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Yap-Chiongco MK, Bergmeier FS, Roberts NG, Jörger KM, Kocot KM. Phylogenomic reconstruction of Solenogastres (Mollusca, Aplacophora) informs hypotheses on body size evolution. Mol Phylogenet Evol 2024; 194:108029. [PMID: 38341006 DOI: 10.1016/j.ympev.2024.108029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024]
Abstract
Body size is a fundamental characteristic of animals that impacts every aspect of their biology from anatomical complexity to ecology. In Mollusca, Solenogastres has been considered important to understanding the group's early evolution as most morphology-based phylogenetic reconstructions placed it as an early branching molluscan lineage. Under this scenario, molluscs were thought to have evolved from a small, turbellarian-like ancestor and small (i.e., macrofaunal) body size was inferred to be plesiomorphic for Solenogastres. More recently, phylogenomic studies have shown that aplacophorans (Solenogastres + Caudofoveata) form a clade with chitons (Polyplacophora), which is sister to all other molluscs, suggesting a relatively large-bodied (i.e., megafaunal) ancestor for Mollusca. Meanwhile, recent investigations into aplacophoran phylogeny have called the assumption that the last common ancestor of Solenogastres was small-bodied into question, but sampling of meiofaunal species was limited, biasing these studies towards large-bodied taxa and leaving fundamental questions about solenogaster body size evolution unanswered. Here, we supplemented available data with transcriptomes from eight diverse meiofaunal species of Solenogastres and conducted phylogenomic analyses on datasets of up to 949 genes. Maximum likelihood analyses support the meiofaunal family Meiomeniidae as the sister group to all other solenogasters, congruent with earlier ideas of a small-bodied ancestor of Solenogastres. In contrast, Bayesian Inference analyses support the large-bodied family Amphimeniidae as the sister group to all other solenogasters. Investigation of phylogenetic signal by comparing site-wise likelihood scores for the two competing hypotheses support the Meiomeniidae-first topology. In light of these results, we performed ancestral character state reconstruction to explore the implications of both hypotheses on understanding of Solenogaster evolution and review previous hypotheses about body size evolution and its potential consequences for solenogaster biology. Both hypotheses imply that body size evolution has been highly dynamic over the course of solenogaster evolution and that their relatively static body plan has successfully allowed for evolutionary transitions between meio-, macro- and megafaunal size ranges.
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Affiliation(s)
| | | | - Nickellaus G Roberts
- Department of Biological Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Katharina M Jörger
- SNSB-Bavarian State Collection for Zoology, Section Mollusca, Munich, Germany
| | - Kevin M Kocot
- Department of Biological Sciences, The University of Alabama, Tuscaloosa, AL, USA; Alabama Museum of Natural History, The University of Alabama, Tuscaloosa, AL, USA.
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Park JJ, Kim KT, Lee EJ, Chun J, Lee S, Shim SR, Kim JH. Current updates relating to treatment for interstitial cystitis/bladder pain syndrome: systematic review and network meta-analysis. BMC Urol 2024; 24:95. [PMID: 38658949 DOI: 10.1186/s12894-024-01485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/16/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Despite the publication of several meta-analyses regarding the efficacy of certain therapies in helping individuals with interstitial cystitis (IC) / bladder pain syndrome (BPS), these have not provided a comprehensive review of therapeutic strategies. The study aimed to determine the efficacy of various therapies for IC/BPS and identify potential moderating factors using randomized controlled trials (RCTs). METHODS We queried the PubMed, Cochrane, and Embase databases to identify prospective RCTs using inclusion criteria: 1) patients diagnosed with IC, 2) interventions included relevant treatments, 3) comparisons were a specified control or placebo, 4) outcomes were mean differences for individual symptoms and structured questionnaires. The pairwise meta-analysis and network meta-analysis (NMA) were performed to compare the treatments used in IC/BPS. Hedges' g standardized mean differences (SMDs) were used for improvement in all outcomes using random-effects models. Efficacy outcomes included individual symptoms such as pain, frequency, urgency, and nocturia, as well as structured questionnaires measuring IC/BPS symptoms. RESULTS A comprehensive literature search was conducted which identified 70 RCTs with 3,651 patients. The analysis revealed that certain treatments, such as instillation and intravesical injection, showed statistically significant improvements in pain and urgency compared to control or placebo groups in traditional pairwise meta-analysis. However, no specific treatment demonstrated significant improvement in all outcomes measured in the NMA. The results of moderator analyses to explore influential variables indicated that increasing age was associated with increased nocturia, while longer follow-up periods were associated with decreased frequency. CONCLUSION This systematic review and meta-analysis provide insights into the efficacy of various treatments for IC. Current research suggests that a combination of therapies may have a positive clinical outcome for patients with IC, despite the fact that treatment for this condition is not straightforward. TRIAL REGISTRATION PROSPERO CRD42022384024.
