1
|
Solid Indeterminate Nodules with a Radiological Stability Suggesting Benignity: A Texture Analysis of Computed Tomography Images Based on the Kurtosis and Skewness of the Nodule Volume Density Histogram. Pulm Med 2019; 2019:4071762. [PMID: 31687208 PMCID: PMC6800929 DOI: 10.1155/2019/4071762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022] Open
Abstract
Background The number of incidental findings of pulmonary nodules using imaging methods to diagnose other thoracic or extrathoracic conditions has increased, suggesting the need for in-depth radiological image analyses to identify nodule type and avoid unnecessary invasive procedures. Objectives The present study evaluated solid indeterminate nodules with a radiological stability suggesting benignity (SINRSBs) through a texture analysis of computed tomography (CT) images. Methods A total of 100 chest CT scans were evaluated, including 50 cases of SINRSBs and 50 cases of malignant nodules. SINRSB CT scans were performed using the same noncontrast enhanced CT protocol and equipment; the malignant nodule data were acquired from several databases. The kurtosis (KUR) and skewness (SKW) values of these tests were determined for the whole volume of each nodule, and the histograms were classified into two basic patterns: peaks or plateaus. Results The mean (MEN) KUR values of the SINRSBs and malignant nodules were 3.37 ± 3.88 and 5.88 ± 5.11, respectively. The receiver operating characteristic (ROC) curve showed that the sensitivity and specificity for distinguishing SINRSBs from malignant nodules were 65% and 66% for KUR values >6, respectively, with an area under the curve (AUC) of 0.709 (p < 0.0001). The MEN SKW values of the SINRSBs and malignant nodules were 1.73 ± 0.94 and 2.07 ± 1.01, respectively. The ROC curve showed that the sensitivity and specificity for distinguishing malignant nodules from SINRSBs were 65% and 66% for SKW values >3.1, respectively, with an AUC of 0.709 (p < 0.0001). An analysis of the peak and plateau histograms revealed sensitivity, specificity, and accuracy values of 84%, 74%, and 79%, respectively. Conclusions KUR, SKW, and histogram shape can help to noninvasively diagnose SINRSBs but should not be used alone or without considering clinical data.
Collapse
|
2
|
Divisi D, Barone M, Bertolaccini L, Zaccagna G, Gabriele F, Crisci R. Diagnostic performance of fluorine-18 fluorodeoxyglucose positron emission tomography in the management of solitary pulmonary nodule: a meta-analysis. J Thorac Dis 2018; 10:S779-S789. [PMID: 29780624 DOI: 10.21037/jtd.2017.12.126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background In the setting of solitary pulmonary nodules (SPNs), fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is considered a useful non-invasive diagnostic tool though false positive (FP) and false negative (FN) results affects accuracy due to different conditions, such as inflammatory diseases or low-uptake neoplasms. Aim of this study is to evaluate overall diagnostic performance of 18F-FDG-PET/CT for malignant pulmonary nodules. Methods A computerized research, including published articles from 2012 and 2017, was carried out. 18F-FDG-PET/CT overall sensitivity (Se), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV), negative predictive value (NPV), diagnostic index and odds ratio were pooled. No selection-bias were found according to asymmetry test. Results A total of twelve studies were included in the meta-analysis. The pooled Se, Spe, PLR, NLR, PPV, NPV and accuracy index (AI) with relative 95% confidence intervals (CI) were 0.819 (95% CI: 0.794-0.843), 0.624 (95% CI: 0.582-0.665), 2.190 (95% CI: 1.950-2.440), 0.290 (95% CI: 0.250-0.330), 0.802 (95% CI: 0.783-0.819), 0.652 (95% CI: 0.618-0.684) and 0.649 (95% CI: 0.625-0.673), respectively. The diagnostic odds ratio (DOR) was 7.049 with a relative 95% CI between 5.550 and 8.944. Conclusions The results suggest 18F-FDG-PET/CT has good diagnostic accuracy in SPNs evaluation; but, it should not be considered as a discriminatory test rather than a method to be included in a clinical and diagnostic pathway.
