was collected on patients from an internal quality database and the Epic (Epic System Corporation, Verone, WI) electronic medical record (EMR) between July 1st, 2019 and November 1st, 2024. Inclusion criteria used were patients with underlying emphysema undergoing BLVR complicated by a post-procedural pneumothorax. Data was analyzed for all pneumothoraces that occurred following BLVR. Pneumothoraces were then stratified based on the target lobe treated with EBVs. Patient's demographics were summarized using descriptive statistics. Chi-square test or Fisher's Exact test when appropriate was used to compare the incidence of pneumothorax following BLVR based on lobe treated with that of the overall population. SAS Version 9.4 (SAS Ins., Cary, NC) was used for analysis. p-value <0.05 was considered statistically significant.

Between July 1st, 2019 and November 1st, 2024, 167 BLVR procedures were performed. A total of 42 procedures were complicated by a post-BLVR pneumothorax (25 percent) requiring chest tube placement. Out of the 42 post-BLVR pneumothoraces, 24 occurred after treatment of the left upper lobe (40 percent), 10 occurred after the treatment of the right upper lobe and right middle lobe (28 percent), 4 occurred after treatment of the RUL (21 percent), 3 occurred after treatment of the left lower lobe (5 percent), 1 occurred after treatment of the right lower lobe (5 percent) and 0 occurred after treatment of the right middle lobe alone. Incidence of pneumothorax when treating the left upper lobe was found to be statistically significant compared to the overall incidence of pneumothorax in other lobes. Twenty-six procedures complicated by pneumothorax (62 percent) were performed in homogeneous patterns of disease in the treated lung, while 16 (38 percent) were performed in heterogeneous patterns of disease.

The incidence of pneumothorax following BLVR varies depending on the target lobe treated. Development of a pneumothorax following BLVR of the left upper lobe carried an incidence of 40 %, which was statistically significant different to the overall incidence (p = 0.03).