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Affiliation(s)
- Jae Joon Park
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsangu, Seoul, 04401, Republic of Korea
| | - Kwang Taek Kim
- Department of Urology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Eun Ji Lee
- Department of Radiology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Joey Chun
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsangu, Seoul, 04401, Republic of Korea
- Cranbrook Kingswood Upper School, Bloomfield Hills, Michigan, United States
| | - Serin Lee
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsangu, Seoul, 04401, Republic of Korea
- Department of Biochemistry, Case Western Reserve University, Cleveland, Ohio, United States
| | - Sung Ryul Shim
- Department of Biomedical Informatics, College of Medicine, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea.
- Konyang Medical data Research group-KYMERA, Konyang University Hospital, Daejeon, Republic of Korea.
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsangu, Seoul, 04401, Republic of Korea.
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May B, Friedlander H, Schust D, Bollig KJ. Pregnancies at the Uterotubal Junction: A Review of Terminology ( Interstitial, Cornual, and Angular) and Recommendations for Management. Reprod Sci 2024:10.1007/s43032-024-01539-2. [PMID: 38653861 DOI: 10.1007/s43032-024-01539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
Ectopic pregnancies are one of the most common causes of obstetric mortality worldwide. Interstitial ectopic pregnancies, defined as an extracavitary pregnancy within the portion of the Fallopian tube that transverses the myometrium, have reported mortality rates approximately seven times higher than all types of ectopic pregnancy combined. In contrast, intracavitary eccentric gestations, often labeled as "cornual" or "angular" pregnancies, have reportedly high rates of live birth. Unfortunately, the terms "interstitial," "cornual," and "angular" have long been used with varying diagnostic criteria and often interchangeably to describe a pregnancy near the uterotubal junction. The inconsistency in nomenclature and lack of clear diagnostic criteria to distinguish among these pregnancies has resulted in a paucity of data to provide accurate prognostic information and guide appropriate management. This review article aims to provide historical context for the terms "interstitial," "cornual," and "angular;" discuss previous and more recent innovations of diagnostic methods; and provide recommendations for concise terminology and inform management.
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Affiliation(s)
- Bobby May
- Department of Obstetrics & Gynecology, Duke University Hospital, Durham, NC, USA.
- Duke University School of Medicine, DUMC 3084, 203 Baker House, 27710, Durham, NC, USA.
| | - Hilary Friedlander
- Department of Reproductive Endocrinology & Infertility, Duke University Hospital, Durham, NC, USA
| | - Danny Schust
- Department of Reproductive Endocrinology & Infertility, Duke University Hospital, Durham, NC, USA
| | - Kassie J Bollig
- Reproductive Medicine Associates, Basking Ridge, NJ, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Lee JH, Chae KJ, Park J, Choi SM, Jang MJ, Hwang EJ, Jin GY, Goo JM. Measurement Variability of Same-Day CT Quantification of Interstitial Lung Disease: A Multicenter Prospective Study. Radiol Cardiothorac Imaging 2024; 6:e230287. [PMID: 38483245 DOI: 10.1148/ryct.230287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Purpose To investigate quantitative CT (QCT) measurement variability in interstitial lung disease (ILD) on the basis of two same-day CT scans. Materials and Methods Participants with ILD were enrolled in this multicenter prospective study between March and October 2022. Participants underwent two same-day CT scans at an interval of a few minutes. Deep learning-based texture analysis software was used to segment ILD features. Fibrosis extent was defined as the sum of reticular opacity and honeycombing cysts. Measurement variability between scans was assessed with Bland-Altman analyses for absolute and relative differences with 95% limits of agreement (LOA). The contribution of fibrosis extent to variability was analyzed using a multivariable linear mixed-effects model while adjusting for lung volume. Eight readers assessed ILD fibrosis stability with and without QCT information for 30 randomly selected samples. Results Sixty-five participants were enrolled in this study (mean age, 68.7 years ± 10 [SD]; 47 [72%] men, 18 [28%] women). Between two same-day CT scans, the 95% LOA for the mean absolute and relative differences of quantitative fibrosis extent were -0.9% to 1.0% and -14.8% to 16.1%, respectively. However, these variabilities increased to 95% LOA of -11.3% to 3.9% and -123.1% to 18.4% between CT scans with different reconstruction parameters. Multivariable analysis showed that absolute differences were not associated with the baseline extent of fibrosis (P = .09), but the relative differences were negatively associated (β = -0.252, P < .001). The QCT results increased readers' specificity in interpreting ILD fibrosis stability (91.7% vs 94.6%, P = .02). Conclusion The absolute QCT measurement variability of fibrosis extent in ILD was 1% in same-day CT scans. Keywords: CT, CT-Quantitative, Thorax, Lung, Lung Diseases, Interstitial, Pulmonary Fibrosis, Diagnosis, Computer Assisted, Diagnostic Imaging Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Jong Hyuk Lee
- From the Department of Radiology and Institute of Radiation Medicine (J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.P., S.M.C.), and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Kum Ju Chae
- From the Department of Radiology and Institute of Radiation Medicine (J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.P., S.M.C.), and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Jimyung Park
- From the Department of Radiology and Institute of Radiation Medicine (J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.P., S.M.C.), and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Sun Mi Choi
- From the Department of Radiology and Institute of Radiation Medicine (J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.P., S.M.C.), and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Myoung-Jin Jang
- From the Department of Radiology and Institute of Radiation Medicine (J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.P., S.M.C.), and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Eui Jin Hwang
- From the Department of Radiology and Institute of Radiation Medicine (J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.P., S.M.C.), and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Gong Yong Jin
- From the Department of Radiology and Institute of Radiation Medicine (J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.P., S.M.C.), and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Jin Mo Goo
- From the Department of Radiology and Institute of Radiation Medicine (J.H.L., E.J.H., J.M.G.), Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (J.P., S.M.C.), and Medical Research Collaborating Center (M.J.J.), Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea; Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University and Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.G.); and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
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García Mullor MM, Arenas-Jiménez JJ, Ureña Vacas A, Gayá García-Manso I, Pérez Pérez JL, Serra Serra N, García Sevila R. Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy. Radiologia (Engl Ed) 2024; 66 Suppl 1:S10-S23. [PMID: 38642956 DOI: 10.1016/j.rxeng.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.