Collapse
Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| | - Mirko Barone
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| | | | - Gino Zaccagna
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| | - Francesca Gabriele
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| |
Collapse
|
3
|
Tejero-Mas M, Gato-Núñez C, Rivera-Jiménez N, Buitrago-Ramírez F, Palmerín-Donoso A. Hamartoma pulmonar como presentación de un nódulo pulmonar solitario. Semergen 2017; 43:465-467. [DOI: 10.1016/j.semerg.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 11/28/2022]
|
4
|
Spadafora M, Pace L, Mansi L. Segmental 18F-FDG-PET/CT in a single pulmonary nodule: a better cost/effectiveness strategy. Eur J Nucl Med Mol Imaging 2017; 44:1-4. [PMID: 27695909 DOI: 10.1007/s00259-016-3532-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Marco Spadafora
- Department of Imaging, S.G. Moscati Hospital, Avellino, Italy
| | - Leonardo Pace
- Department of Medicine and Surgery, University of Salerno, Baronissi, SA, Italy
| | - Luigi Mansi
- Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale, Second University of Naples, Napoli, Italy.
| |
Collapse
|
5
|
Seijo LM. Electromagnetic navigation bronchoscopy: clinical utility in the diagnosis of lung cancer. LUNG CANCER-TARGETS AND THERAPY 2016; 7:111-118. [PMID: 28210167 PMCID: PMC5310707 DOI: 10.2147/lctt.s98643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Electromagnetic navigation bronchoscopy (ENB) is one of several technological advances which have broadened the indications for bronchoscopy in the diagnostic workup of lung cancer. The technique facilitates bronchoscopic sampling of peripheral pulmonary nodules as well as mediastinal lymph nodes, although wide availability and expertise in endobronchial ultrasonography has limited its application in routine clinical practice to the former. ENB in this setting is quite versatile and may be considered an established alternative to more invasive techniques, especially in selected patients with underlying pulmonary disease or comorbidities at high risk for complications from computer topography-guided fine needle aspiration or surgical resection. Nodule sampling may be performed with a variety of instruments, including forceps, cytology brushes, and transbronchial needles. Although samples are generally small, they are often suitable for molecular analysis.
Collapse
Affiliation(s)
- Luis M Seijo
- Pulmonary Department, Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-Centro de Investigación Biomedica en Red Enfermedades Respiratorias, Madrid, Spain
| |
Collapse
|
6
|
Barreiro E, Bustamante V, Curull V, Gea J, López-Campos JL, Muñoz X. Relationships between chronic obstructive pulmonary disease and lung cancer: biological insights. J Thorac Dis 2016; 8:E1122-E1135. [PMID: 27867578 DOI: 10.21037/jtd.2016.09.54] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Lung cancer (LC) has become one of the leading causes of preventable death in the last few decades. Cigarette smoking (CS) stays as the main etiologic factor of LC despite that many other causes such as occupational exposures, air pollution, asbestos, or radiation have also been implicated. Patients with chronic obstructive pulmonary disease (COPD), which also represents a major cause of morbidity and mortality in developed countries, exhibit a significantly greater risk of LC. The study of the underlying biological mechanisms that may predispose patients with chronic respiratory diseases to a higher incidence of LC has also gained much attention in the last few years. The present review has been divided into three major sections in which different aspects have been addressed: (I) relevant etiologic agents of LC; (II) studies confirming the hypothesis that COPD patients are exposed to a greater risk of developing LC; and (III) evidence on the most relevant underlying biological mechanisms that support the links between COPD and LC. Several carcinogenic agents have been described in the last decades but CS remains to be the leading etiologic agent in most geographical regions in which the incidence of LC is very high. Growing evidence has put the line forward the implications of COPD and especially of emphysema in LC development. Hence, COPD represents a major risk factor of LC in patients. Different avenues of research have demonstrated the presence of relevant biological mechanisms that may predispose COPD patients to develop LC. Importantly, the so far identified biological mechanisms offer targets for the design of specific therapeutic strategies that will further the current treatment options for patients with LC. Prospective screening studies, in which patients with COPD should be followed up for several years will help identify biomarkers that may predict the risk of LC among these patients.
