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Otaola M, Paulin F, Rosemffet M, Balcazar J, Perandones M, Orausclio P, Cazenave T, Rossi S, Marciano S, Schneeberger E, Citera G. Lung ultrasound is a promising screening tool to rule out interstitial lung disease in patients with rheumatoid arthritis. Respirology 2024. [PMID: 38369685 DOI: 10.1111/resp.14679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND AND OBJECTIVE It is still controversial how to screen for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). We aimed to evaluate the performance of lung ultrasound (LUS) as a screening tool for RA-ILD and to compare it with the performance of chest auscultation, chest x-ray and pulmonary function tests (PFTs). METHODS Cross-sectional study of consecutive RA patients evaluated at a Rheumatology Clinic in Buenos Aires between January and December 2022. High-resolution computed tomography (HRCT) was the gold standard for diagnosing ILD and was performed within 30 days of the LUS, chest x-ray and PFTs. Investigators were blinded to HRCT results and patients' clinical data. LUS was performed by exploring 14 areas and was considered positive when the sum of B lines was ≥5. Performance for the diagnosis of ILD was reported for each diagnostic test. RESULTS One hundred and six patients were included; 87 (82%) were women. Median age was 60.9 (±9.5) years-old. A total of 32 (30.2%, 95% CI: 21.6%-39.9%) had ILD. The sensitivity and negative predictive value of LUS were 90.6% (95% CI 75.0%-98.0%) and 94.7% (95% CI 85.4%-98.9%), respectively. LUS performance was superior to that of the other evaluated diagnostic tests for screening ILD. CONCLUSIONS Given that the US is a low-cost point-of-care tool with a high negative predictive value, it is emerging as a valuable tool for ruling out ILD in patients with RA.
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Affiliation(s)
- M Otaola
- Instituto de Rehabilitacion Psicofisica de Buenos Aires-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - F Paulin
- Hospital Fernandez-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - M Rosemffet
- Instituto de Rehabilitacion Psicofisica de Buenos Aires-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - J Balcazar
- Instituto de Rehabilitacion Psicofisica de Buenos Aires-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - M Perandones
- Instituto de Rehabilitacion Psicofisica de Buenos Aires-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - P Orausclio
- Centro de Diagnóstico Rossi-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - T Cazenave
- Instituto de Rehabilitacion Psicofisica de Buenos Aires-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - S Rossi
- Centro de Diagnóstico Rossi-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - S Marciano
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - E Schneeberger
- Instituto de Rehabilitacion Psicofisica de Buenos Aires-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
| | - G Citera
- Instituto de Rehabilitacion Psicofisica de Buenos Aires-Ciudad Autónoma Buenos Aires, Buenos Aires, Argentina
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Zamfir AS, Zabara ML, Arcana RI, Cernomaz TA, Zabara-Antal A, Marcu MTD, Trofor A, Zamfir CL, Crișan-Dabija R. Exploring the Role of Biomarkers Associated with Alveolar Damage and Dysfunction in Idiopathic Pulmonary Fibrosis-A Systematic Review. J Pers Med 2023; 13:1607. [PMID: 38003922 PMCID: PMC10672103 DOI: 10.3390/jpm13111607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is one of the most aggressive forms of interstitial lung diseases (ILDs), marked by an ongoing, chronic fibrotic process within the lung tissue. IPF leads to an irreversible deterioration of lung function, ultimately resulting in an increased mortality rate. Therefore, the focus has shifted towards the biomarkers that might contribute to the early diagnosis, risk assessment, prognosis, and tracking of the treatment progress, including those associated with epithelial injury. METHODS We conducted this review through a systematic search of the relevant literature using established databases such as PubMed, Scopus, and Web of Science. Selected articles were assessed, with data extracted and synthesized to provide an overview of the current understanding of the existing biomarkers for IPF. RESULTS Signs of epithelial cell damage hold promise as relevant biomarkers for IPF, consequently offering valuable support in its clinical care. Their global and standardized utilization remains limited due to a lack of comprehensive information of their implications in IPF. CONCLUSIONS Recognizing the aggressive nature of IPF among interstitial lung diseases and its profound impact on lung function and mortality, the exploration of biomarkers becomes pivotal for early diagnosis, risk assessment, prognostic evaluation, and therapy monitoring.
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Affiliation(s)
- Alexandra-Simona Zamfir
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (A.-S.Z.); (R.I.A.); (A.T.); (R.C.-D.)
- Department of Medical Sciences III, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Mihai Lucian Zabara
- Department of Surgery, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Clinic of Surgery (II), St. Spiridon Emergency Hospital, 700111 Iasi, Romania
| | - Raluca Ioana Arcana
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (A.-S.Z.); (R.I.A.); (A.T.); (R.C.-D.)
- Doctoral School of the Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Tudor Andrei Cernomaz
- Department of Medical Sciences III, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Andreea Zabara-Antal
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (A.-S.Z.); (R.I.A.); (A.T.); (R.C.-D.)
- Doctoral School of the Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Marius Traian Dragoș Marcu
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (A.-S.Z.); (R.I.A.); (A.T.); (R.C.-D.)
- Department of Medical Sciences I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Antigona Trofor
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (A.-S.Z.); (R.I.A.); (A.T.); (R.C.-D.)
- Department of Medical Sciences III, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
| | - Carmen Lăcrămioara Zamfir
- Department of Morpho-Functional Sciences I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Radu Crișan-Dabija
- Clinical Hospital of Pulmonary Diseases, 700115 Iasi, Romania; (A.-S.Z.); (R.I.A.); (A.T.); (R.C.-D.)
- Department of Medical Sciences III, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
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Rajendran K, Koo CW. Photon-counting detector CT: improving interstitial lung disease classification using ultra-high resolution at a fraction of the radiation dose? Eur Radiol 2023; 33:5526-5527. [PMID: 37071170 PMCID: PMC10112303 DOI: 10.1007/s00330-023-09617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Kishore Rajendran
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Chi Wan Koo
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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4
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Kamgo T, Spalgais S, Ravishankar N, Kumar R. Role of sleep questionnaires in predicting obstructive sleep apnea amongst interstitial lung diseases patients. Lung India 2023; 40:327-332. [PMID: 37417085 PMCID: PMC10401977 DOI: 10.4103/lungindia.lungindia_731_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 12/27/2022] [Accepted: 01/27/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction The co-existence of obstructive sleep apnea (OSA) and interstitial lung diseases (ILD) results in significant morbidity and mortality. So screening for OSA is important for its early diagnosis among ILD patients. The commonly used questionnaires for screening of OSA are Epworth sleep score (ESS) and STOP-BANG. However, the validity of these questionnaires among ILD patients is not well studied. The aim of this study was to assess the utility of these sleep questionnaires in detection of OSA among ILD patients. Methods It was a prospective observational study of one year in a tertiary chest centre in India. We enrolled 41 stable cases of ILD who were subjected to self-reported questionnaires (ESS, STOP-BANG, and Berlin questionnaire). The diagnosis of OSA was done by Level 1 polysomnography. The correlation analysis was done between the sleep questionnaires and AHI. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for all the questionnaires. The cutoff values of STOPBANG and ESS questionnaire were calculated from the ROC analyses. P value of <0.05 was considered to be significant. Results OSA was diagnosed in 32 (78%) patients with mean AHI of 21.8 ± 17.6.The mean age was 54.8 ± 8.9 years with majority being female (78%) and mean body mass index (BMI) was 29.7 ± 6.4 kg/m2. The mean ESS and STOPBANG score were 9.2 ± 5.4 and 4.3 ± 1.8, respectively, and 41% patients showed high risk for OSA with Berlin questionnaire. The sensitivity for detection of OSA was highest (96.1%) with ESS and lowest with Berlin questionnaire (40.6%). The receiver operating characteristics (ROC) area under curve for ESS was 0.929 with optimum cutoff point of 4, sensitivity of 96.9%, and specificity of 55.6%, while ROC area under curve for STOPBANG was 0.918 with optimum cutoff point of 3, sensitivity of 81.2% and specificity of 88.9%.The combination of two questionnaires showed sensitivity of >90%. The sensitivity also increased with the increasing severity of OSA. AHI showed positive correlation with ESS (r = 0.618, P < 0.001) and STOPBANG (r = 0.770, P < 0.001). Conclusion The ESS and STOPBANG showed high sensitivity with positive correlation for prediction of OSA in ILD patients. These questionnaires can be used to prioritize the patients for polysomnography (PSG) among ILD patients with suspicion of OSA.
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Affiliation(s)
- Tome Kamgo
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, Delhi, India
| | - N Ravishankar
- Department of Biostatics, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, Delhi, India
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Xiong T, Bai X, Wei X, Wang L, Li F, Shi H, Shi Y. Exercise Rehabilitation and Chronic Respiratory Diseases: Effects, Mechanisms, and Therapeutic Benefits. Int J Chron Obstruct Pulmon Dis 2023; 18:1251-1266. [PMID: 37362621 PMCID: PMC10289097 DOI: 10.2147/copd.s408325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023] Open
Abstract
Chronic respiratory diseases (CRD), is a group of disorders, primarily chronic obstructive pulmonary disease and asthma, which are characterized by high prevalence and disability, recurrent acute exacerbations, and multiple comorbidities, resulting in exercise limitations and reduced health-related quality of life. Exercise training, an important tool in pulmonary rehabilitation, reduces adverse symptoms in patients by relieving respiratory limitations, increasing gas exchange, increasing central and peripheral hemodynamic forces, and enhancing skeletal muscle function. Aerobic, resistance, and high-intensity intermittent exercises, and other emerging forms such as aquatic exercise and Tai Chi effectively improve exercise capacity, physical fitness, and pulmonary function in patients with CRD. The underlying mechanisms include enhancement of the body's immune response, better control of the inflammatory response, and acceleration of the interaction between the vagus and sympathetic nerves to improve gas exchange. Here, we reviewed the new evidence of benefits and mechanisms of exercise intervention in the pulmonary rehabilitation of patients with chronic obstructive pulmonary disease, bronchial asthma, bronchiectasis, interstitial lung disease, and lung cancer.