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Affiliation(s)
- M M García Mullor
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - J J Arenas-Jiménez
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - A Ureña Vacas
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - I Gayá García-Manso
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - J L Pérez Pérez
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - N Serra Serra
- Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - R García Sevila
- Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
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Harrison M, Jo HE, Troy LK, Nguyen B, Webster SE, Geis M, Lai S, Mulyadi E, Cooper WA, Mahar A, Teoh A, Jee A, Corte TJ. Disease Behaviour Classification: A pragmatic model for predicting outcomes in Interstitial Lung Disease. Respir Med 2024; 224:107533. [PMID: 38355019 DOI: 10.1016/j.rmed.2024.107533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/04/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND OBJECTIVE The interstitial lung diseases (ILD) are a heterogenous group of disorders with similar clinical presentation, but widely varying prognoses. The use of a pragmatic disease behaviour classification (DBC), first proposed in international guidelines in 2013, categorises diseases into five behavioural classes based on their predicted clinical course. This study aimed to determine the prognostic utility of the DBC in an ILD cohort. METHODS Consecutive patients presented at the weekly multidisciplinary meeting (MDM) of a specialist ILD centre were included. MDM consensus was obtained for diagnosis and DBC category (1-5). Baseline and serial clinical and physiological data were collected over the study period (median 3.9 years, range 0-5.4 years). The relationship between DBC and prognostic outcomes was explored. RESULTS 137 ILD patients, [64 (47%) female] were included with mean age 67.0 ± 1.1 years, baseline FVC% 72.7 ± 1.7, and baseline DLco% 57.8 ± 1.6%. Patients were stratified into DBC by consensus at MDM: DBC1 n = 0 (0%), DBC2 n = 16 (12%), DBC3 n = 10 (7.3%), DBC4 n = 55 (40%), and DBC5 n = 56 (41%). On univariable Cox regression, increasing DBC class was associated with poorer progression-free survival (HR 1.6, 95% CI 1.2-2.0, p < 0.001). On multivariable Cox regression, DBC remained predictive of PFS when combined with age and gender (HR 1.4, 95% CI 1.1-1.9, p = 0.011), baseline FVC% (HR 1.5, 95% CI 1.1-1.8, p = 0.003) and ILD diagnosis (HR 1.6, 95% CI 1.2-2.2, p < 0.0001). CONCLUSION DBC as determined at ILD multidisciplinary meeting may be a useful prognostic tool for the management of ILD patients.
