Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction.

Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction

Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

Tracheal cryopreservation: caspase-3 immunoreactivity in tracheal epithelium and in mixed glands

Cryopreservation has an immunomodulating effect on tracheal tissue as a result of class II antigen depletion due to epithelium exfoliation. However, not all epithelium is detached. We evaluated the role of apoptosis in the remaining epithelium of 30 cryopreserved tracheal grafts. Caspase-3 immunoreactivity of tracheal epithelium was studied in canine tracheal segments cryopreserved with F12K medium, with or without subsequent storage in liquid nitrogen at -196°C for 15 days. Loss of structural integrity of tracheal mixed glands was observed in all cryopreserved tracheal segments. Caspase-3 immunoreactivity in tracheal mucosa and in mixed glands was significantly decreased, in contrast to the control group and to cryopreserved tracheal segments in which it remained high, due to the effect of storage in liquid nitrogen (P < 0.05, ANOVA and Tukey test). We conclude that apoptosis can be triggered in epithelial cells during tracheal graft harvesting even prior to cryopreservation, and although the epithelial caspase-3 immunoreactivity is reduced in tracheal cryopreservation, this could be explained by increased cell death. Apoptosis cannot be stopped during tracheal cryopreservation.

Tracheal cryopreservation: caspase-3 immunoreactivity in tracheal epithelium and in mixed glands.

Cryopreservation has an immunomodulating effect on tracheal tissue as a result of class II antigen depletion due to epithelium exfoliation. However, not all epithelium is detached. We evaluated the role of apoptosis in the remaining epithelium of 30 cryopreserved tracheal grafts. Caspase-3 immunoreactivity of tracheal epithelium was studied in canine tracheal segments cryopreserved with F12K medium, with or without subsequent storage in liquid nitrogen at -196 degrees C for 15 days. Loss of structural integrity of tracheal mixed glands was observed in all cryopreserved tracheal segments. Caspase-3 immunoreactivity in tracheal mucosa and in mixed glands was significantly decreased, in contrast to the control group and to cryopreserved tracheal segments in which it remained high, due to the effect of storage in liquid nitrogen (P < 0.05, ANOVA and Tukey test). We conclude that apoptosis can be triggered in epithelial cells during tracheal graft harvesting even prior to cryopreservation, and although the epithelial caspase-3 immunoreactivity is reduced in tracheal cryopreservation, this could be explained by increased cell death. Apoptosis cannot be stopped during tracheal cryopreservation.

Beta1-integrins shedding in a guinea-pig model of chronic asthma with remodelled airways.

BACKGROUND: A hallmark of airway remodelling in asthma is subepithelial fibrosis, but its relation with airway dysfunction is still controversial. OBJECTIVE: To describe airway functional abnormalities and subepithelial remodelling induced by repetitive antigenic challenges. METHODS: Nine inhaled antigenic challenges were applied every 10 days to guinea-pigs sensitized to ovalbumin (OVA). Antigen-induced airway hyperresponsiveness (AI-AHR) to histamine and its immunohistopathological relationship was evaluated at the first, third and ninth OVA challenges. RESULTS: From the first challenge on, OVA induced acute transient bronchoobstruction followed by development of AI-AHR. A progressive rise in baseline Penh (a bronchoobstruction index) and granulocyte airway infiltration was also observed. After the ninth OVA challenge, the amount of extracellular matrix in the subepithelial region (SER) of bronchi and bronchioles was increased. Immunohistochemistry analysis showed that this SER fibrosis was associated to beta1-integrin subunit overexpression, even in acellular areas. Immunoelectronmicroscopy corroborated the location of beta1-integrin in extracellular matrix, essentially in types l and II collagen fibres. Presence of alpha1- and alpha2-integrin subunits in these areas was also corroborated. AI-AHR was correlated with degree of SER increment, cell infiltration, and beta1-integrin expression. CONCLUSION: Our data suggested that beta1-integrin shedding produced by repetitive allergen challenges in guinea-pigs was associated with collagen deposition in SER of bronchi and bronchioles, along with inflammatory cells infiltration and AI-AHR development.