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Affiliation(s)
- Ting Xiong
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Xinyue Bai
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Xingyi Wei
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Lezheng Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Fei Li
- School of Athletic Performance, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Yue Shi
- School of Athletic Performance, Shanghai University of Sport, Shanghai, 200438, People’s Republic of China
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Doshi JA, Mundhra KS, Shah DS, Shah SN, Patel TV, Bhatt A. Role of High-Resolution CT Thorax in Diagnosing Interstitial Lung Disease and Its Association With Smoking and Connective Tissue Disorder. Cureus 2022; 14:e31107. [DOI: 10.7759/cureus.31107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 11/07/2022] Open
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Kifjak D, Leitner J, Ambros R, Heidinger BH, Milos RI, Beer L, Prayer F, Röhrich S, Prosch H. Röntgenbefunde bei diffusen parenchymatösen Lungenerkrankungen. ZEITSCHRIFT FÜR PNEUMOLOGIE 2022. [PMCID: PMC9386651 DOI: 10.1007/s10405-022-00464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Klinisches Problem Empfehlungen für die Praxis
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Affiliation(s)
- Daria Kifjak
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
- Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA USA
| | - Johannes Leitner
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Raphael Ambros
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Benedikt H. Heidinger
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Lucian Beer
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Florian Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Sebastian Röhrich
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
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Broască L, Trușculescu AA, Ancușa VM, Ciocârlie H, Oancea CI, Stoicescu ER, Manolescu DL. A Novel Method for Lung Image Processing Using Complex Networks. TOMOGRAPHY (ANN ARBOR, MICH.) 2022; 8:1928-1946. [PMID: 35894027 PMCID: PMC9332806 DOI: 10.3390/tomography8040162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 02/07/2023]
Abstract
The High-Resolution Computed Tomography (HRCT) detection and diagnosis of diffuse lung disease is primarily based on the recognition of a limited number of specific abnormal findings, pattern combinations or their distributions, as well as anamnesis and clinical information. Since texture recognition has a very high accuracy percentage if a complex network approach is used, this paper aims to implement such a technique customized for diffuse interstitial lung diseases (DILD). The proposed procedure translates HRCT lung imaging into complex networks by taking samples containing a secondary lobule, converting them into complex networks and analyzing them in three dimensions: emphysema, ground glass opacity, and consolidation. This method was evaluated on a 60-patient lot and the results showed a clear, quantifiable difference between healthy and affected lungs. By deconstructing the image on three pathological axes, the method offers an objective way to quantify DILD details which, so far, have only been analyzed subjectively.
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Affiliation(s)
- Laura Broască
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania; (L.B.); (V.M.A.); (H.C.)
| | - Ana Adriana Trușculescu
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timișoara, Romania;
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’, University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Correspondence:
| | - Versavia Maria Ancușa
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania; (L.B.); (V.M.A.); (H.C.)
| | - Horia Ciocârlie
- Department of Computer and Information Technology, Automation and Computers Faculty, “Politehnica” University of Timișoara, Vasile Pârvan Blvd. No. 2, 300223 Timișoara, Romania; (L.B.); (V.M.A.); (H.C.)
| | - Cristian-Iulian Oancea
- Pulmonology Department, ‘Victor Babes’ University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timișoara, Romania;
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’, University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Emil-Robert Stoicescu
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania;
- Research Center for Pharmaco-Toxicological Evaluations, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania
| | - Diana Luminița Manolescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases (CRIPMRD), ‘Victor Babes’, University of Medicine and Pharmacy, 300041 Timișoara, Romania;
- Department of Radiology and Medical Imaging, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timișoara, Romania;
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Romero-Bueno F, Rodríguez-Nieto MJ, Naredo E. Education and Use of Lung Ultrasound in Rheumatology and Pneumology in Spain: A SER-SEPAR Survey. REUMATOLOGIA CLINICA 2022; 18:94-99. [PMID: 35074285 DOI: 10.1016/j.reumae.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Lung ultrasound (LUS) is a clinical and research tool with great potential in the diagnosis and monitoring of diffuse interstitial lung disease (ILD) present in systemic autoimmune diseases (SAD). Appropriate training in LUS is essential for the correct and safe use of this technique. OBJECTIVE To document the current state of LUS education and use among Spanish rheumatologists and pneumologists. MATERIAL AND METHODS A national online survey was designed for members of the Spanish Society of Rheumatology and the ILD Area of the Spanish Society of Pneumology and Thoracic Surgery. The survey consisted of 22 questions on demographics, professional activity, performance and training in LUS. RESULTS One hundred and thirty-five (56.72% rheumatologists, 41.79% pneumologists) responded to the survey. Of these, 56.30% were part of an ILD Unit in their centre. LUS in clinical practice was performed by 35.82% but only 14.93% performed it in ILD, mainly for diagnostic purposes. Training in LUS of responders had been diverse in format, content and sponsors. The vast majority (87.79%) considered that the optimal model of education in LUS should be standardized and structured and consist of a combination of theoretical-practical courses and the conduct of a minimum number of supervised LUS examinations, with competency assessment. CONCLUSIONS The current lack of formal structured education in LUS is an opportunity to develop quality educational programmes in this emerging field.
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Affiliation(s)
| | | | - Esperanza Naredo
- Servicio de Reumatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
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10
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Kifjak D, Leitner J, Ambros R, Heidinger BH, Milos RI, Beer L, Prayer F, Röhrich S, Prosch H. [Chest radiography findings in diffuse parenchymal lung diseases]. Radiologe 2022; 62:130-139. [PMID: 34997260 PMCID: PMC8740870 DOI: 10.1007/s00117-021-00955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 10/28/2022]
Abstract
CLINICAL ISSUE Diffuse parenchymal lung diseases include a heterogeneous group of diseases of the lung parenchyma, the alveolar spaces, the vessels and the airways, which can be triggered by various pathomechanisms, such as inflammation and fibrotic changes. Since the therapeutic approaches and prognoses differ significantly between the diseases, the correct diagnosis is of fundamental importance. In routine clinical practice, next to the patients' history, the clinical presentation, the laboratory findings and the bronchoscopy, imaging plays a central role in establishing a diagnosis. PRACTICAL RECOMMENDATIONS The diagnosis of diffuse parenchymal lung diseases is an enormous challenge for clinicians, radiologists as well as pathologists and should therefore preferably be carried out in a multidisciplinary setting. Since patients often present with unspecific, respiratory symptoms, chest radiographs are the first imaging method used. Many patterns of diffuse parenchymal lung diseases (e.g., ground-glass opacities and consolidations), their distribution (e.g., cranial-caudal) and the presence of additional findings (e.g., mediastinal lymphadenopathy) are often already detectable on chest X‑rays. However, the imaging reference standard and thus, an integral part of the assessment of diffuse parenchymal lung disease, is the chest HR-CT. In some cases, the pattern of the HR-CT is pathognomonic, in others it is unspecific for a disease, so that further diagnostic steps are necessary.
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Affiliation(s)
- Daria Kifjak
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.,Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Johannes Leitner
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Raphael Ambros
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Benedikt H Heidinger
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Lucian Beer
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Florian Prayer
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Sebastian Röhrich
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich.,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medizinische Universität Wien, Wien, Österreich. .,Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Ishak SR, Hassan AM, Kamel TB. Environmental hazards and demographic and clinical data of childhood interstitial lung diseases in a tertiary institute in Egypt. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-020-00048-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The incidence of childhood interstitial lung diseases increased in the last years in Egypt. Changes in environmental and climatic conditions may be contributing factors. Also, raising birds at home increased in the past years due to financial issues. Other environmental factors include increased industries, traffic, and pollution. Our study aimed to assess the environmental hazards and the severity of childhood interstitial lung diseases.
Results
Sixty-five percent of patients with childhood interstitial lung diseases (chILD) were exposed to cigarette smoke; 45% were exposed to birds, 30% to industrial wastes, 20% to grass and pesticides, and 10% to animals.
Conclusions
Exposure to cigarette smoke and birds increases the risk of development of chILD.
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12
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Mehta M, Dhanjal DS, Satija S, Wadhwa R, Paudel KR, Chellappan DK, Mohammad S, Haghi M, Hansbro PM, Dua K. Advancing of Cellular Signaling Pathways in Respiratory Diseases Using Nanocarrier Based Drug Delivery Systems. Curr Pharm Des 2021; 26:5380-5392. [PMID: 33198611 DOI: 10.2174/1381612826999201116161143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 10/01/2020] [Indexed: 11/22/2022]
Abstract
Cell Signaling pathways form an integral part of our existence that allows the cells to comprehend a stimulus and respond back. Such reactions to external cues from the environment are required and are essential to regulate the normal functioning of our body. Abnormalities in the system arise when there are errors developed in these signals, resulting in a complication or a disease. Presently, respiratory diseases contribute to being the third leading cause of morbidity worldwide. According to the current statistics, over 339 million people are asthmatic, 65 million are suffering from COPD, 2.3 million are lung cancer patients and 10 million are tuberculosis patients. This toll of statistics with chronic respiratory diseases leaves a heavy burden on society and the nation's annual health expenditure. Hence, a better understanding of the processes governing these cellular pathways will enable us to treat and manage these deadly respiratory diseases effectively. Moreover, it is important to comprehend the synergy and interplay of the cellular signaling pathways in respiratory diseases, which will enable us to explore and develop suitable strategies for targeted drug delivery. This review, in particular, focuses on the major respiratory diseases and further provides an in-depth discussion on the various cell signaling pathways that are involved in the pathophysiology of respiratory diseases. Moreover, the review also analyses the defining concepts about advanced nano-drug delivery systems involving various nanocarriers and propose newer prospects to minimize the current challenges faced by researchers and formulation scientists.
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Affiliation(s)
- Meenu Mehta
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
| | - Daljeet Singh Dhanjal
- School of Biosciences and Bioengineering, Lovely Professional University, Phagwara, Punjab 144411, India
| | - Saurabh Satija
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
| | - Ridhima Wadhwa
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
| | - Keshav Raj Paudel
- School of Life Sciences, Faculty of Science, University of Technology Sydney (UTS), Ultimo, NSW, 2007, Australia
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Shiva Mohammad
- School of Life Sciences, Faculty of Science, University of Technology Sydney (UTS), Ultimo, NSW, 2007, Australia
| | - Mehra Haghi
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
| | - Philip M Hansbro
- School of Life Sciences, Faculty of Science, University of Technology Sydney (UTS), Ultimo, NSW, 2007, Australia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo NSW 2007, Australia
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Giannouli V, Markopoulou A, Kiosseoglou G, Kosmidis MH. Neuropsychological functioning in patients with interstitial lung disease. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1290-1295. [PMID: 33506719 DOI: 10.1080/23279095.2020.1870465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We undertook the present study to investigate the cognitive status of patients with interstitial lung disease (ILD) and its relationship to pulmonary function and cardiovascular efficiency. METHOD Fifty-one patients with a diagnosis of ILD [mean duration = 3.13 years (SD = 3.01)] received a respiratory examination, including spirometry and the six-minute walk test, and completed a neuropsychological assessment including several cognitive domains. Eighty-eight healthy individuals matched on age, education, and gender, completed the neuropsychological test battery. RESULTS Patients performed more poorly than their healthy peers on cognitive tasks related to verbal and visual memory, visual perception, and working memory, but not attention, processing speed and executive functioning. Stepwise linear regression analyses showed that exercise-related measures (heart rate, oxygen saturation and distance walked) predicted performance on neuropsychological tests of psychomotor speed, verbal memory and word production. Additionally, an index of pulmonary function, specifically, lung diffusion capacity, predicted performance on selective and sustained attention and word generation. CONCLUSION The present preliminary findings may have implications for the quality of life and treatment compliance of patients with ILD and warrant further study with a larger sample of patients.