Collapse
Affiliation(s)
- Esther Barreiro
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Víctor Bustamante
- Pneumology Department, Basurto University Hospital, Osakidetza, Department of Medicine, EHU-University of the Basque Country, Bilbao, Bizkaia, Spain
| | - Víctor Curull
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Joaquim Gea
- Pulmonology Department-Lung Cancer and Muscle Research Group, IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Pompeu Fabra University (UPF), Barcelona Autonomous University (UAB), Barcelona Biomedical Research Park (PRBB), Barcelona, Spain; ; Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain
| | - José Luis López-Campos
- Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain; ; Medical-Surgery Unit of Respiratory Disease, Sevilla Biomedicine Institute (IBIS), Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Xavier Muñoz
- Network of Excellence in Lung Diseases (CIBERES), Carlos III Health Institute (ISCIII), Madrid, Spain; ; Pulmonology Service, Medicine Department, Vall d'Hebron University Hospital, Barcelona Autonomous University (UAB), Barcelona, Spain
| |
Collapse
|
7
|
Villar Álvarez F, Muguruza Trueba I, Belda Sanchis J, Molins López-Rodó L, Rodríguez Suárez PM, Sánchez de Cos Escuín J, Barreiro E, Borrego Pintado MH, Disdier Vicente C, Flandes Aldeyturriaga J, Gámez García P, Garrido López P, León Atance P, Izquierdo Elena JM, Novoa Valentín NM, Rivas de Andrés JJ, Royo Crespo Í, Salvatierra Velázquez Á, Seijo Maceiras LM, Solano Reina S, Aguiar Bujanda D, Avila Martínez RJ, de Granda Orive JI, de Higes Martinez E, Diaz-Hellín Gude V, Embún Flor R, Freixinet Gilart JL, García Jiménez MD, Hermoso Alarza F, Hernández Sarmiento S, Honguero Martínez AF, Jimenez Ruiz CA, López Sanz I, Mariscal de Alba A, Martínez Vallina P, Menal Muñoz P, Mezquita Pérez L, Olmedo García ME, Rombolá CA, San Miguel Arregui I, de Valle Somiedo Gutiérrez M, Triviño Ramírez AI, Trujillo Reyes JC, Vallejo C, Vaquero Lozano P, Varela Simó G, Zulueta JJ. Executive Summary of the SEPAR Recommendations for the Diagnosis and Treatment of Non-small Cell Lung Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
8
|
Villar Álvarez F, Muguruza Trueba I, Belda Sanchis J, Molins López-Rodó L, Rodríguez Suárez PM, Sánchez de Cos Escuín J, Barreiro E, Borrego Pintado MH, Disdier Vicente C, Flandes Aldeyturriaga J, Gámez García P, Garrido López P, León Atance P, Izquierdo Elena JM, Novoa Valentín NM, Rivas de Andrés JJ, Royo Crespo Í, Salvatierra Velázquez Á, Seijo Maceiras LM, Solano Reina S, Aguiar Bujanda D, Avila Martínez RJ, de Granda Orive JI, de Higes Martinez E, Diaz-Hellín Gude V, Embún Flor R, Freixinet Gilart JL, García Jiménez MD, Hermoso Alarza F, Hernández Sarmiento S, Honguero Martínez AF, Jimenez Ruiz CA, López Sanz I, Mariscal de Alba A, Martínez Vallina P, Menal Muñoz P, Mezquita Pérez L, Olmedo García ME, Rombolá CA, San Miguel Arregui I, de Valle Somiedo Gutiérrez M, Triviño Ramírez AI, Trujillo Reyes JC, Vallejo C, Vaquero Lozano P, Varela Simó G, Zulueta JJ. Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer. Arch Bronconeumol 2016; 52:378-88. [PMID: 27237592 DOI: 10.1016/j.arbres.2016.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 02/07/2023]
Abstract
The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.