Fibrosis pulmonar idiopática: en busca de un tratamiento eficaz / No disponible

No disponible

[Effect of the hyaluronic acid on tracheal healing. A canine experimental mode]. / Efecto del ácido hialurónico sobre la cicatrización traqueal en un modelo experimental canino.

Several drugs have been used to modulate of the tracheal healing process in order to prevent tracheal stenosis. Hyaluronic acid (HA) is a modulator of the fibrogenesis. In this work we evaluate the effect in order the application of hyaluronic acid has on tracheal healing, after cervical tracheoplasty in dogs. A cervical tracheal resection and tracheoplasty was performed in 12 dogs and they were treated following surgery as follows: Group I (n = 6) Topical application of normal saline solution (0.9%) on the anastomosis site. Group II Topical application of hyaluronic acid on the trachea anastomosed. The animals were evaluated clinical, radiological and tracheoscopically during 4 weeks and were submitted to euthanasia. Macroscopic and microscopic examinations of the tracheal anastomotic healing were evaluated. Biochemical collagen quantification by the Woessner method was performed to evaluate the collagen development at the anastomotic site. All the animals survived the surgical procedure and the study time. No animal presented differences in clinical evaluation. Radiological and endoscopical findings both two showed more development of the tracheal stenosis in-group than in group II. The tracheoscopy and macroscopic studies showed major inflammation and development of fibrotic tissue with a firm consistency in the healing of the group I than in group II. Microscopic examination in group I showed severe fibrosis and inflammatory reaction. The group II presented deposits of a thin and organized collagen fibers and minimal inflammatory reaction. Biochemical collagen concentration was larger in-group I, however significantly. We conclude that the hyaluronic acid applied after cervical tracheoplasty in dogs reduces postsurgical tracheal stenosis and inflammation, as well as improve the quality of the tracheal healing.

Angiogenesis in hypersensitivity pneumonitis.

Angiogenesis is an essential process required for growth and tissue repair after injury, but it may also contribute to the pathology of a number of human disorders including neoplasias, atherosclerosis and inflammatory diseases. Vascular endothelial growth factor (VEGF) is a potent angiogenic peptide upregulated by many cytokines and endothelium shear stresses. Lung is a highly vascular tissue with finely organized and regulated microvascular beds, and its inflammation may lead to dysregulated angiogenesis. Hypersensitivity pneumonitis (HP) is a lung disorder characterized by chronic lymphocytic inflammation and endothelial damage. However, neovascularization has not been previously explored. In this study, we examined the expression and localization of VEGF in 38 patients with HP and 14 healthy control subjects (CS). VEGF levels in bronchoalveolar lavage fluid (BALF) were measured by ELISA, and cellular lung localization was determined by immunohistochemistry. In addition, VEGF expression was analyzed in lung tissue by RT-PCR. Our results showed sera levels significantly increased in HP patients compared with CS (209.3 +/- 189.3 vs. 55.3 +/- 31.4 pg/ml; p = 0.004). By contrast, BALF levels of VEGF were significantly decreased in HP patients compared with CS (35.3 +/- 51.5 pg/ml vs. 185.1 +/- 191.4 pg/ml; p < 0.001). VEGF was primary expressed by epithelial cells, smooth muscle cells, and interstitial macrophages in HP tissue. Flt-1 and Flk-1 receptors were highly expressed by endothelial cells from medium and small vessels in HP tissue. By RT-PCR the VEGF RNA was increased compared with those in normal lung. Our results suggest that abnormal expression of VEGF may contribute to impair the lung repair in HP.

Vascular endothelial growth factor plasma levels in patients with systemic lupus erythematosus and primary antiphospholipid syndrome.