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Affiliation(s)
- Vaitsa Giannouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Grigoris Kiosseoglou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Romero-Bueno F, Rodríguez-Nieto MJ, Naredo E. Education and Use of Lung Ultrasound in Rheumatology and Pneumology in Spain: A SER-SEPAR Survey. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(20)30239-4. [PMID: 33495104 DOI: 10.1016/j.reuma.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Lung ultrasound (LUS) is a clinical and research tool with great potential in the diagnosis and monitoring of diffuse interstitial lung disease (ILD) present in systemic autoimmune diseases (SAD). Appropriate training in LUS is essential for the correct and safe use of this technique. OBJECTIVE To document the current state of LUS education and use among Spanish rheumatologists and pneumologists. MATERIAL AND METHODS A national online survey was designed for members of the Spanish Society of Rheumatology and the ILD Area of the Spanish Society of Pneumology and Thoracic Surgery. The survey consisted of 22 questions on demographics, professional activity, performance and training in LUS. RESULTS One hundred and thirty-five (56.72% rheumatologists, 41.79% pneumologists) responded to the survey. Of these, 56.30% were part of an ILD Unit in their centre. LUS in clinical practice was performed by 35.82% but only 14.93% performed it in ILD, mainly for diagnostic purposes. Training in LUS of responders had been diverse in format, content and sponsors. The vast majority (87.79%) considered that the optimal model of education in LUS should be standardized and structured and consist of a combination of theoretical-practical courses and the conduct of a minimum number of supervised LUS examinations, with competency assessment. CONCLUSIONS The current lack of formal structured education in LUS is an opportunity to develop quality educational programmes in this emerging field.
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Affiliation(s)
| | | | - Esperanza Naredo
- Servicio de Reumatología. Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
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15
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Souza LFDF, Silva ICL, Marques AG, Silva FHDS, Nunes VX, Hassan MM, de Albuquerque VHC, Filho PPR. Internet of Medical Things: An Effective and Fully Automatic IoT Approach Using Deep Learning and Fine-Tuning to Lung CT Segmentation. SENSORS 2020; 20:s20236711. [PMID: 33255308 PMCID: PMC7727680 DOI: 10.3390/s20236711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022]
Abstract
Several pathologies have a direct impact on society, causing public health problems. Pulmonary diseases such as Chronic obstructive pulmonary disease (COPD) are already the third leading cause of death in the world, leaving tuberculosis at ninth with 1.7 million deaths and over 10.4 million new occurrences. The detection of lung regions in images is a classic medical challenge. Studies show that computational methods contribute significantly to the medical diagnosis of lung pathologies by Computerized Tomography (CT), as well as through Internet of Things (IoT) methods based in the context on the health of things. The present work proposes a new model based on IoT for classification and segmentation of pulmonary CT images, applying the transfer learning technique in deep learning methods combined with Parzen’s probability density. The proposed model uses an Application Programming Interface (API) based on the Internet of Medical Things to classify lung images. The approach was very effective, with results above 98% accuracy for classification in pulmonary images. Then the model proceeds to the lung segmentation stage using the Mask R-CNN network to create a pulmonary map and use fine-tuning to find the pulmonary borders on the CT image. The experiment was a success, the proposed method performed better than other works in the literature, reaching high segmentation metrics values such as accuracy of 98.34%. Besides reaching 5.43 s in segmentation time and overcoming other transfer learning models, our methodology stands out among the others because it is fully automatic. The proposed approach has simplified the segmentation process using transfer learning. It has introduced a faster and more effective method for better-performing lung segmentation, making our model fully automatic and robust.
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Affiliation(s)
- Luís Fabrício de Freitas Souza
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza CE 60020-181, Brazil
| | - Iágson Carlos Lima Silva
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
| | - Adriell Gomes Marques
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
| | - Francisco Hércules dos S. Silva
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
| | - Virgínia Xavier Nunes
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
| | - Mohammad Mehedi Hassan
- Information Systems Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
- Correspondence:
| | - Victor Hugo C. de Albuquerque
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza CE 60020-181, Brazil
| | - Pedro P. Rebouças Filho
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza CE 60020-181, Brazil
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16
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De Nardo P, Gentilotti E, Mazzaferri F, Cremonini E, Hansen P, Goossens H, Tacconelli E. Multi-Criteria Decision Analysis to prioritize hospital admission of patients affected by COVID-19 in low-resource settings with hospital-bed shortage. Int J Infect Dis 2020; 98:494-500. [PMID: 32619766 PMCID: PMC7326449 DOI: 10.1016/j.ijid.2020.06.082] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To use Multi-Criteria Decision Analysis (MCDA) to determine weights for eleven criteria in order to prioritize COVID-19 non-critical patients for admission to hospital in healthcare settings with limited resources. Methods The MCDA was applied in two main steps: specification of criteria for prioritizing COVID-19 patients (and levels within each criterion); and determination of weights for the criteria based on experts’ knowledge and experience in managing COVID-19 patients, via an online survey. Criteria were selected based on available COVID-19 evidence with a focus on low- and middle-income countries (LMICs). Results The most important criteria (mean weights, summing to 100%) are: PaO2 (16.3%); peripheral O2 saturation (15.9%); chest X-ray (14.1%); Modified Early Warning Score-MEWS (11.4%); respiratory rate (9.5%); comorbidities (6.5%); living with vulnerable people (6.4%); body mass index (5.6%); duration of symptoms before hospital evaluation (5.4%); CRP (5.1%); and age (3.8%). Conclusions At the beginning of a new pandemic, when evidence for disease predictors is limited or unavailable and effective national contingency plans are difficult to establish, the MCDA prioritization model could play a pivotal role in improving the response of health systems.
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Affiliation(s)
- Pasquale De Nardo
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy.
| | - Elisa Gentilotti
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy.
| | - Fulvia Mazzaferri
- Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy.
| | - Eleonora Cremonini
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy.
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand.
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium.
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy.
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Stącel T, Nęcki M, Antończyk R, Latos M, Urlik M, Kościołek J, Kordylewska-Kubus A, Litewka J, Przybyłowski P, Zawadzki F, Wajda-Pokrontka M, Pyrć K, Zembala M, Ochman M. Effectiveness of Lung Transplantation in Patients With Interstitial Lung Diseases. Transplant Proc 2020; 52:2143-2148. [PMID: 32571712 DOI: 10.1016/j.transproceed.2020.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interstitial lung diseases (ILDs) are a heterogeneous group of more than 200 diseases manifested by progressive exercise dyspnea, radiological lung changes, and ventilation restrictive disorders. ILDs are the second most common indication for lung transplantation (LTx). Our study group consisted of 139 patients who qualified for LTx at the Silesian Center for Heart Diseases between 2004 and 2018. Of the 139, 92 patients died while on the waiting list, and 47 patients underwent LTx. Medical records including laboratory test results, spirometry, and the 6-minute walk test (6MWT) were analyzed to determine eligibility for LTx. We also assessed quality of life post-LTx. RESULTS Patients who qualified for LTx showed decreased values of parameters measured by spirometry (43.69 ± 19.05% of forced expiratory volume in the first second [FEV1] and 43.07 ± 20.55% of forced vital capacity [FVC] and severe desaturation during the 6MWT (SpO2 = 88.78% before 6-minute walk test and 73.23% after the test). After LTx, longer distances were achieved in the 6MWT (235.47 ± 159.57 m during qualification vs 533.2 ± 34.15 m 12 months after LTx) and increased values of spirometry. On average, patients had stopped working 6 years prior to LTx. CONCLUSION There is no effective medical treatment for patients with end-stage ILDs. Therefore, lung transplantation is a lifesaving procedure for patients that also extends patients' lives and improves their quality of life.
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Affiliation(s)
- Tomasz Stącel
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mirosław Nęcki
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Remigiusz Antończyk
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Magdalena Latos
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Maciej Urlik
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Joanna Kościołek
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Angelika Kordylewska-Kubus
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Joanna Litewka
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland; Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Fryderyk Zawadzki
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marta Wajda-Pokrontka
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Pyrć
- Małopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marek Ochman
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
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Shukla SD, Swaroop Vanka K, Chavelier A, Shastri MD, Tambuwala MM, Bakshi HA, Pabreja K, Mahmood MQ, O’Toole RF. Chronic respiratory diseases: An introduction and need for novel drug delivery approaches. TARGETING CHRONIC INFLAMMATORY LUNG DISEASES USING ADVANCED DRUG DELIVERY SYSTEMS 2020. [PMCID: PMC7499075 DOI: 10.1016/b978-0-12-820658-4.00001-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Globally, chronic respiratory diseases (CRDs), both communicable and noncommunicable, are among the leading causes of mortality, morbidity, economic and societal burden, and disability-adjusted life years (DALYs). CRDs affect multiple components of respiratory system, including the airways, parenchyma, and pulmonary vasculature. Although noncommunicable respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), cystic fibrosis (CF), and lung cancer (LC), account for enormous disease burden, the currently available therapies only focus on alleviating the symptoms of diseases rather than providing optimal treatment and/or prevention. Similarly a major respiratory communicable disease, that is, tuberculosis (TB), is associated with the challenge of increasingly developing antibiotic resistance in the bacterial pathogen Mycobacterium tuberculosis. In light of these challenges, we aim to summarize the underlying molecular and cellular mechanisms that lead to hallmark pathophysiology of CRDs. Moreover, we will also highlight the limitations of current therapeutic strategies and explore novel drug delivery options that may be potentially more effective in the management of CRDs.