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Affiliation(s)
- Megan Harrison
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - Helen E Jo
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Lauren K Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Benjamin Nguyen
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Susanne E Webster
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Monika Geis
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Simon Lai
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ellie Mulyadi
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wendy A Cooper
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; School of Medicine, University of Western Sydney, Sydney, Australia
| | - Annabelle Mahar
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alan Teoh
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adelle Jee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Centre of Research Excellence in Pulmonary Fibrosis, Australia
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7
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Díaz-Gavela AA, Cerro Peñalver ED, Sanchez-Garcia S, Pardo-Perez E, Thuissard-Vasallo IJ, Andreu-Vázquez C, Molina López MY, Pena Huertas M, Guerrero-Gómez LL, Sanz-Rosa D, Lorenzo FC. Hypofractionated whole breast IMRT with HDR brachytherapy boost in early-stage breast cancer: Long-term results from a single-center. Brachytherapy 2024:S1538-4721(24)00041-2. [PMID: 38522961 DOI: 10.1016/j.brachy.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION/OBJECTIVES The addition of a boost to the lumpectomy bed after whole-breast (WB) radiotherapy plays a key role in the treatment of patients with breast cancer (BC). The clinical benefits of a boost with high-dose-rate brachytherapy (HDR-BT) after conventional fractionation is supported by a large body of evidence. However, few studies have described its outcomes after a hypofractionated scheme. MATERIALS AND METHODS We included all patients treated with adjuvant WB-IMRT in 15 sessions followed by a single-session HDR-BT boost with local anesthesia on an outpatient basis. RESULTS Between 2009 and 2017, 638 patients with early-stage BC were treated according to the aforementioned protocol after breast-conserving surgery. Median follow-up was 6 years (4-11). Despite the low incidence of side effects and their slightness, we did identify an impact of breast volume on the risk of acute radiodermatitis, fibrosis, pain and edema. However, we did not identify any relationship between the volume in cubic centimeters of the BT-implant with acute or long-term side effects. 2.2% patients had an actual local relapse, 2.4% a 2nd primary in the same breast and 2.39% were diagnosed with contralateral BC. Event-free survival at 11 years was 85.5% with an overall survival of 95.7%. CONCLUSION Adjuvant hypofractionated whole-breast IMRT followed by a single dose HDR-BT boost has a low incidence of acute and chronic toxicity and excellent oncological outcomes. However, it may be worthwhile to intensify self-care protocols and surveillance in women with large breasts who may be at increased risk of side effects.
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Affiliation(s)
- Ana Aurora Díaz-Gavela
- Radiation Therapy Department, Quironsalud Madrid University Hospital, Pozuelo de Alarcón, Madrid, Spain; Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; Radiation Therapy Department, Quironsalud La Luz Hospital, Madrid, Spain.
| | - Elia Del Cerro Peñalver
- Radiation Therapy Department, Quironsalud Madrid University Hospital, Pozuelo de Alarcón, Madrid, Spain; Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; Radiation Therapy Department, Quironsalud La Luz Hospital, Madrid, Spain
| | | | - Eduardo Pardo-Perez
- Radiophysics Department, Quironsalud Madrid University Hospital, Pozuelo de Alarcón, Madrid, Spain
| | - Israel John Thuissard-Vasallo
- Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Cristina Andreu-Vázquez
- Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | | | - Marina Pena Huertas
- Radiation Therapy Department, Quironsalud Madrid University Hospital, Pozuelo de Alarcón, Madrid, Spain; Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | | | - David Sanz-Rosa
- Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Felipe Counago Lorenzo
- Radiation Therapy Department, Quironsalud Madrid University Hospital, Pozuelo de Alarcón, Madrid, Spain; Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain; Radiation Therapy Department, Quironsalud La Luz Hospital, Madrid, Spain; Present address: Department of Radiation Oncology, San Francisco de Asís Hospital, Madrid, Spain; Department of Radiation Oncology, La Milagrosa Hospital, Madrid, Spain
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Farquhar HJ, Beckert L, Edwards AL, Matteson EL, Frampton CMA, Ganly E, Yetton R, Thiessen R, Haslett J, Bucknall D, Stamp LK. Rheumatoid interstitial lung disease in Canterbury, Aotearoa New Zealand - A retrospective cohort study. Semin Arthritis Rheum 2024; 64:152359. [PMID: 38157761 DOI: 10.1016/j.semarthrit.2023.152359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/28/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Rheumatoid arthritis associated interstitial lung disease (RA-ILD), is an important extra-articular manifestation of rheumatoid arthritis (RA). The frequency, risk factors, and prognosis of RA-ILD are incompletely understood. AIMS To determine the prevalence and incidence, clinical characteristics and risk factors for development, and outcomes of persons with RA-ILD in the population of the Canterbury District Health Board (CDHB) catchment area. METHODS Individuals aged ≥ 18 years with RA, resident in the CDHB catchment area between 1 January 2006 and 31 December 2008 (Period One), and 1 January 2011 to 31 December 2013 (Period Two) were identified by medical record review and followed until 30 June 2019. Individuals with RA-ILD as defined by pre-specified criteria were identified. The association between demographic and clinical characteristics and RA-ILD development and mortality was examined using Cox-proportional hazards models. RESULTS The prevalence of RA-ILD per 100,000 was 10.97 (95 % CI 7.53,14.42) for Period One, and 14.74 (95 % CI 10.84,18.63) for Period Two. Among individuals evaluated for risk factors for RA-ILD development, the estimated cumulative incidence of ILD at 10 years was 4.47 % (95 % CI 3.14, 6.14). After adjusting for age, rheumatoid factor positivity (HR 3.73, 95 % CI, 1.32,10.56), extra-articular manifestations other than RA-ILD (HR 4.48, 95 % CI 2.36,8.48), and subcutaneous rheumatoid nodules (HR 4.66, 95 % CI 2.34, 9.26) were associated with increased risk of developing RA-ILD. The standardised mortality ratio for RA-ILD was 3.90 (95 % CI 2.55,5.72) compared to the general population. Extent of ILD on CT chest was associated with mortality (HR for >20% vs. < 20 % 4.47, 95 % CI 1.67,11.96). CONCLUSIONS Clinically evident RA-ILD occurred in approximately 5 % of individuals with RA. Mortality was increased almost fourfold compared to the general population. Radiologic extent was the most important prognostic factor.