The objective of this study was to assess the possible role of vascular endothelial growth factor (VEGF) in the pathogenesis of systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (PAPS). We studied 28 patients with SLE, 10 patients with PAPS, and 24 healthy controls. VEGF plasma levels were measured by ELISA. Immunolocalization of VEGF was done in renal tissue from SLE patients and cadaveric controls. Our results showed that VEGF plasma levels were increased in SLE patients compared with PAPS and controls. The correlation between clinical manifestations and VEGF levels revealed that SLE patients with renal failure had significantly increased plasma VEGF levels (134.1 + 91.0 pg/ml) compared with SLE patients with normal renal function (42.9 + 19.0 pg/ml), PAPS patients (41.9 + 26.6 pg/ml), and controls (36.2 + 27.0 pg/ml; P < 0.01). Immunostaining showed a strong expression of VEGF in SLE renal tissue samples. Our preliminary results indicate that VEGF is increased in plasma from patients with lupus nephritis and a moderate degree of renal failure and is overexpressed in renal tissue from these patients.

Suture-line reinforcement with glutaraldehyde-preserved bovine pericardium for nonanatomic resection of lung tissue.

In this study we assessed the usefulness of glutaraldehyde-preserved bovine pericardium (GPBP), preparated in our laboratory, in nonanatomic resection of lung tissue in dogs. A 30% resection of the right cranial lobe of the lung was performed in 18 mongrel dogs. The suture line was reinforced with GPBP strips. For group I (n = 6), the GPBP strips were fixed on the lung with nonabsorbable suture by thoracotomy. In Group II (n = 6), the resection and fixation of the GPBP strips were performed with an endoscopic linear stapler by thoracotomy. In Group III (n = 6), the resection and fixation of the GPBP strips were performed with a linear stapler by thoracoscopy. The animals were evaluated each day during the first week after surgery and every other day during the study time. At the end of the study all animals were euthanized with an overdose of pentobarbital. Macroscopic and microscopic examinations of the bioprosthesis and lung were evaluated. All animals survived the surgical procedure and study time (8 weeks). In the three groups, macroscopic examination of the bioprosthesis showed good adaptation to the lung tissue. Microscopically, all groups of animals presented good healing, with the presence of fibrotic tissue layer on the GPBP and its periphery as well as in the lung. However, in group I we observed the presence of giant cells in the suture line. GPBP proved to be a useful material for reinforcement of the nonanatomic resection suture line of lung tissue in dogs.

Delayed P300 during Sternberg and color discrimination tasks in poor readers.

The P300 ERP component was studied in poor and normal readers, using Sternberg and color discrimination (Spaceships) tasks. During the first one, subjects must decide if a probe item belongs or not to a set of digits previously presented. In the second one, the participants must shoot violet spaceships with one key and other than violet spaceships with another key. There were no significant differences between groups with respect to reaction times, but a larger proportion of errors was observed in poor readers. Longer P300 latencies were recorded for poor readers than controls in both tasks. P300 amplitudes showed topographical differences between the two groups: Poor readers' P300 is larger frontally during the Sternberg task, but smaller at posterior sites during the Spaceships task. These results suggest that poor readers may have deficiencies during the early processing stage, such as visual stimulus evaluation. Poor readers also appear to have deficits for classifying and memorizing visual stimuli.

Effect of perfusion and preservation on IL1-beta, IL-6, and IL-10 production in murine lung.