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19
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Shafiek H, Elbialy S, El Achy SN, Gad AYS. Transbronchial cryobiopsy validity in diagnosing diffuse parenchymal lung diseases in Egyptian population. J Multidiscip Healthc 2019; 12:719-726. [PMID: 31507323 PMCID: PMC6719837 DOI: 10.2147/jmdh.s208824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/19/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives We aimed to evaluate the efficacy, safety, and diagnostic utility of transbronchial cryobiopsy (TBCB) in diagnosing diffuse parenchymal lung diseases (DPLDs) in an Egyptian population and to identify common DPLD pathologies among them. Methods This prospective interventional study enrolled 25 Egyptian patients presenting to the Main Alexandria University Hospital who had clinical and radiological features of DPLD, but insufficient elements to achieve definite features of usual interstitial pneumonia on chest high-resolution computed tomography. Twelve patients were subjected to TBCB and 13 to forceps transbronchial lung biopsy (TBLB). Results The diagnostic yield was significantly higher among the TBCB group (83.3%), and increased to 100% with clinicopathological correlation vs the TBLB group (38.5%, P=0.041). Granulomatous diseases (24%, either sarcoidosis or hypersensitivity pneumonitis) were the commonest pathology, followed by malignancy (12%) in both groups. TBCB sizes were 2.5–5 mm vs 1-3 mm in TBLB (P<0.001), with preserved tissue architecture (91.7% vs 38.5%, respectively; P=0.011). Only 8.3% were complicated by insignificant bleeding grade 2 after TBCB, but no pneumothorax was detected. Conclusion TBCB is a safe, tolerable procedure with high diagnostic yield for evaluating DPLD with indefinite usual interstitial pneumonia pattern on high-resolution computed tomography.
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Affiliation(s)
- Hanaa Shafiek
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Shaimaa Elbialy
- Chest Diseases Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Samar Nabil El Achy
- Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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20
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Lundstrom ZT, Pennington KM, Braun CM. 57-Year-Old Woman With Dyspnea and Rash. Mayo Clin Proc 2019; 94:1079-1083. [PMID: 31171118 DOI: 10.1016/j.mayocp.2018.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Zachary T Lundstrom
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Kelly M Pennington
- Resident in Pulmonary and Critical Care Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Cassandra M Braun
- Advisor to residents and Consultant in Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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21
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Walsh SLF, Devaraj A, Enghelmayer JI, Kishi K, Silva RS, Patel N, Rossman MD, Valenzuela C, Vancheri C. Role of imaging in progressive-fibrosing interstitial lung diseases. Eur Respir Rev 2018; 27:27/150/180073. [PMID: 30578332 PMCID: PMC9488692 DOI: 10.1183/16000617.0073-2018] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/01/2018] [Indexed: 01/03/2023] Open
Abstract
Imaging techniques are an essential component of the diagnostic process for interstitial lung diseases (ILDs). Chest radiography is frequently the initial indicator of an ILD, and comparison of radiographs taken at different time points can show the rate of disease progression. However, radiography provides only limited specificity and sensitivity and is primarily used to rule out other diseases, such as left heart failure. High-resolution computed tomography (HRCT) is a more sensitive method and is considered central in the diagnosis of ILDs. Abnormalities observed on HRCT can help identify specific ILDs. HRCT also can be used to evaluate the patient's prognosis, while disease progression can be assessed through serial imaging. Other imaging techniques such as positron emission tomography-computed tomography and magnetic resonance imaging have been investigated, but they are not commonly used to assess patients with ILDs. Disease severity may potentially be estimated using quantitative methods, as well as visual analysis of images. For example, comprehensive assessment of disease staging and progression in patients with ILDs requires visual analysis of pulmonary features that can be performed in parallel with quantitative analysis of the extent of fibrosis. New approaches to image analysis, including the application of machine learning, are being developed. Imaging techniques, particularly HRCT, are the cornerstone for ILD diagnosis and new approaches to analysing HRCT images, including machine-learning technology, are being developedhttp://ow.ly/1R1e30mOqhn
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Affiliation(s)
- Simon L F Walsh
- Dept of Radiology, King's College NHS Foundation Trust, London, UK.,Both authors contributed equally
| | - Anand Devaraj
- Dept of Radiology, Royal Brompton & Harefield Hospital, London, UK.,Both authors contributed equally
| | - Juan Ignacio Enghelmayer
- División Neumonología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Fundación Funef, Buenos Aires, Argentina
| | - Kazuma Kishi
- Dept of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan
| | - Rafael S Silva
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Nina Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Milton D Rossman
- Pulmonary, Allergy & Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases, University Hospital "Policlinico", Dept of Clinical and Respiratory Medicine, University of Catania, Catania, Italy
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Prasad KT, Sehgal IS, Dhooria S, Singh N, Agarwal R, Behera D, Aggarwal AN. Patient characteristics and outcome of end-stage lung diseases referred for lung transplantation in North India. Lung India 2018; 35:290-294. [PMID: 29970766 PMCID: PMC6034368 DOI: 10.4103/lungindia.lungindia_436_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Most countries worldwide have transplant registries for patients with end-stage lung diseases (ESLD) requiring lung transplantation. There is no such lung transplant registry in India. Herein, we describe the demographic profile and clinical outcomes among patients referred for lung transplantation at a tertiary care center in North India. Materials and Methods: This was a prospective, observational study of consecutive patients with chronic respiratory diseases who were referred for lung transplantation between July 2013 and December 2016. Patients were evaluated using standard criteria for listing for lung transplantation. Results: Of the 176 patients assessed for lung transplantation, 167 were included in the study. The mean (standard deviation [SD]) age of the study population (52.1% females) was 53.2 (14.7) years. Interstitial lung disease (ILD, 46.7%), chronic obstructive pulmonary disease (COPD, 25.7%), and bronchiectasis (10.2%) were the most common diseases in this population. The median (interquartile range, IQR) survival was worst for patients with bronchiolitis (78.5 [9–208] days) and idiopathic pulmonary fibrosis (IPF, 93.5 [19–239] days) and best for patients with idiopathic pulmonary arterial hypertension (757 [340–876] days) and COPD (578 [184–763] days). Only 13% of the patients expressed willingness for lung transplantation. Patients willing for transplantation died earlier than those unwilling (median [IQR], 102 [36-224] days vs. 310 [41-713] days, P < 0.001). Conclusion: ILD was the most common cause of ESLD in patients referred for lung transplantation. The waitlist mortality was highest for patients with bronchiolitis and IPF. Despite having ESLD, very few patients were willing for lung transplantation. Patients willing for lung transplantation died earlier than those who were unwilling.
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Affiliation(s)
- Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ilyas SZ, Tabassum R, Hamed H, Rehman SU, Qadri I. Hepatitis C Virus-Associated Extrahepatic Manifestations in Lung and Heart and Antiviral Therapy-Related Cardiopulmonary Toxicity. Viral Immunol 2017; 30:633-641. [PMID: 28953449 DOI: 10.1089/vim.2017.0009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Besides liver cirrhosis and hepatocellular carcinoma, chronic hepatitis C virus (HCV) infection is associated with many extrahepatic manifestations (EHMs). HCV exhibits lymphotropism that is responsible for various EHM. An important characteristic of HCV is escape from the immune system, which enables it to produce chronic infections and autoimmune disorders along with accumulation of circulating immune complexes. These EHMs have large spectrum, because they affect many organs such as heart, lungs, kidney, brain, thyroid, and skin. HCV-related cardiac and pulmonary manifestations include myocarditis, cardiomyopathies, cardiovascular diseases (i.e., Stroke, ischemic heart disease), chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, asthma, and interstitial lung diseases. This review discusses etiology and pathogenesis of HCV-associated cardiac and pulmonary manifestations and how different genes, immune system, indirectly linked factors (mixed cryoglobulinemia), liver cirrhosis, and antiviral treatment are involved in HCV-related heart and lung diseases, however, their exact mechanism is not clear.
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Affiliation(s)
- Syeda Zainab Ilyas
- 1 Department of Microbiology and Molecular Genetics, University of the Punjab , Lahore, Pakistan
| | - Rabia Tabassum
- 1 Department of Microbiology and Molecular Genetics, University of the Punjab , Lahore, Pakistan
| | - Haroon Hamed
- 2 Department of Biological Sciences, King Abdul Aziz University , Jeddah, Kingdom of Saudi Arabia
| | - Shafiq Ur Rehman
- 1 Department of Microbiology and Molecular Genetics, University of the Punjab , Lahore, Pakistan
| | - Ishtiaq Qadri
- 2 Department of Biological Sciences, King Abdul Aziz University , Jeddah, Kingdom of Saudi Arabia
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De Weerdt A, Dendooven A, Snoeckx A, Pen J, Lammens M, Jorens PG. Prognosis and treatment of FOLFOX therapy related interstitial pneumonia: a plea for multimodal immune modulating therapy in the respiratory insufficient patient. BMC Cancer 2017; 17:586. [PMID: 28851379 PMCID: PMC5576105 DOI: 10.1186/s12885-017-3576-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/22/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The FOLFOX regimen, i.e., folinic acid (FOL), fluorouracil (F) and oxaliplatin (OX), is a drug cocktail that is used to treat gastric and colorectal cancers. Despite the concomitant improvements in response rate, duration of response and patient survival, reports of serious toxic pulmonary side effects have progressively emerged. CASE PRESENTATION We describe a patient who was treated with FOLFOX as an adjuvant to a rectosigmoidal resection of a rectosigmoidal carcinoma and who developed respiratory insufficiency requiring mechanical ventilation. Computed tomography (CT) imaging and open lung biopsy findings were compatible with interstitial pneumonia (IP). She received multimodal combination treatment (acetylcysteine, corticosteroids, immune globulins and cyclophosphamide) and survived. We performed a systematic literature search and reviewed all 45 reported cases of FOLFOX-related lung toxicity and/or pulmonary fibrosis for their clinical characteristics and their outcomes related to therapy. CONCLUSIONS We found that for the 45 cases with available data, the median age was 70 years, and the male-female ratio was 3.5: 1. In the patients exhibiting only mild respiratory symptoms, discontinuation of the culprit drug (oxaliplatin) resulted in a 100% regression of the symptoms. However the prognosis of the respiratory insufficient patient proved to be grim: death occurred in 76.9% of the cases despite conventional treatment with corticosteroids. We therefore urge oncologists and critical care specialists not to limit their interventions to the discontinuation of chemotherapy, artificial ventilation, corticosteroids and glutathione replenishment and to consider the gradual introduction of additional immune-modulating agents whenever life-threatening respiratory symptoms in oxaliplatin-treated patients do not subside; all the more so considering the fact that our analysis showed that every patient who survived intubation and mechanical ventilation experienced a full clinical recovery.