Collapse
Affiliation(s)
| | | | - José Belda Sanchis
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, España
| | | | | | | | - Esther Barreiro
- Grupo de Investigación en Desgaste Muscular y Caquexia en Enfermedades Crónicas Respiratorias y Cáncer de Pulmón, Instituto de Investigación del Hospital del Mar (IMIM)-Hospital del Mar, Departamento de Ciencias Experimentales y de la Salud (CEXS), Universidad Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona (PRBB); Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona. España
| | | | | | - Javier Flandes Aldeyturriaga
- Unidad de Broncoscopias y Neumología Intervencionista, Servicio de Neumología, ISS Fundación Jiménez Díaz, UAM, CIBERES, Madrid, España
| | - Pablo Gámez García
- Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Pilar Garrido López
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Pablo León Atance
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, España
| | | | | | - Juan José Rivas de Andrés
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | - Íñigo Royo Crespo
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | | | | | | | - David Aguiar Bujanda
- Servicio de Oncología Médica, Hospital Universitario de Gran Canaria «Dr. Negrín», España
| | | | | | | | | | - Raúl Embún Flor
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | | | | | | | | | | | | | - Iker López Sanz
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, España
| | | | - Primitivo Martínez Vallina
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | - Patricia Menal Muñoz
- Servicio de Radiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Laura Mezquita Pérez
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Carlos A Rombolá
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, España
| | - Iñigo San Miguel Arregui
- Servicio de Oncología Radioterápica, Hospital Universitario de Gran Canaria «Dr. Negrín», España
| | - María de Valle Somiedo Gutiérrez
- Unidad de Broncoscopias y Neumología Intervencionista, Servicio de Neumología, ISS Fundación Jiménez Díaz, UAM, CIBERES, Madrid, España
| | | | | | - Carmen Vallejo
- Servicio de Oncología Radioterápica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Paz Vaquero Lozano
- Unidad de Tabaquismo, Servicio de Neumología H.G.U. Gregorio Marañón, Madrid, España
| | - Gonzalo Varela Simó
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, España
| | | |
Collapse
|
9
|
Mateu-Jiménez M, Sánchez-Font A, Rodríguez-Fuster A, Aguilό R, Pijuan L, Fermoselle C, Gea J, Curull V, Barreiro E. Redox Imbalance in Lung Cancer of Patients with Underlying Chronic Respiratory Conditions. Mol Med 2016; 22:85-98. [PMID: 26772773 DOI: 10.2119/molmed.2015.00199] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/07/2016] [Indexed: 12/11/2022] Open
Abstract
Chronic respiratory diseases such as obstructive pulmonary disease (COPD) and oxidative stress may underlie lung cancer (LC). We hypothesized that the profile of oxidative and antioxidant events may differ in lung tumors and blood compartments of patients with non-small cell LC (NSCLC) with and without COPD. Redox markers (immunoblotting, ELISA, chemiluminescence, 2D electrophoresis and proteomics) were analyzed in blood samples of 17 control subjects and 80 LC patients (59 LC-COPD and 21 LC) and lung specimens (tumor and nontumor) from those undergoing thoracotomy (35 patients: 23 LC-COPD and 12 LC). As smoking history was more prevalent in LC-COPD patients, these were further analyzed post hoc as heavy and moderate smokers (cutoff, 60 pack-years). Malondialdehyde (MDA)-protein adducts and SOD1 levels were higher in tumor and nontumor samples of LC-COPD than in LC. In tumors compared with nontumors, SOD2 protein content was greater, whereas catalase levels were decreased in both LC and LC-COPD patients. Blood superoxide anion levels, protein carbonylation and nitration were greater in LC and LC-COPD patients than in the controls, and in the latter patients compared with the former. Systemic superoxide anion, protein carbonyls and nitrotyrosine above specific cutoff values best identified underlying COPD among all patients. Smoking did not influence the study results. A differential expression profile of oxidative stress markers exists in blood and, to a lesser extent, in the tumors of LC-COPD patients. These findings suggest that systemic oxidative stress and lung antioxidants (potential biomarkers) may predispose patients with chronic respiratory diseases to a higher risk for LC.
Collapse
Affiliation(s)
- Mercè Mateu-Jiménez
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Albert Sánchez-Font
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Alberto Rodríguez-Fuster
- Thoracic Surgery Department and Pathology Department, IMIM-Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Rafael Aguilό
- Thoracic Surgery Department and Pathology Department, IMIM-Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Lara Pijuan
- Pathology Department, IMIM-Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Clara Fermoselle
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Joaquim Gea
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Victor Curull
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Esther Barreiro
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Parc de Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Universitat Autònoma de Barcelona, Parc de Recerca Biomèdica de Barcelona (PRBB), Barcelona, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| |
Collapse
|