We evaluated the production of the interleukins (ILs) IL-1beta, IL-6, and IL-10 in both the vasculature and pulmonary tissue before and after 24 h of lung preservation. The cardiopulmonary blocs of 21 Balb-c mice were divided into three study groups (7 mice/group) and were flushed through the pulmonary artery with Krebs-Henseleit buffer (K-Hb) at 4 degrees C at a rate of 0.2 mL/min as follows: Group 1, lung washout: lungs were flushed until pulmonary effluent was clear. Group 2, perfusion: After lungs were flushed until pulmonary effluent was clear, lungs were perfused during 30 min. Group 3, preservation: Lungs were flushed until pulmonary effluent was clear, and the cardiopulmonary bloc was preserved immersed into (K-Hb) at 4 degrees C. After 24 h of preservation, lungs were reperfused during 30 min. In all study groups the caudal lobe from the left lung was taken for microscopical study; all other lobes were homogenized with (K-Hb) and the supernatant was obtained. IL-1beta, IL-6, and IL-10 production in lung effluents (washout, perfusion, and reperfusion) and in lung tissue were measured by enzyme-linked immunosorbent assay (ELISA). In the lung effluent, there was no statistical difference between IL-1beta and IL-6 concentrations. In all study groups, IL-10 production was significantly higher than IL-1beta and IL-6 levels. IL-10 level was lowest in the 24-h preservation group when it was compared to the other groups. In group 1, there was a negative correlation (r = -.599, p < .05) between IL-1beta and IL-10. In pulmonary tissue, IL-1beta was higher in group 2 when compared to groups 1 (p = .001) and 3 (p = .002), and it was significantly lower in group 3. IL-10 was lower in group 1 when compared to groups 2 (p = .001) and 3 (p = .004). In groups 1 and 2, IL-1beta was significantly higher than IL-6 and IL-10. In group 3, IL-10 was higher than IL-1beta (p = .0001) and IL-6 (p = .0001). Correlation of effluent/tissue index with histological findings showed a negative correlation between IL-10 effluent/tissue relation and inflammation (r = -.68, p < .01). In conclusion, the main cytokine found in lung effluents was IL-10, followed by IL-6 and IL-1beta. On the other hand, cytokine concentration in lung tissue homogenates was mainly due to the presence of IL-1beta. However, this cytokine shows a significant reduction in lung tissue after prolonged preservation.

Electrophysiological correlates of category goodness.

We report the results obtained from a behavioural and electrophysiological study. A synthesised continuum going from labial /ba/ to retroflex /da/ through dental /da/ was tested for category goodness. Native English speakers rated different tokens from each category as good, bad or ambiguous. The results showed that not all of the representatives of each category were ideal and that the categories tested have an internal structure. The electrophysiological study evaluated whether event related potentials (ERPs) mirrored the goodness judgements. During a passive oddball task, the same participants were exposed to native /ba/-/da/, Hindi dental /da/-retroflex /da/ and within-category /ba/-/ba/ contrasts. Results showed that participants pre-attentively perceive the differences in all cases, as shown by mis-match negativities (MMN), late positive deflections (LPD) or greater N1 and/or P2 components for deviant stimuli. Acoustic sensitivities, categorical perception and category goodness all contributed to the waveforms obtained. We attribute the ERP effects to a combination of (1) prototypes built from initial sensitivities, (2) reinforcement with exposure to one's native language and (3) no permanent loss of the initial boundaries explains the effects observed.

Electrophysiological correlates of cross-linguistic speech perception in native English speakers.

The present study examined the electrophysiological responses that Native English speakers display during a passive oddball task when they are presented with different types of syllabic contrasts, namely a labial /ba/-dental /d a/, a Hindi dental /d a/-retroflex /da/ and a within-category (two /ba/ tokens) contrasts. The analyses of the event-related potentials obtained showed that subjects pre-attentively perceive the differences in all experimental conditions, despite not showing such detection behaviourally in the Hindi and within-category conditions. These results support the notion that there is no permanent loss of the initial perceptual abilities that humans have as infants, but that there is an important neural reorganisation which allows the system to overcome the differences detected and only be aware of contrasts that are relevant in the language which will become the subjects native tongue. We also report order asymmetries in the ERP responses and suggest that the percepts and not only the physical attributes of the stimuli have to be considered for the evaluation of the responses obtained.

Increase of lung neutrophils in hypersensitivity pneumonitis is associated with lung fibrosis.