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Affiliation(s)
- Annick De Weerdt
- Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium.
| | - Amélie Dendooven
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Jan Pen
- Department of Gastroenterology, Heilig Hart Hospital, Lier, Belgium
| | - Martin Lammens
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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Robalo-Cordeiro C, Campos P, Carvalho L, Borba A, Clemente S, Freitas S, Furtado S, Jesus JM, Leal C, Marques A, Melo N, Souto-Moura C, Neves S, Sousa V, Santos A, Morais A. Idiopathic pulmonary fibrosis in the era of antifibrotic therapy: Searching for new opportunities grounded in evidence. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:287-293. [PMID: 28668400 DOI: 10.1016/j.rppnen.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/29/2017] [Indexed: 11/16/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease that up to now has been associated with a poor prognosis. However, the results of the INPULSIS and ASCEND trials and the approval of nintedanib and pirfenidone have marked the beginning of a new era for IPF patients. Questions remain, however. Should these drugs be used earlier? What effect will they have on more severe disease? Will their effects last beyond the trial period? This manuscript is the outcome of a multidisciplinary meeting between pulmonology, radiology, and pathology clinicians on the use of antifibrotic agents in IPF. In our opinion, the existing data show that pirfenidone and nintedanib slow functional decline in early stages of disease. These drugs also appear to result in therapeutic benefits when administered to patients with advanced disease at diagnosis and maintain effective over time. The data also suggest that continuing antifibrotic therapy after disease progression may confer benefits, but more evidence is needed. Early diagnosis and treatment are crucial for reducing functional decline, slowing disease progression, and improving quality of life.
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Affiliation(s)
- C Robalo-Cordeiro
- Pulmonology Department, Coimbra University Hospital, Faculty of Medicine of Coimbra, Coimbra, Portugal.
| | - P Campos
- Imagiology Department, Santa Maria Hospital, Northern Lisbon Hospital Centre, Lisbon, Portugal
| | - L Carvalho
- Pathology Department, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | - A Borba
- Pulmonology Department, Santa Marta Hospital, Central Lisbon Hospital Centre, Lisbon, Portugal
| | - S Clemente
- Pulmonology Department, Beatriz Ângelo Hospital, Loures, Portugal
| | - S Freitas
- Pulmonology Department, Coimbra University Hospital Centre, Coimbra, Portugal
| | - S Furtado
- Pulmonology Department, Beatriz Ângelo Hospital, Loures, Portugal
| | - J M Jesus
- Radiology Department, São João Hospital Centre, Oporto, Portugal
| | - C Leal
- Radiology Department, Santa Marta Hospital, Central Lisbon Hospital Centre, Lisbon, Portugal
| | - A Marques
- Pulmonology Department, São João Hospital Centre, Oporto, Portugal
| | - N Melo
- Pulmonology Department, São João Hospital Centre, Oporto, Portugal
| | - C Souto-Moura
- Pathology Department, São João Hospital Centre, Faculty of Medicine of Porto University, Oporto, Portugal
| | - S Neves
- Pulmonology Department, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
| | - V Sousa
- Pathology Department, Faculty of Medicine of the University of Coimbra, Coimbra, Portugal
| | | | - A Morais
- Pulmonology Department, São João Hospital Centre, Oporto, Portugal
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Affiliation(s)
- Tony S Mok
- State Key Laboratory in Oncology in South China, Hong Kong, China
| | - Yi-Long Wu
- Guangdong General Hospital, Guangzhou, China
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Abstract
Although the lung is not traditionally thought of as an organ affected by sex-based differences, emerging literature elucidates major differences between men and women in the development, physiology, and predilection to and outcomes in lung diseases. These differences are driven by both differences in sex hormones and differences in environmental exposures. However, in many cases the underlying etiology of these sex- and gender-based differences is unknown. This article outlines the state-of-the-art knowledge on the etiology of sex differences in lung disease, including differences in lung development and physiology, and reviews therapy recommendations that are sex based.
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Affiliation(s)
- Emily G Kocurek
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, T1218 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA.
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, T1218 Medical Center North, 1161 21st Avenue South, Nashville, TN 37232, USA
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Vizioli L, Ciccarese F, Forti P, Chiesa AM, Giovagnoli M, Mughetti M, Zompatori M, Zoli M. Integrated Use of Lung Ultrasound and Chest X-Ray in the Detection of Interstitial Lung Disease. Respiration 2016; 93:15-22. [DOI: 10.1159/000452225] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/30/2016] [Indexed: 11/19/2022] Open
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Berngard SC, Afshar K. Idiopathic pulmonary fibrosis: past, present, future-a review from Talmadge King's ATS 2016 presentation. J Thorac Dis 2016; 8:S559-61. [PMID: 27606094 DOI: 10.21037/jtd.2016.07.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- S Clark Berngard
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, USA
| | - Kamyar Afshar
- Division of Pulmonary and Critical Care Medicine, University of California, San Diego, USA
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Pinheiro L, Blake K, Januskiene J, Yue QY, Arlett P. Geographical variation in reporting Interstitial Lung Disease as an adverse drug reaction: findings from an European Medicines Agency analysis of reports in EudraVigilance. Pharmacoepidemiol Drug Saf 2016; 25:705-12. [PMID: 27004571 DOI: 10.1002/pds.3998] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/17/2016] [Accepted: 02/21/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE Clinically, interstitial lung disease (ILD) is a heterogeneous group of over 150 respiratory disorders. In the context of its signal evaluation work, the European Medicines Agency's (EMA) Pharmacovigilance Risk Assessment Committee (PRAC) has seen geographic clustering of case reports of ILD from Japan. To explore this further, EudraVigilance (EV), the EMA's database of adverse drug reactions (ADRs), was analysed. The results have been used to inform on implications for pharmacovigilance including signal detection and evaluation activities. METHODS EV was queried for reports of respiratory ADRs coded using MedDRA for the period 1994-2014 for all medicinal products. Descriptive statistics and non-parametric (chi-square) independence tests were produced to compare reporting of ILD from Japan versus the rest of the world. RESULTS As of 31 December 2014, there were 26 551 case reports of ILD in EV of which 17 526 (66%) originated in Japan. The reporting rate of ILD for Japan has been consistently higher over the period. The odds that a case report from Japan in EV refers to ILD is OR = 20.7, 95% CI 20.2, 21.3 (p < 0.001), compared to OR = 0.60, 95% CI 0.54, 0.67 (p < 0.001) for pulmonary fibrosis. CONCLUSIONS A geographic imbalance between Japan and the rest of the world in reporting respiratory ADRs as ILD is confirmed. Consequently, the PRAC has developed approaches to address this in relation to signals of ILD it assesses to allow for more targeted risk minimisation including updates to the product information in the EU setting. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Luis Pinheiro
- European Medicines Agency, Inspections and Human Medicines Pharmacovigilance Division, London, United Kingdom of Great Britain and Northern Ireland
| | - Kevin Blake
- European Medicines Agency, Inspections and Human Medicines Pharmacovigilance Division, London, United Kingdom of Great Britain and Northern Ireland
| | - Justina Januskiene
- European Medicines Agency, Inspections and Human Medicines Pharmacovigilance Division, London, United Kingdom of Great Britain and Northern Ireland
| | - Qun-Ying Yue
- Läkemedelsverket (Medical Product Agency Sweden), Pharmacovigilance, Uppsala, Sweden
| | - Peter Arlett
- European Medicines Agency, Inspections and Human Medicines Pharmacovigilance Division, London, United Kingdom of Great Britain and Northern Ireland
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Consensus document for the diagnosis and treatment of idiopathic pulmonary fibrosis: Joint Consensus of Sociedade Portuguesa de Pneumologia, Sociedade Portuguesa de Radiologia e Medicina Nuclear e Sociedade Portuguesa de Anatomia Patológica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:112-22. [PMID: 26906287 DOI: 10.1016/j.rppnen.2016.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Indexed: 12/15/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a rare interstitial lung disease included in the Idiopathic Interstitial Pneumonias group. Although several potential risk factors have been described, it is a progressive fibrosing disease of unknown cause affecting mainly adults over 50 years and associated with a poor prognosis, reflected in a median survival of 2-3 years after diagnosis. The concept of a multidisciplinary working group for the diagnosis of idiopathic pulmonary fibrosis is based on the need to have experienced pulmonologists, radiologists and pathologists in the evaluation and correct treatment of the disease, and requires the use of all available data about individual patients, standardized (largely through High Resolution Computed Tomography and pathology when needed) as well as non-standardized data (laboratory, serology and biomarkers). This approach helps to increase diagnostic accuracy and is an internationally accepted recommendation. In regard to therapy, the situation has changed radically since the publication of the ATS/ERS/JRS/ALAT 2011 guidelines on the diagnosis and management of idiopathic pulmonary fibrosis where it was stressed that no proven therapy exists for this disease. Currently besides non-pharmacological treatment, therapy of complications and comorbidities and palliative care, nintedanib and pirfenidone, two compounds with pleiotropic mechanisms of action, are to date, the two drugs with confirmed efficacy in slowing functional decline and disease progression in idiopathic pulmonary fibrosis patients.
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Cobra SDB, Cardoso RM, Rodrigues MP. Usefulness of the second heart sound for predicting pulmonary hypertension in patients with interstitial lung disease. SAO PAULO MED J 2016; 134:34-9. [PMID: 26786609 PMCID: PMC10496576 DOI: 10.1590/1516-3180.2015.00701207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 04/12/2015] [Accepted: 07/12/2015] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE P2 hyperphonesis is considered to be a valuable finding in semiological diagnoses of pulmonary hypertension (PH). The aim here was to evaluate the accuracy of the pulmonary component of second heart sounds for predicting PH in patients with interstitial lung disease. DESIGN AND SETTING Cross-sectional study at the University of Brasilia and Hospital de Base do Distrito Federal. METHODS Heart sounds were acquired using an electronic stethoscope and were analyzed using phonocardiography. Clinical signs suggestive of PH, such as second heart sound (S2) in pulmonary area louder than in aortic area; P2 > A2 in pulmonary area and P2 present in mitral area, were compared with Doppler echocardiographic parameters suggestive of PH. Sensitivity (S), specificity (Sp) and positive (LR+) and negative (LR-) likelihood ratios were evaluated. RESULTS There was no significant correlation between S2 or P2 amplitude and PASP (pulmonary artery systolic pressure) (P = 0.185 and 0.115; P= 0.13 and 0.34, respectively). Higher S2 in pulmonary area than in aortic area, compared with all the criteria suggestive of PH, showed S = 60%, Sp= 22%; LR+ = 0.7; LR- = 1.7; while P2> A2 showed S= 57%, Sp = 39%; LR+ = 0.9; LR- = 1.1; and P2 in mitral area showed: S= 68%, Sp = 41%; LR+ = 1.1; LR- = 0.7. All these signals together showed: S= 50%, Sp = 56%. CONCLUSIONS The semiological signs indicative of PH presented low sensitivity and specificity levels for clinically diagnosing this comorbidity.