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Affiliation(s)
- Hamish J Farquhar
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
| | - Lutz Beckert
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Adriene L Edwards
- Respiratory Department, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Eric L Matteson
- Division of Rheumatology and Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Edward Ganly
- Radiology Department, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Renee Yetton
- Radiology Department, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Rennae Thiessen
- Radiology Department, Te Whatu Ora Waitaha, Christchurch, New Zealand
| | - Janine Haslett
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Danielle Bucknall
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Ahn Y, Lee SM, Nam Y, Lee H, Choe J, Do KH, Seo JB. Deep Learning-Based CT Reconstruction Kernel Conversion in the Quantification of Interstitial Lung Disease: Effect on Reproducibility. Acad Radiol 2024; 31:693-705. [PMID: 37516583 DOI: 10.1016/j.acra.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/11/2023] [Accepted: 06/12/2023] [Indexed: 07/31/2023]
Abstract
RATIONALE AND OBJECTIVES The effect of different computed tomography (CT) reconstruction kernels on the quantification of interstitial lung disease (ILD) has not been clearly demonstrated. The study aimed to investigate the effect of reconstruction kernels on the quantification of ILD on CT and determine whether deep learning-based kernel conversion can reduce the variability of automated quantification results between different CT kernels. MATERIALS AND METHODS Patients with ILD or interstitial lung abnormality who underwent noncontrast high-resolution CT between June 2022 and September 2022 were retrospectively included. Images were reconstructed with three different kernels: B30f, B50f, and B60f. B60f was regarded as the reference standard for quantification, and B30f and B50f images were converted to B60f images using a deep learning-based algorithm. Each disease pattern of ILD and the fibrotic score were quantified using commercial software. The effect of kernel conversion on measurement variability was estimated using intraclass correlation coefficient (ICC) and Bland-Altman method. RESULTS A total of 194 patients were included in the study. Application of different kernels induced differences in the quantified extent of each pattern. Reticular opacity and honeycombing were underestimated on B30f images and overestimated on B50f images. After kernel conversion, measurement variability was reduced (mean difference, from -2.0 to 3.9 to -0.3 to 0.4%, and 95% limits of agreement [LOA], from [-5.0, 12.7] to [-2.7, 2.1]). The fibrotic score for converted B60f from B50f images was almost equivalent to the original B60f (ICC, 1.000; mean difference, 0.0; and 95% LOA [-0.4, 0.4]). CONCLUSION Quantitative CT analysis of ILD was affected by the application of different kernels, but deep learning-based kernel conversion effectively reduced measurement variability, improving the reproducibility of quantification.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.)
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.).
| | - Yujin Nam
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea (Y.N.)
| | - Hyunna Lee
- Bigdata Research Center, Asan Institute for Life Science, Asan Medical Center, Seoul, Republic of Korea (H.L.)
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.)
| | - Kyung-Hyun Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.)
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea (Y.A., S.M.L., J.C., K.-H.D., J.B.S.)
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10
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Sarwar KA, Hussain S, Syed AS, Khan K, Maqsood T, Azeem T. Outcomes and comparison of dosimetric parameters between intracavitary (Fletcher) and combined intracavitary/ interstitial (Utrecht) brachytherapy in locally advanced cervical cancer. Brachytherapy 2024; 23:10-17. [PMID: 37813708 DOI: 10.1016/j.brachy.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To report outcomes of combined intracavitary/interstitial (IC/IS) image-guided brachytherapy (IGBT) in locally advanced cervical cancer, and to compare its dosimetric parameters with intracavitary-only (IC) brachytherapy in a first-in-country experience. METHODS AND MATERIALS Between January 2021 and September 2022, a total of 160 insertions were done in 40 patients with FIGO IB3-IVA cervical cancer undergoing IGBT using a hybrid (Utrecht) applicator. Corresponding treatment plans for IC brachytherapy were generated during treatment, and optimized. A preplanned comparison of dosimetric parameters, defined in GEC-ESTRO was conducted. RESULTS The clinical use of a hybrid IC/IS applicator was feasible in all insertions. An average of 14 needles were inserted in each patient over four fractions. Mean HR-CTV D90 and D98 was 86 (SD 1.9) Gy and 75.7 (SD 2.3) Gy using hybrid applicator, and 80 (SD 5.4) Gy and 69.8 (SD 5.2) Gy using IC applicator, with a mean dose gain of 6.0 (SD 5.0) Gy and 5.9 (SD 4.7) Gy (p <0.001), respectively. Likewise, mean D2cc for bladder and sigmoid were significantly lower in the hybrid technique. Mean contribution of brachytherapy to total HR-CTV D90 (in absolute EQD2 Gy) was 41.7 Gy using IC/IS applicator while 35.7 Gy for IC-only applicator (p = 0.027). Clinical response at 12 weeks showed an overall response rate (ORR) and complete response (CR) rates of 92.5% and 77.5%, respectively. CONCLUSIONS IGBT using a hybrid IC/IS applicator showed excellent tolerability and yielded favorable results, resulting in significant dosimetric improvement in terms of primary target dose, and sparing OARs.
