READING LESSON 1

READING PART A 

How can we improve reading part A score?

Is it important to score maximum on Part A?

What is the strategy to do Part A Reading in OET exam?

 Let's discuss with one example type of question.

One main type of question is to decide from which texts the information in the question comes from.

Probably you have 6 to 7 questions from this type.

It is easy to find if we have enough time, however, we don't have much time to do it. we have only 4 minutes to do 7 questions.

So, time management is very important.

Try the below example in two minutes and comment your answer 

TEXT 1 . Fibrosis

Fibrosis, the progressive accumulation of connective tissue that occurs in response to injury, causes irreparable organ damage and may result in organ failure. The few available antifibrotic treatments modify the rate of fibrosis progression, but there are no available treatments to reverse established fibrosis. Thus, more effective therapies are urgently needed. Molecular imaging is a promising biomedical methodology that enables noninvasive visualization of cellular and subcellular processes. It provides a unique means to monitor and quantify dysregulated molecular fibrotic pathways in a non-invasive manner. Molecular imaging could be used for early detection, disease staging, and prognostication, as well as for assessing disease activity and treatment response. As fibrotic diseases are often molecularly heterogeneous, molecular imaging of a specific pathway could be used for patient stratification and cohort enrichment with the goal of improving clinical trial design and feasibility and increasing the ability to detect a definitive outcome for new therapies. Here we review currently available molecular imaging probes for detecting fibrosis and fibrogenesis, the active formation of new fibrous tissue, and their application to models of fibrosis across organ systems and fibrotic processes. We provide our opinion as to the potential roles of molecular imaging in human fibrotic diseases.

TEXT 2

Molecular imaging is invaluable in a number of diseases. In oncology, for example, 18F-fluorodeoxyglucose PET-CT is the standard of care for diagnosis, staging, and determination of treatment response for many cancers. In cardiology, SPECT radionuclide imaging can assess cardiac perfusion and viability. In neurology, molecular imaging techniques may assist with earlier diagnosis of neurodegenerative conditions such as Parkinson’s disease. While molecular imaging already has important clinical applicability in many human diseases, to date it has been sparingly applied to fibrotic diseases. With the recent development of molecular probes that target fibrosis-specific or fibrosis-associated processes, molecular imaging is poised to enter the realm of fibrotic diseases. In this context, molecular imaging may enable earlier diagnosis, allow accurate staging of disease, improve phenotyping of those with active disease, select patients for personalized treatment, determine whether a drug is engaging its target, and provide earlier assessments of treatment responses 

TEXT 3  Fibroblast activation and myofibroblasts differentiation

In response to tissue injury, fibroblasts produce extracellular matrix (ECM) and contribute to formation of granulation tissue, the connective and vascular tissue on the surface of a healing wound . During fibrosis, fibroblasts become activated, proliferate, and differentiate into myofibroblasts. Somatostatin receptors expressed on normal fibroblasts become upregulated in fibrosis . 111In-octreotide scintigraphy, currently available as the FDA-approved Octreoscan, uses a somatostatin peptide mimic derivatized with a chelated gamma ray–emitting 111In isotope. 111In-octreotide scintigraphy was performed in subjects with IPF, pulmonary fibrosis due to systemic sclerosis (SSc), and control subjects . Octreotide expression was increased in IPF and SSc compared with control subjects, with expression higher in IPF than in SSc subjects. 111In-octreotide scintigraphy has also been performed on subjects with sarcoidosis and idiopathic interstitial pneumonia. Octreotide uptake was highest in sarcoidosis subjects. IPF subjects in this study, however, had a normal uptake index . Somatostatin analogs have also been derivatized with PET reporters, including the recently FDA-approved 68Ga-DOTATATE (NETSPOT). 68Ga-DOTANOC PET-CT was performed in IPF and nonspecific interstitial pneumonia subjects . Probe uptake was higher in IPF subjects, consistent with increased somatostatin expression, and occurred in areas of CT-detected fibrosis. In the IPF subjects, PET signal correlated linearly with the amount of fibrosis on CT. However, somatostatin type 2 receptors are also expressed in “proinflammatory” M1 macrophages, which may be present during fibrosis and fibrogenesis . 68Ga-DOTATATE was recently used in a prospective clinical trial to image atherosclerotic inflammation . In excised carotid plaques, SSTR2 gene expression occurred exclusively in M1 macrophages. 68Ga-DOTATATE tissue-to-blood ratios correctly identified culprit versus nonculprit arteries in patients with acute coronary syndrome and transient ischemic attack/stroke.

TEXT 4 Fibrosis-associated process

Vascular leak is one of the cardinal responses to tissue injury . While necessary to promote resolution of disrupted tissue integrity, marked increases in vascular leak can become pathogenic. The persistence or overexuberance of leak can contribute to the development of fibrosis . Gadofosveset is an FDA-approved gadolinium-based contrast agent that reversibly binds serum albumin. After injection, at least 80% of circulating gadofosveset is albumin-bound at any one time . Gadofosveset can image vascular leak by assessing extravascular albumin accumulation. Gadofosveset’s ability to detect albumin extravasation was validated using Evans blue dye (EBD) in a mouse model of accelerated atherosclerosis . Using apolipoprotein E–deficient mice fed HFD, MR signal intensity of the brachiocephalic artery vessel wall correlated with degree of EBD uptake and increased with atherosclerotic progression . We performed gadofosveset-enhanced lung MRI to detect a vascular leak in patients with pulmonary fibrosis . Using an albumin extravasation index (the change in lung parenchyma signal intensity with contrast administration normalized to the change in aorta signal intensity), we found that the lungs of patients with pulmonary fibrosis had increased albumin extravasation in all measured lung regions compared with the lungs of healthy volunteers. The increased vascular leak detected in pulmonary fibrosis occurred in areas of radiographically normal lung, as determined by CT, in addition to areas of known fibrosis.ref:https://www.jci.org/articles/view/122132

1. A particular test should be performed to identify different types.

2. How to find damage in the lungs.

3. Early diagnosis of fibrosis

4. How fibrosis developed.

Take 2 minutes and comment your answer.