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Affiliation(s)
- Sandra de Barros Cobra
- MD, MSc. Cardiologist, Hospital de Base do Distrito Federal (HBDF), Brasília, Federal District, Brazil.
| | - Rayane Marques Cardoso
- MD. Resident in General Surgery, Universidade de Brasília (UnB), Brasília, Federal District, Brazil.
| | - Marcelo Palmeira Rodrigues
- MD, MSc, PhD. Professor, School of Medicine, Universidade de Brasília (UnB), Brasília, Federal District, Brazil.
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Vedel-Krogh S, Nielsen SF, Nordestgaard BG. Statin Use Is Associated with Reduced Mortality in Patients with Interstitial Lung Disease. PLoS One 2015; 10:e0140571. [PMID: 26473476 PMCID: PMC4608706 DOI: 10.1371/journal.pone.0140571] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/26/2015] [Indexed: 12/15/2022] Open
Abstract
Introduction We hypothesized that statin use begun before the diagnosis of interstitial lung disease is associated with reduced mortality. Methods We studied all patients diagnosed with interstitial lung disease in the entire Danish population from 1995 through 2009, comparing statin use versus no statin use in a nested 1:2 matched study. Results The cumulative survival as a function of follow-up time from the date of diagnosis of interstitial lung disease (n = 1,786+3,572) and idiopathic lung fibrosis (n = 261+522) was higher for statin users versus never users (log-rank: P = 7·10−9 and P = 0.05). The median survival time in patients with interstitial lung disease was 3.3 years in statin users and 2.1 years in never users. Corresponding values in patients with idiopathic lung fibrosis were 3.4 versus 2.4 years. After multivariable adjustment, the hazard ratio for all-cause mortality for statin users versus never users was 0.73 (95% confidence interval, 0.68 to 0.79) in patients with interstitial lung disease and 0.76 (0.62 to 0.93) in patients with idiopathic lung fibrosis. Results were robust in all sensitivity analyses. Conclusion Among patients with interstitial lung disease statin use was associated with reduced all-cause mortality.
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Affiliation(s)
- Signe Vedel-Krogh
- Department of Clinical Biochemistry, Herlev and Gentofte Hospitals, Copenhagen University Hospital, Herlev, Denmark
| | - Sune F. Nielsen
- Department of Clinical Biochemistry, Herlev and Gentofte Hospitals, Copenhagen University Hospital, Herlev, Denmark
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospitals, Copenhagen University Hospital, Herlev, Denmark
- * E-mail:
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Rabea AEM, Zidan M, Daabis R, El Sayed P, Samir S. Prevalence of chronic hepatitis C virus (HCV) infection in patients with idiopathic pulmonary fibrosis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Erlotinib-associated interstitial lung disease in advanced pancreatic carcinoma: a case report and literature review. TUMORI JOURNAL 2015; 101:e122-7. [PMID: 25953445 DOI: 10.5301/tj.5000327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 12/25/2022]
Abstract
The combination of erlotinib and gemcitabine is a recognized option for patients with metastatic pancreatic cancer whose common adverse events such as skin rash, diarrhea, or fatigue are usually easily manageable. Interstitial lung disease (ILD) is a life-threatening toxicity reported in patients with non-small-cell lung cancers treated with epidermal growth factor receptor-tyrosine kinase inhibitors or gemcitabine. This side effect is extremely rare in patients with pancreatic cancer. We report fatal treatment-related ILD that occurred in a 67-year-old patient with metastatic pancreatic cancer. Risk factors and pathophysiology of ILD need further investigation but caution is highly recommended for patients with an underlying pulmonary disease when using erlotinib in monotherapy or combination therapy.
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Keyser RE, Christensen EJ, Chin LMK, Woolstenhulme JG, Drinkard B, Quinn A, Connors G, Weir NA, Nathan SD, Chan LE. Changes in fatigability following intense aerobic exercise training in patients with interstitial lung disease. Respir Med 2015; 109:517-25. [PMID: 25698651 PMCID: PMC6388636 DOI: 10.1016/j.rmed.2015.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine if, in patients with interstitial lung disease (ILD), fatigue might be lessened after vigorous aerobic exercise. METHODS 13 physically inactive patients (5 men and 8 women; age 57.2 ± 9.1 years, BMI 28.2 ± 4.6 kgm(-2)) with ILD of heterogeneous etiology and able to walk on a motor driven treadmill without physical limitation were enrolled. Subjects underwent cardiopulmonary exercise (CPET) and 6-min walk (6MWT) tests and completed Fatigue Severity Scale and Human Activity Profile questionnaires before and after an aerobic exercise-training regimen. The training regimen required participation in at least 24 of 30 prescribed aerobic exercise training sessions at a target heart rate of 70-80% of the heart rate reserve, 30 min per session, 3 times per week for 10 weeks. RESULTS After training, a 55% (p < 0.001) increase in time to anaerobic threshold on the CPET, and an 11% (p = 0.045) reduction in performance fatigability index (PFI), calculated from the performance on the 6MWT were observed. Distance walked on the 6MWT (6MWD) increased by 49.7 ± 46.9 m (p = 0.002). Significant improvements in scores on the Fatigue Severity Scale (p = 0.046) and Human Activity Profile (AAS p = 0.024; MAS p = 0.029) were also observed. No adverse events related to the training regimen were noted. CONCLUSION After training, the decrease in fatigability appeared to result in increased 6MWD and was associated with physical activity. Since significant declines in 6MWD may be a marker for impending mortality in ILD, a better understanding of the etiological state of fatigue in patients with ILD and its reversal might provide fundamental insight into disease progression and even survival. [ClinicalTrials.gov identifier NCT00678821].
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Affiliation(s)
- Randall E Keyser
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA; Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA.
| | - Eric J Christensen
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA
| | - Lisa M K Chin
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA; Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA
| | - Joshua G Woolstenhulme
- Department of Rehabilitation Science, College of Health and Human Services, George Mason University, 4400 University Drive, Fairfax, VA 22030, USA; Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA
| | - Bart Drinkard
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA
| | - Anne Quinn
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA
| | - Gerilynn Connors
- Pulmonary Rehabilitation Center, Inova Farifax Hospital, Falls Church, VA 22046, USA
| | - Nargues A Weir
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22046, USA
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22046, USA
| | - Leighton E Chan
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, 10 Center Drive, Bethesda, MD 20892, USA
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Bauer PR, Kalra S, Osborn TG, St Sauver J, Hanson AC, Schroeder DR, Ryu JH. Influence of autoimmune biomarkers on interstitial lung diseases: A tertiary referral center based case-control study. Respir Med 2015; 109:397-405. [PMID: 25670028 PMCID: PMC4351115 DOI: 10.1016/j.rmed.2015.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 12/30/2014] [Accepted: 01/19/2015] [Indexed: 11/20/2022]
Abstract
Background The benefit of routinely measuring autoimmune biomarkers to evaluate patients with interstitial lung disease (ILD) remains debated outside specific contexts such as connective tissue disease (CTD). This study aimed at evaluating the influence of biomarkers on outcome on patients with ILD in a case-control study at a tertiary referral center. We hypothesized that patients with positive autoimmune biomarkers have increased odds of developing ILD even in the absence of CTD. Methods We reviewed the medical records of 3573 patients seen at the ILD clinic in Mayo Clinic Rochester between September 2001 and September 2006. We assessed their clinical course through June 25, 2013. We included patients with patterns of ILD most often associated with CTD (n=1256) while excluding patients with other known causes of ILD. Controls (n=2317) included cases seen at the ILD clinic without evidence of ILD. Results We identified 930 (26%) cases of ILD alone, 124 (3%) CTD alone, 326 (9%) ILD combined with CTD, and 2193 (61%) with no ILD or CTD. Positive antinuclear antibodies (ANA), rheumatoid factor and aldolase were associated with ILD. After adjustment for age, gender, race, smoking history and CTD, ANA remained an independent risk factor for ILD (OR 1.70, 95% CI 1.33–2.17). Among patients with ILD, the presence of CTD but not biomarker alone was associated with a better survival. Conclusion In this study, the presence of positive biomarkers was associated with increased odds of ILD, even in the absence of overt CTD, but was not associated with a better outcome.
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Affiliation(s)
- Philippe R Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Sanjay Kalra
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | - Jennifer St Sauver
- Health Sciences Research - Epidemiology, Mayo Clinic, Rochester, MN, USA.
| | - Andrew C Hanson
- Health Sciences Research - Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Darrell R Schroeder
- Health Sciences Research - Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Jay H Ryu
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
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Lammi MR, Baughman RP, Birring SS, Russell AM, Ryu JH, Scholand M, Distler O, LeSage D, Sarver C, Antoniou K, Highland KB, Kowal-Bielecka O, Lasky JA, Wells AU, Saketkoo LA. Outcome Measures for Clinical Trials in Interstitial Lung Diseases. CURRENT RESPIRATORY MEDICINE REVIEWS 2015; 11:163-174. [PMID: 27019654 PMCID: PMC4806861 DOI: 10.2174/1573398x11666150619183527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The chronic fibrosing idiopathic interstitial pneumonias (IIPs) are a group of heterogeneous pulmonary parenchymal disorders described by radiologic and histological patterns termed usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). These include idiopathic pulmonary fibrosis (IPF) and those related to connective tissue disease (CTD) and are associated with substantial morbidity and mortality. Beyond the importance of establishing an appropriate diagnosis, designing optimal clinical trials for IIPs has been fraught with difficulties in consistency of clinical endpoints making power analyses, and the establishment of efficacy and interpretation of results across trials challenging. Preliminary recommendations, developed by rigorous consensus methods, proposed a minimum set of outcome measures, a 'core set', to be incorporated into future clinical trials (Saketkoo et al, THORAX. 2014.). This paper sets out to examine the candidate instruments for each domain (Dyspnea, Cough, Health Related Quality of Life, Imaging, Lung Physiology and Function, Mortality). Candidate measures that were not selected as well as measures that were not available for examination at the time of the consensus process will also be discussed.