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Affiliation(s)
- Kashif Ali Sarwar
- Combined Military Hospital, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan.
| | - Sameed Hussain
- Combined Military Hospital, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Abdus Samad Syed
- Combined Military Hospital, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Khurram Khan
- Combined Military Hospital, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Talha Maqsood
- Combined Military Hospital, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
| | - Tariq Azeem
- Combined Military Hospital, National University of Medical Sciences (NUMS), Rawalpindi, Pakistan
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Zhang YH, Martin S, Liu H, Todor D, Sohn JJ, Quinn B, Francis LE, Roach M, Fields EC. Utilizing a novel hybrid brachytherapy technique FINITO (Freehand Interstitial Needles in addition to Tandem and Ovoid) for locally advanced cervical cancer. Brachytherapy 2023; 22:746-752. [PMID: 37722989 DOI: 10.1016/j.brachy.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE We aimed to assess the clinical feasibility and advantages of using a novel hybrid brachytherapy technique by placing Freehand Interstitial Needles in addition to the Tandem and Ovoid applicator (FINITO) for the treatment of locally advanced cervical cancer (LAC). METHODS AND MATERIALS A retrospective analysis was performed on two cohorts of patients with LACC treated at our institution: 29 patients in the FINITO group and 17 patients in the control group using T&O only approach. Clinical outcomes of interest included local control (LC), progression-free survival (PFS), overall survival (OS), and rates of acute and late toxicities. Kaplan-Meier methodology was used to estimate OS, PFS, and LC. Wilcoxon signed-rank test was used to compare the median values for dosimetry parameters. A p-value of ≤ 0.05 was considered statistically significant. All statistical analyses were performed using RStudio. RESULTS At a median of 2 years there was no difference in rates of OS, PFS or LC between the FINITO and the control group of patients. The 2-year OS, PFS, and LC for the FINITO group were 59% (95% CI 34%-100%), 58% (95% CI 38%-89%), and 84% (95% CI 69%-100%), respectively. Late toxicities were significantly lower in the FINITO group for both gastrointestinal and genitourinary symptoms (p = 0.001 and 0.01, respectively) as compared to the T&O group. CONCLUSION Based on the equivalent LC rate and lower toxicity profile, our FINITO technique appears to be an excellent alternative to the standard intracavitary brachytherapy in patients with advanced disease, especially in resource-limited settings.
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Affiliation(s)
- Yue H Zhang
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA
| | - Sara Martin
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA
| | - Han Liu
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA
| | - Dorin Todor
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA
| | - James J Sohn
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bridget Quinn
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA
| | - Louise E Francis
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA
| | - Melinda Roach
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA
| | - Emma C Fields
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, VA.
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12
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Ladbury C, Harkenrider M, Taunk N, Fisher C, Mayadev J, Venkat P, Yashar C, Gaffney D, Beriwal S, Glaser S. A practical guide to hybrid interstitial/intracavitary brachytherapy for locally-advanced cervical cancer. Brachytherapy 2023; 22:640-648. [PMID: 37481370 DOI: 10.1016/j.brachy.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE In select cases of locally advanced cervical cancer, a hybrid brachytherapy (HBT) approach consisting of a combined intracavitary (IC)/insterstitial (IS) implant can yield improved target coverage and/or decreased organ at risk dose compared to IC techniques while limiting invasiveness compared to IS techniques. METHODS AND MATERIALS The technique involves placement of transvaginal and/or perineal needles in addition to the tandem and ring/ovoids using either a specialized applicator or free-hand placement. Following applicator and needle placement, brachytherapy may then be planned using principles similar to IC or IS techniques. During treatment planning, it can be helpful to obtain both MRI and CT imaging, as plastic MRI-compatible needles do not show up well on MRI. RESULTS In patients where acceptable target coverage cannot be achieved using IC alone or doses to nearby OAR are too high, HBT should be evaluated. HBT can improve both dose to target and OAR while sparing patients the morbidity of perineal template-based interstitial brachytherapy. Specific scenarios where HBT may be preferred include bulky residual primary tumor especially with poor response to EBRT, extension into the lateral parametrium, vaginal extension of tumor, and an asymmetric target. Use of HBT can typically permit extension of dose coverage by an additional 1-2 cm beyond what can be achieved with an IC alone technique. CONCLUSION HBT allows for improved therapeutic ratio by improving target volume coverage and/or lowering doses to OARs. Brachytherapists should be trained on the practical aspects of administering HBT to be able to offer a less invasive and impactful treatment option when appropriate.