Hypersensitivity pneumonitis (HP) is characterized by a T-cell-mediated alveolitis, and the putative role of other inflammatory cells in its pathogenesis remains unclear. In this study we determined whether increased quantities of neutrophils were present in HP lungs, and if they were positive for gelatinase B and collagenase-2. Fifteen nonsmoking patients with subacute/chronic active HP were included. Lung samples were analyzed using myeloperoxidase antibody, and neutrophil/total cell ratio was evaluated by digital processing. All HP tissue samples exhibited variable quantities of neutrophils located inside vessels, and in the interstitial and alveolar spaces. Lung neutrophil percentage ranged from 0.7% to 4.8% (2.1 +/- 1.4%). There was a positive correlation between the percentage of lung neutrophils and the percentage of lung fibrosis (r = 0.6, p < 0.02). Tissue neutrophils showed intense immunoreactive collagenase-2 and gelatinase B staining. Additionally, gelatinolytic activities corresponding to progelatinases A and B and their activated forms, were several-fold increased in the bronchoalveolar lavage fluid (BALF) from patients with HP as compared with control subjects. These findings suggest that in HP lungs there is a persistent traffic of neutrophils loaded with gelatinase B and collagenase-2 that may play a role in the lung damage and in the fibrotic response.

Upregulation of gelatinases A and B, collagenases 1 and 2, and increased parenchymal cell death in COPD.

BACKGROUND: A central feature in the pathogenesis of COPD is the inflammation coexisting with an abnormal protease/antiprotease balance. However, the possible role of different serine and metalloproteinases remains controversial. PATIENTS AND MEASUREMENTS: We examined the expression of gelatinases A and B (matrix metalloproteinase [MMP]-2 and MMP-9); collagenases 1, 2, and 3 (MMP-1, MMP-8, and MMP-13); as well as the presence of apoptosis in lung tissues of 10 COPD patients and 5 control subjects. In addition, gelatinase-A and gelatinase-B activities were assessed in BAL obtained from eight COPD patients, and from six healthy nonsmokers and six healthy smoker control subjects. SETTING: Tertiary referral center and university laboratories of biochemistry, and lung cell kinetics. RESULTS: Immunohistochemical analysis of COPD lungs showed a markedly increased expression of collagenases 1 and 2, and gelatinases A and B, while collagenase 3 was not found. Neutrophils exhibited a positive signal for collagenase 2 and gelatinase B, whereas collagenase 1 and gelatinase A were revealed mainly in macrophages and epithelial cells. BAL gelatin zymography showed a moderate increase of progelatinase-A activity and intense bands corresponding to progelatinase B. In situ end labeling of fragmented DNA displayed foci of positive endothelial cells, although some alveolar epithelial, interstitial, and inflammatory cells also revealed intranuclear staining. CONCLUSION: These findings suggest that there is an upregulation of collagenase 1 and 2 and gelatinases A and B, and an increase in endothelial and epithelial cell death, which may contribute to the pathogenesis of COPD through the remodeling of airways and alveolar structures.

Effect of NMDA antagonists on the activity of glutaminase and aspartate aminotransferase in the developing rat cerebellum.