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Affiliation(s)
- Matthew R. Lammi
- Louisiana State University Health Sciences Center, New Orleans,
New Orleans, LA, USA
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
| | | | | | - Anne-Marie Russell
- Royal Brompton Hospital and National Heart and Lung Institute;
London, UK
| | - Jay H. Ryu
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich,
Switzerland
| | - Daphne LeSage
- Patient Research Partner, Office of Public Health, New Orleans,
LA, USA
| | | | | | | | | | - Joseph A. Lasky
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
- Tulane University Lung Center; New Orleans, LA, USA
| | - Athol U. Wells
- Royal Brompton Hospital and National Heart and Lung Institute;
London, UK
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
- Tulane University Lung Center; New Orleans, LA, USA
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Vasudevan S, Palle AR, Sylvia DS, Renuka V, Challa R. A rare case of temporal arteritis with rheumatoid arthritis and interstitial lung disease mimicking pulpo-periodontal pathology. J Indian Soc Periodontol 2014; 18:531-5. [PMID: 25210275 PMCID: PMC4158602 DOI: 10.4103/0972-124x.138764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/21/2014] [Indexed: 11/30/2022] Open
Abstract
A 75-year-old male patient was planned for dental treatment due to pain of suspected pulpo-periodontal origin in relation to right maxillary first molar. Careful evaluation revealed the pain to be non-odontogenic in nature and led to the diagnosis of temporal arteritis with rheumatoid arthritis along with interstitial lung disease (ILD). Characteristic findings of temporal arteritis include headache, jaw claudication, visual loss, and constitutional symptoms (malaise, fever, weight loss, loss of appetite). Temporal artery biopsy (TAB) remains the gold standard for diagnosis. Additional diagnostic tests include blood tests (ESR, CRP). This article reports and discusses how the orofacial manifestations can lead to misdiagnosis of temporal arteritis. Hence, temporal arteritis should be included in the differential diagnosis of orofacial pain in the elderly especially to prevent complications like vision loss.
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Affiliation(s)
- Sanjay Vasudevan
- Department of Periodontics, Army College of Dental Sciences, Secunderabad, Andhra Pradesh, India
| | - Ajay Reddy Palle
- Department of Periodontics, Army College of Dental Sciences, Secunderabad, Andhra Pradesh, India
| | - Dulapalli Sharon Sylvia
- Department of Periodontics, Army College of Dental Sciences, Secunderabad, Andhra Pradesh, India
| | - Valli Renuka
- Department of Periodontics, Army College of Dental Sciences, Secunderabad, Andhra Pradesh, India
| | - Radhika Challa
- Department of Periodontics, Army College of Dental Sciences, Secunderabad, Andhra Pradesh, India
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Ryu JH, Moua T, Daniels CE, Hartman TE, Yi ES, Utz JP, Limper AH. Idiopathic pulmonary fibrosis: evolving concepts. Mayo Clin Proc 2014; 89:1130-42. [PMID: 24867394 DOI: 10.1016/j.mayocp.2014.03.016] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 02/06/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) occurs predominantly in middle-aged and older adults and accounts for 20% to 30% of interstitial lung diseases. It is usually progressive, resulting in respiratory failure and death. Diagnostic criteria for IPF have evolved over the years, and IPF is currently defined as a disease characterized by the histopathologic pattern of usual interstitial pneumonia occurring in the absence of an identifiable cause of lung injury. Understanding of the pathogenesis of IPF has shifted away from chronic inflammation and toward dysregulated fibroproliferative repair in response to alveolar epithelial injury. Idiopathic pulmonary fibrosis is likely a heterogeneous disorder caused by various interactions between genetic components and environmental exposures. High-resolution computed tomography can be diagnostic in the presence of typical findings such as bilateral reticular opacities associated with traction bronchiectasis/bronchiolectasis in a predominantly basal and subpleural distribution, along with subpleural honeycombing. In other circumstances, a surgical lung biopsy may be needed. The clinical course of IPF can be unpredictable and may be punctuated by acute deteriorations (acute exacerbation). Although progress continues in unraveling the mechanisms of IPF, effective therapy has remained elusive. Thus, clinicians and patients need to reach informed decisions regarding management options including lung transplant. The findings in this review were based on a literature search of PubMed using the search terms idiopathic pulmonary fibrosis and usual interstitial pneumonia, limited to human studies in the English language published from January 1, 2000, through December 31, 2013, and supplemented by key references published before the year 2000.
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Affiliation(s)
- Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Craig E Daniels
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - James P Utz
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Andrew H Limper
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Verma S, Cardenas-Garcia J, Mohapatra PR, Talwar A. Depression in pulmonary arterial hypertension and interstitial lung diseases. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:240-9. [PMID: 25006558 PMCID: PMC4083524 DOI: 10.4103/1947-2714.134368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Advanced lung diseases such as pulmonary arterial hypertension (PAH) and interstitial lung diseases (ILD) are chronic diseases that cause significantly high morbidity and mortality. As a result, patients can undergo some psychological changes leading to a poor quality of life and depression. Diagnosis of depression is often obscured because fatigue and apathy, two common symptoms of depression, frequently overlap with PAH and ILD. Healthcare providers are sometimes reluctant to ask or mistakenly believe that these symptoms are part of the ongoing disease process, rather than a serious condition like depression. Screening tools are available for physicians to be well positioned in recognizing clinical depression in PAH and ILD. A MedLine/PubMED search was performed identifying all relevant articles with “PAH”, “ILD”, “screening tools” and/or “Depression” in the title. The aim of this review is to provide a brief description of some of the instruments used to screen patients and classes of psychotropic medications accessible to physicians. While pulmonary rehabilitation programs can have a positive impact on patients, physicians should also utilize cognitive behavioral therapy (CBT) as part of regular care.
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Affiliation(s)
- Sameer Verma
- Department of Pulmonary, Critical Care and Sleep Medicine, North Shore - Long Island Jewish Health System, New York, USA
| | - Jose Cardenas-Garcia
- Department of Pulmonary, Critical Care and Sleep Medicine, North Shore - Long Island Jewish Health System, New York, USA
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Sijua, Bhubaneswar, Odisha, India
| | - Arunabh Talwar
- Department of Pulmonary, Critical Care and Sleep Medicine, North Shore - Long Island Jewish Health System, New York, USA
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Taniuchi S, Fujishima F, Miki Y, Abe K, Nakamura Y, Sato S, Kasajima A, Fue M, Ishida K, Watanabe M, Sakakibara T, Maeda S, Suzuki T, Sasano H. Tissue concentrations of estrogens and aromatase immunolocalization in interstitial pneumonia of human lung. Mol Cell Endocrinol 2014; 392:136-43. [PMID: 24861259 DOI: 10.1016/j.mce.2014.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/18/2014] [Accepted: 05/16/2014] [Indexed: 01/07/2023]
Abstract
Interstitial pneumonia (IP) is characterized by various degrees of pulmonary fibrosis and inflammation. Estrogens have been demonstrated to play important roles in physiological and pathological conditions of human lung, but significance of estrogens has remained unknown in human IP. Therefore, we measured estrogen concentrations and immunolocalized aromatase and estrogen receptor β (ERβ) in IP tissues. Estradiol concentration was significantly (2.8-fold) higher in IP than normal lung tissues, and aromatase activity evaluated by estradiol/testosterone ratio was also significantly (7.2-fold) elevated in IP tissues. Aromatase immunoreactivity in alveolar epithelial cells was significantly frequent in IP than normal lung or inflammatory lung disease other than IP, and it was positively associated with ERβ immunoreactivity in these cells of IP. These results suggest that estradiol concentration is locally increased in human IP tissue by aromatase, and increased estrogens may play an important role in the development of IP through ERβ in the alveolar epithelial cells.
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Affiliation(s)
- Shinji Taniuchi
- Departments of Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Fumiyoshi Fujishima
- Departments of Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Miki
- Departments of Anatomic Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan; Department of Disaster Obstetrics and Gynecology, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Keiko Abe
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yasuhiro Nakamura
- Departments of Anatomic Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Satoko Sato
- Departments of Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Atsuko Kasajima
- Departments of Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Misaki Fue
- Department of Disaster Obstetrics and Gynecology, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Kazuyuki Ishida
- Division of Diagnostic Molecular Pathology, Department of Pathology, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Mika Watanabe
- Departments of Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Tomohiro Sakakibara
- Departments of Respiratory Medicine, Tohoku University, Graduate School of Medicine, Sendai, Japan
| | - Sumiko Maeda
- Departments of Thoracic Surgery, Tohoku University Hospital, Sendai, Japan
| | - Takashi Suzuki
- Departments of Pathology and Histotechnology, Tohoku University, Graduate School of Medicine, Sendai, Japan.
| | - Hironobu Sasano
- Departments of Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan; Departments of Anatomic Pathology, Tohoku University, Graduate School of Medicine, Sendai, Japan
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Tansley SL, Betteridge ZE, Gunawardena H, Jacques TS, Owens CM, Pilkington C, Arnold K, Yasin S, Moraitis E, Wedderburn LR, McHugh NJ. Anti-MDA5 autoantibodies in juvenile dermatomyositis identify a distinct clinical phenotype: a prospective cohort study. Arthritis Res Ther 2014; 16:R138. [PMID: 24989778 PMCID: PMC4227127 DOI: 10.1186/ar4600] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/24/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The aim of this study was to define the frequency and associated clinical phenotype of anti-MDA5 autoantibodies in a large UK based, predominantly Caucasian, cohort of patients with juvenile dermatomyositis (JDM). METHODS Serum samples and clinical data were obtained from 285 patients with JDM recruited to the UK Juvenile Dermatomyositis Cohort and Biomarker Study. The presence of anti-MDA5 antibodies was determined by immunoprecipitation and confirmed by ELISA using recombinant MDA5 protein. Results were compared with matched clinical data, muscle biopsies (scored by an experienced paediatric neuropathologist) and chest imaging (reviewed by an experienced paediatric radiologist). RESULTS Anti-MDA5 antibodies were identified in 7.4% of JDM patients and were associated with a distinct clinical phenotype including skin ulceration (P = 0.03) oral ulceration (P = 0.01), arthritis (P <0.01) and milder muscle disease both clinically (as determined by Childhood Myositis Assessment Score (P = 0.03)) and histologically (as determined by a lower JDM muscle biopsy score (P <0.01)) than patients who did not have anti-MDA5 antibodies. A greater proportion of children with anti-MDA5 autoantibodies achieved disease inactivity at two years post-diagnosis according to PRINTO criteria (P = 0.02). A total of 4 out of 21 children with anti-MDA5 had interstitial lung disease; none had rapidly progressive interstitial lung disease. CONCLUSIONS Anti-MDA5 antibodies can be identified in a small but significant proportion of patients with JDM and identify a distinctive clinical sub-group. Screening for anti-MDA5 autoantibodies at diagnosis would be useful to guide further investigation for lung disease, inform on prognosis and potentially confirm the diagnosis, as subtle biopsy changes could otherwise be missed.