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Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Matthew Harkenrider
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Neil Taunk
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Christine Fisher
- Department of Radiation Oncology School of Medicine, University of Colorado, Aurora, CO
| | - Jyoti Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Catheryn Yashar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Sushil Beriwal
- Department of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA.
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Zheng F, Tang D, Li S, Luo Z, Song Y, Huang Y, Gan Q, Liu H, Zhang X, Liu D, Wang Q, Xiong Z, Dai Y. Spatial proteomics landscape and immune signature analysis of renal sample of lupus nephritis based on laser-captured microsection. Inflamm Res 2023; 72:1603-1620. [PMID: 37474625 PMCID: PMC10499763 DOI: 10.1007/s00011-023-01767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE We aimed to reveal a spatial proteomic and immune signature of kidney function regions in lupus nephritis (LN). MATERIAL AND METHODS The laser capture microdissection (LCM) was used to isolate the glomerulus, tubules, and interstitial of the kidney from paraffin samples. The data-independent acquisition (DIA) method was used to collect proteomics data. The bioinformatic analysis was performed. RESULTS A total of 49,658 peptides and 4056 proteins were quantitated. Our results first showed that a high proportion of activated NK cells, naive B cells, and neutrophils in the glomerulus, activated NK cells in interstitial, and resting NK cells were accumulated in tubules in LN. The immune-related function analysis of differential expression proteins in different regions indicated that the glomerulus and interstitial were major sites of immune disturbance and regulation connected with immune response activation. Furthermore, we identified 7, 8, and 9 hub genes in LN's glomerulus, renal interstitial, and tubules. These hub genes were significantly correlated with the infiltration of immune cell subsets. We screened out ALB, CTSB, LCN2, A2M, CDC42, VIM, LTF, and CD14, which show higher performance as candidate biomarkers after correlation analysis with clinical indexes. The function within three regions of the kidney was analyzed. The differential expression proteins (DEGs) between interstitial and glomerulus were significantly enriched in the immune-related biological processes, and myeloid leukocyte-mediated immunity and cellular response to hormone stimulus. The DEGs between tubules and glomerulus were significantly enriched in cell activation and leukocyte-mediated immunity. While the DEGs between tubules and interstitial were enriched in response to lipid, antigen processing, and presentation of peptide antigen response to oxygen-containing compound, the results indicated a different function within kidney regions. CONCLUSIONS Collectively, we revealed spatial proteomics and immune signature of LN kidney regions by combined using LCM and DIA.
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Affiliation(s)
- Fengping Zheng
- Department of Nephrology, Peking University Shenzhen Hospital, Shenzhen Peking University, The Hong Kong University of Science and Technology Medical Center, Shenzhen, 518036, Guangdong, China
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Donge Tang
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Shanshan Li
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Zhifeng Luo
- The Second Department of Urology, Affiliated Hospital of Guilin Medical University, Guangxi, 541001, China
| | - Yueqi Song
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Yinxin Huang
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Qing Gan
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Hanyong Liu
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Xinzhou Zhang
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Dongzhou Liu
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China
| | - Qingwen Wang
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen, 5218036, Guangdong, China.
| | - Zuying Xiong
- Department of Nephrology, Peking University Shenzhen Hospital, Shenzhen Peking University, The Hong Kong University of Science and Technology Medical Center, Shenzhen, 518036, Guangdong, China.
| | - Yong Dai
- The Second Clinical Medical College, Shenzhen People's Hospital, Jinan University, Shenzhen, 518020, Guangdong, China.
- School of Medicine, The First Affiliated Hospital, Anhui University of Science and Technology, Huainan, 232001, Anhui, China.
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Dhanju G, Goubran A, Zimolag L, Chartrand R, Matthew F, Breddam A. Distinguishing between cornual, angular and interstitial ectopic pregnancy: A case report and a brief literature review. Radiol Case Rep 2023; 18:2531-2544. [PMID: 37235077 PMCID: PMC10208802 DOI: 10.1016/j.radcr.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/09/2023] [Accepted: 04/15/2023] [Indexed: 05/28/2023] Open
Abstract
For all clinical purposes, cornual, angular, and interstitial pregnancies are considered ectopic pregnancies that can have grave consequences for the patient. In this article, we describe and distinguish 3 types of ectopic pregnancies in the cornual region of the uterus. The authors advocate using the "cornual pregnancy" term only for ectopic pregnancies in malformed uteruses. We describe an ectopic pregnancy in a 25-year-old G2P1 patient in the cornual region of the uterus that was missed twice sonographically in the second trimester and had almost fatal consequences in the patient. Radiologists and sonographers should be aware of the sonographic diagnosis of angular, cornual and interstitial pregnancies. Whenever possible, first-trimester transvaginal ultrasound scanning is crucial for diagnosing these 3 types of ectopic pregnancies in the cornual region. In the second and third trimesters, ultrasound tends to become equivocal; hence alternate imaging, such as MRI, might add additional value to the management of the patient. A case report assessment and a comprehensive literature review comprising 61 case reports of ectopic pregnancy in the second and third trimesters are diligently undertaken in the Medline, Embase and Web of Science databases. The major strength of our study is that it is one of the few studies that describe a literature review of ectopic pregnancy in the cornual region exclusively in the second and third trimesters.