Chronic treatment of rats from postnatal day 6 to 25 with drugs that interact with the N-methyl-D-aspartate (NMDA) receptor induced a differential effect on the activity of some enzymes involved in neurotransmitter synthesis. Two of these drugs ((5R,10S)-(+)-5-methyl-10,11 -dihydro-5H-dibenzo(a,d)cyclohepten-5,10-imine hydrogen maleate (MK-801) and 3-(2-carboxypiperazin-4-yl)propyl-1phosphonic acid (CPP)) caused a marked reduction (20-40%) of glutaminase and aspartate aminotransferase activity in the cerebellum. These changes were observed only at a very precise time of development (i.e. 10 to 19 postnatal day). The competitive antagonist, amino phosphonovaleric acid (APV), did not affect any of the enzymes studied at all tested ages. When animals were treated with NMDA only a slight, but significant, increase in the activity of glutaminase was observed at 9-11 postnatal day only. Any of the agonists or antagonists tested significantly affected the activity of lactate dehydrogenase as compared to control animals. Histologic observations of cerebella treated with the indicated drugs showed that only MK-801, and CPP to a lesser extent, induced a small reduction in the width of the internal granule layer. The body weight of animals treated with MK-801 was clearly reduced, but only in more mature rats (> 16 postnatal day), when animals did not show any alteration in the enzymes tested. These results support the suggestion that presynaptic influences, particularly from glutamatergic neurons, are critical to promote cerebellar granule neurons differentiation during critical periods of the cerebellar development.

Discrimination of speech sounds in a boy with Landau-Kleffner syndrome: an intraoperative event-related potential study.

A 7-year-old boy with severe acquired epileptic aphasia (Landau-Kleffner syndrome) was treated by multiple subpial transections to the left temporal lobe. In the course of electrocorticography, event-related potentials (ERP) were recorded to the phonemes /ba/ and /ga/; /ba/ occurred 72.5% of the time and /ga/ 27.5%, in a pseudo-random sequence. The ERPs were distributed over the middle and inferior temporal gyri and there was a marked overlap with the area of maximal spiking detected on the electrocorticogram. Repetition of the frequent syllable /ba/ was associated with diminution of the prominent negative component of the ERP culminating around 550 ms suggesting habituation. Presentation of the novel syllable /ga/ restored the amplitude of this negative component, showing that discrimination was preserved despite the apparent global aphasia. This finding supports clinical evidence that some children with epileptic aphasia can still process auditory speech input. Intraoperative ERP recording may help improve our understanding of the relationship between epileptiform activity and aspects of language processing in Landau-Kleffner syndrome where lack of cooperation precludes detailed clinical testing.

Bronchiolitis in chronic pigeon breeder's disease. Morphologic evidence of a spectrum of small airway lesions in hypersensitivity pneumonitis induced by avian antigens.

We analyzed 36 open lung biopsy specimens from patients with chronic pigeon breeder's disease (PBD) to assess bronchiolar involvement and its relationship to the parenchymal pathologic abnormalities. Likewise, 21 biopsy specimens obtained from patients with usual interstitial pneumonia (UIP) were also examined. The bronchiolar abnormalities were scored by the method of Wright et al using a panel of photographs. In addition, the severity of lung fibrosis was evaluated in all samples and expressed as percentage in multiples of ten. A variable degree of epithelial cell metaplasia, bronchiolar inflammation and fibrosis, smooth muscle hypertrophy, extrinsic small airways narrowing, and intraluminal macrophages was observed in both diseases. Occasionally, hyperplasia of lymphoid follicles was also present. Bronchiolar changes were proportional in type and severity to the parenchymal damage. Spearman's nonparametric correlation between fibrosis in parenchyma and fibrosis in membranous bronchiole for the complete group (including patients with UIP and with PBD) showed a moderate but significant association (R = 0.51; p < 0.01). A significant association was also demonstrated when the score for bronchiolar fibrosis and inflammation was evaluated in relation to lung fibrosis divided in high degree (> 50%) and low degree (< 50%), respectively. In the case of patients with PBD, the correlation between bronchiolar and parenchymatous fibrosis was of 0.33 (p < 0.05). In general, bronchiolar fibrosis was less severe and inflammation more severe in PBD lungs compared with patients with UIP. Fibrosis in membranous bronchioles correlated with increased mortality in the complete group of patients, but the impact on mortality disappeared after correcting for overall fibrosis in the biopsy sample. Our findings demonstrate that a spectrum of bronchiolar lesions is usually observed in chronic PBD lungs, although the predominant pattern is similar to that found in the surrounding parenchyma, suggesting that the damage occurs in parallel.