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Objective: In many neurosurgical departments, patients routinely receive 24-hour intensive care monitoring after elective craniotomy. However, there is no scientific evidence for the benefit of intensive medical monitoring in postoperative patients. Due to the current COVID-19 pandemic, there are further [for full text, please go to the a.m. URL]

Objective: To date, there is no medical treatment to prevent subsequent progression to rupture of intracranial aneurysms and to control rupture-followed complications to improve the clinical outcome after SAH. We explored the role of Vitamin D (VitD3) status because of its known anti-inflammatory effect [for full text, please go to the a.m. URL]

Idiopathic pulmonary fibrosis (IPF) is a devastating lung disease with a median survival of 3 yr. IPF deteriorates upon viral or bacterial lung infection although pulmonary infection (pneumonia) in healthy lungs rarely induces fibrosis. Bacterial lipopolysaccharide (LPS) activates Toll like receptor 4 (TLR4) initiating proinflammatory pathways. As TLR4 has already been linked to hepatic fibrosis and scleroderma we now investigated the role of TLR4 in IPF fibroblasts. Lung tissue sections from patients with IPF were analyzed for TLR4 expression. Isolated normal human lung fibroblasts (NL FB) and IPF fibroblasts (IPF FB) were exposed to LPS and transforming growth factor ß (TGF ß) before expression analysis of receptors profibrotic mediators and cytokines. TLR4 is expressed in fibroblast foci of IPF lungs as well as in primary NL FB and IPF FB. As a model for a gram negative pneumonia in the nonfibrotic lung NL FB and IPF FB were coexposed to LPS and TGF ß. Whereas NL FB produced significantly less connective tissue growth factor upon costimulation compared with TGF ß stimulation alone IPF FB showed significantly increased profibrotic markers compared with control fibroblasts after costimulation. Although levels of antifibrotic prostaglandin E2 were elevated after costimulation they were not responsible for this effect. However significant downregulation of TGF ß receptor type 1 in control fibroblasts seems to contribute to the reduced profibrotic response in our in vitro model. Normal and IPF fibroblasts thus differ in their profibrotic response upon LPS induced TLR4 stimulation.

Multidisciplinary team (MDT) diagnosis of interstitial lung disease (ILD) has been proposed as a gold standard, but there are no formal recommendations for MDT process or composition and limited knowledge regarding prevalence in routine practice. We performed a systematic evaluation of ILD diagnostic practice across a range of healthcare settings around the world. Electronic questionnaires were distributed across all global regions via society and collaborators networks. Responses from 457 unique centres across 64 countries were included in the analysis. Of the 350 (76.6%) centres holding formal meetings, the majority held face-to-face MDT meetings (80%), for a minimum of 30 min (93%), and discussed diagnosis (96.9%) and patient management (94.9%) at the meetings. Compared with non-academic and academic non-ILD centres, ILD academic centres reported a higher ILD caseload, held more formal MDT meetings, and were more likely to include histopathology and rheumatology specialists in their diagnostic team. Of the centres holding MDT meetings, 5.5% routinely discussed all new cases at such meetings. An MDT approach to ILD diagnosis is consistently interpreted and widely implemented across a range of routine care settings around the world. This observation will inform future ILD diagnostic agreement studies and diagnostic pathway recommendations. © ERS 2019.