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Fruchter O, Fridel L, El Raouf BA, Abdel-Rahman N, Rosengarten D, Kramer MR. Histological diagnosis of interstitial lung diseases by cryo-transbronchial biopsy. Respirology 2014; 19:683-8. [PMID: 24750376 DOI: 10.1111/resp.12296] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/29/2014] [Accepted: 02/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The gold standard for the histological diagnosis of interstitial lung diseases (ILD) is an open lung biopsy (OLB). Tissue samples obtained by forceps transbronchial lung biopsies (TBB) are usually too small. We aim to evaluate the efficacy and safety of cryo-TBB for the diagnosis of ILD and to explore its role as substitute for OLB. METHODS Seventy-five patients (mean age 56.2 years) with clinical and radiological features suggestive of ILD underwent cryo-TBB under moderate sedation. The diagnostic contribution on the work-up of suspected ILD was assessed. RESULTS No major complications occurred during cryo-TBB procedures. The mean cross-sectional area of the biopsy specimen obtained was 9 mm2 with an average of 70% alveolated tissue. The most common pathological diagnoses were idiopathic nonspecific interstitial pneumonitis (n = 22), cryptogenic organizing pneumonia (n = 11) and usual interstitial pneumonitis (n = 7). There were three patients of pulmonary Langerhans cell histiocytosis and one patient of pulmonary lymphangioleiomyomatosis. A definite and probable clinicopathological consensus diagnosis was possible in 70% and 28% of patients, respectively. In only 2% of patients' diagnosis could not be established. CONCLUSIONS Cryo-TBB is a safe and effective minimally invasive modality for the diagnosis of ILD. No OLB is needed in the majority of patients.
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Affiliation(s)
- Oren Fruchter
- Institute of Pulmonary, Rabin Medical Center, Petah Tiqwa, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Bauer PR, Schiavo DN, Osborn TG, Levin DL, St Sauver J, Hanson AC, Schroeder DR, Ryu JH. Influence of interstitial lung disease on outcome in systemic sclerosis: a population-based historical cohort study. Chest 2014; 144:571-577. [PMID: 23450327 DOI: 10.1378/chest.12-2768] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc) and a major cause of SSc-related deaths. This study aimed to determine the influence of ILD on SSc in a population-based historical cohort study. The hypothesis was that patients with SSc who develop ILD have increased morbidity and mortality when compared with patients with SSc without ILD. METHODS Using the record linkage system of the Rochester Epidemiology Project in Olmsted County, Minnesota, this study identified the incidence of SSc between 1980 and 2010 and point prevalence on December 31, 2010 and determined the progression of organ involvement and its influence on outcome. RESULTS During the 30-year interval, we identified 64 incident cases of SSc: 57 women and seven men, median age 49.1 years (interquartile range [IQR], 39.8-67.6 years). There were 43 prevalent cases. ILD occurred in 19 cases, usually after the diagnosis of SSc (median, 2 years; IQR, 0-10 years), with only three cases occurring 6 to 24 months beforehand. Pulmonary arterial hypertension (PAH) was diagnosed in 14 cases, heart failure in 27 cases, and chronic kidney disease (CKD) in 21 cases. Seventeen patients died during the study period, with a median survival time after diagnosis of 22.9 years. ILD, PAH, and CKD were associated with an increased risk of death. CONCLUSIONS The incidence of ILD associated with SSc was relatively low in this population-based cohort. ILD appeared to be a contributing factor to mortality. Other factors, including age, PAH, and CKD, were also associated with poor outcome.
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Affiliation(s)
- Philippe R Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - Dante N Schiavo
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Andrew C Hanson
- Health Sciences Research-Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Darrell R Schroeder
- Health Sciences Research-Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Unsupervised Pre-training Across Image Domains Improves Lung Tissue Classification. MEDICAL COMPUTER VISION: ALGORITHMS FOR BIG DATA 2014. [DOI: 10.1007/978-3-319-13972-2_8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gounari E, Chatzizisi O, Diza-Mataftsi E, Papakosta D, Kontakiotis T, Iakovidis D, Zoglopitis F, Bougiouklis D, Markopoulou A, Serasli E, Kyriazis G. Potential prognostic value of intracellular cytokine detection by flow cytometry in pulmonary sarcoidosis. J Interferon Cytokine Res 2013; 33:261-9. [PMID: 23656599 DOI: 10.1089/jir.2012.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In pulmonary sarcoidosis, differential cytokine production in the lungs could be related to variable prognosis of patients at different stages of disease. Twenty patients with pulmonary sarcoidosis (10 at radiographic stage I and 10 at stages II-IV), as well as 10 age-matched healthy volunteers participated in the study. A 4-colour flow cytometric technique was used to measure interferon-γ (IFN-γ), interleukin (IL)-2, tumour necrosis factor-α (TNF-α), IL-4, and IL-13 production in phorbol myristate acetate (PMA)/ionomycin-stimulated CD4+ and CD8+ T cells from bronchoalveolar lavage fluid (BALF) and peripheral blood (PB) of patients, and PB of control subjects. CD4+ T cells from patients showed higher expression of IFN-γ in BALF than in PB. Significant correlations were observed between the percentages of BALF CD4+ and CD8+ T cells expressing intracellular IFN-γ, IL-2, and TNF-α. Stage I patients had lower percentages of IFN-γ-producing CD4+ and CD8+ T cells, as well as TNF-α-producing CD8+ T cells, in BALF (but not in PB) than stage II-IV patients. A decreased TH1 and TC1 response was demonstrated in BALF of patients at stage I of disease, which could explain their anticipated better prognosis.
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Affiliation(s)
- Evdoxia Gounari
- Department of Pneumonology, Aristotle University of Thessaloniki, Georgios Papanikolaou Hospital, Thessaloniki, Greece.
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Malviya G, Anzola KL, Podestà E, Laganà B, Del Mastro C, Dierckx RA, Scopinaro F, Signore A. (99m)Tc-labeled rituximab for imaging B lymphocyte infiltration in inflammatory autoimmune disease patients. Mol Imaging Biol 2013; 14:637-46. [PMID: 22127469 PMCID: PMC3443359 DOI: 10.1007/s11307-011-0527-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose The rationale of the present study was to radiolabel rituximab with 99m-technetium and to image B lymphocytes infiltration in the affected tissues of patients with chronic inflammatory autoimmune diseases, in particular, the candidates to be treated with unlabelled rituximab, in order to provide a rationale for ‘evidence-based’ therapy. Procedures Rituximab was labelled with 99mTc via 2-ME reduction method. In vitro quality controls of 99mTc-rituximab included stability assay, cysteine challenge, SDS-PAGE, immunoreactive fraction assay and competitive binding assay on CD20+ve Burkitt lymphoma-derived cells. For the human pilot study, 350–370 MBq (100 μg) of 99mTc-rituximab were injected in 20 patients with different chronic inflammatory autoimmune diseases. Whole body anteroposterior planar scintigraphic images were acquired 6 and 20 h p.i. Results Rituximab was labelled to a high labelling efficiency (>98%) and specific activity (3515–3700 MBq/mg) with retained biochemical integrity, stability and biological activity. Scintigraphy with 99mTc-rituximab in patients showed a rapid and persistent spleen uptake, and the kidney appeared to be a prominent source for the excretion of radioactivity. Inflamed joints showed a variable degree of uptake at 6 h p.i. in patients with rheumatoid arthritis indicating patient variability; similarly, the salivary and lacrimal glands showed variable uptake in patients with Sjögren’s syndrome, Behçet’s disease and sarcoidosis. Inflammatory disease with particular characteristics showed specific uptake in inflammatory lesions, such as, dermatopolymyositis patients showed moderate to high skin uptake, a sarcoidosis patient showed moderate lung uptake, a Behçet’s disease patient showed high oral mucosa uptake and a polychondritis patient showed moderate uptake in neck cartilages. In one patient with systemic lupus erythematosus, we did not find any non-physiological uptake. Conclusion Rituximab can be efficiently labelled with 99mTc with high labelling efficiency. The results suggest that this technique might be used to assess B lymphocyte infiltration in affected organs in patients with autoimmune diseases; this may provide a rationale for anti-CD20 therapies.
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Affiliation(s)
- G Malviya
- Nuclear Medicine Department, Faculty of Medicine and Surgery, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy.
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Huang LK, Tsai MJ, Tsai HC, Chao HS, Lin FC, Chang SC. Statin-induced lung injury: diagnostic clue and outcome. Postgrad Med J 2013; 89:14-9. [PMID: 23043128 PMCID: PMC3533381 DOI: 10.1136/postgradmedj-2011-130209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/28/2012] [Accepted: 09/03/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND Statin-induced lung injury (SILI) is an uncommon but serious complication of statins. The clinical features and outcome of patients with SILI vary widely. Clinical data relevant to diagnosis and outcome of patients with SILI were investigated in this study. METHOD Four cases of SILI diagnosed at our institute and 12 cases reported in the English literature from 1995 to 2010 were studied. The patients were further divided into favourable and unfavourable outcome groups and compared. RESULTS Compared with the 12 previously reported cases, fever (p=0.008) and consolidation (p=0.027) were more common and duration of statin treatment was significantly shorter (p=0.030) in our patients. Foamy alveolar macrophages in bronchoalveolar lavage fluid (BALF) were found in our four patients. Patients with cough (p=0.024), fever (p=0.026) and alveolar infiltrates (p=0.036), especially ground-glass opacity (GGO) (p=0.001) shown on thoracic high-resolution CT (HRCT), had a favourable outcome. Conversely, those with fibrosis shown on HRCT (p=0.008) had an unfavourable outcome. Stepwise logistic regression analysis demonstrated that cough (p=0.011), fever (p=0.005), and alveolar infiltrates (p=0.017), GGO (p<0.001) and fibrosis (p=0.002) shown on thoracic HRCT were independent factors affecting the outcome of SILI. CONCLUSIONS For patients with SILI, pulmonary phospholipidosis, as shown by foamy alveolar macrophages in BALF, may be valuable in diagnosis, and clinical symptoms and thoracic HRCT findings are of value in predicting the outcome.
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Affiliation(s)
- Li-Kuo Huang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Ji Tsai
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Chen Tsai
- Respiratory Care Unit, Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Heng-Sheng Chao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fang-Chi Lin
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shi-Chuan Chang
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
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