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Affiliation(s)
- Gurinder Dhanju
- Department of Public Health, University of Saskatchewan, 105 Administration Place, Saskatoon, SK S7N 5A2, Canada
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Ashraf Goubran
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Lukasz Zimolag
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Robyn Chartrand
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Frankel Matthew
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Alli Breddam
- Department of Ultrasound, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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15
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Kudla M, Bachand F, Moore J, Batchelar D. Patient-specific cylinder templates for hybrid interstitial vaginal brachytherapy: Feasibility of automated 3-D design, 3D printing, and dosimetric outlook. Brachytherapy 2023; 22:468-476. [PMID: 37169607 DOI: 10.1016/j.brachy.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/24/2023] [Accepted: 03/09/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Delivering highly conformal treatment plans for high-dose rate vaginal brachytherapy using commercially available applicators can be challenging. A partially automated workflow is presented for the in-house modeling and 3D printing of patient-specific cylindrical templates (PSCTs), which facilitate placement of flexible intracavitary and interstitial needles. To demonstrate feasibility, we compare PSCT treatment plans to retrospective interstitial brachytherapy plans delivered at our center. PSCTs derived from these plans were 3D printed to test the validity of the auto-design process. To facilitate clinical implementation, we validated the steam sterilization compatibility of PSCTs printed using polyetheretherketone (PEEK). METHODS AND MATERIALS Plans for ten patients treated using a combination of vaginal cylinder and interstitial needles were compared to PSCT-based plans created for the same patient. DVH parameters for the HRCTV (V100, V150, V200, D90) and OARs (D2 cm3) were evaluated, as well as the number of needles used and the total interstitial length. Each planned PSCT was printed and compared to the intended needle geometry. 3D printed models were sterilization validated by an independent contractor for an autoclave protocol. RESULTS PSCT plans demonstrated advantages over template based perineal BT in reducing the total interstitial needle length required while preserving or improving HRCTV and OAR dosimetry. All printed PSCTs matched planned geometry. CONCLUSIONS PSCTs stand to be an alternative to current HDR-BT templates/applicators for patients with vaginal and locally recurrent endometrial cancers. Clinically equivalent or improved treatment plans can be created and devices to deliver these plans can be accurately printed and sterilized.
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Affiliation(s)
- Michael Kudla
- Department of Physics, The University of British Columbia - Okanagan, Kelowna, BC, Canada.
| | - Francois Bachand
- Department of Radiation Oncology, BC Cancer - Kelowna, Kelowna, BC, Canada
| | - Jocelyn Moore
- Department of Radiation Oncology, Saskatoon Cancer Center, Saskatoon, SK, Canada
| | - Deidre Batchelar
- Department of Physics, The University of British Columbia - Okanagan, Kelowna, BC, Canada; Department of Medical Physics, BC Cancer - Kelowna, Kelowna, BC, Canada
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Park S, Jang Y, Koo SM, Nam BD, Yoon HY. Glucocorticoid pulse therapy in an elderly patient with post-COVID-19 organizing pneumonia: A case report. World J Clin Cases 2023; 11:4152-4158. [PMID: 37388801 PMCID: PMC10303612 DOI: 10.12998/wjcc.v11.i17.4152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/29/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Pulmonary fibrosis often occurs as a sequel of coronavirus disease 2019 (COVID-19); however, in some cases, it can rapidly progress, similar to the acute exacerbation of interstitial lung disease. Glucocorticoids are the standard treatment for severe COVID-19 pneumonia requiring oxygen supply; however, the post-COVID-19 efficacy of high-dose steroid therapy remains unclear. Here, we presented a case of an 81-year-old man who developed acute respiratory failure after COVID-19 and was treated with glucocorticoid pulse therapy.
CASE SUMMARY An 81-year-old man with no respiratory symptoms was admitted due to a diabetic foot. He had been previously treated for COVID-19 pneumonia six weeks prior. However, upon admission, he suddenly complained of dyspnea and required a high-flow oxygen supply. Initial simple chest radiography and computed tomography (CT) revealed diffuse ground-glass opacities and consolidation in both lungs. However, repeated sputum tests did not identify any infectious pathogens, and initial broad-spectrum antibiotic therapy did not result in any clinical improvement with the patient having an increasing oxygen demand. The patient was diagnosed with post-COVID-19 organizing pneumonia. Thus, we initiated glucocorticoid pulse therapy of 500 mg for three days followed by a tapered dose on hospital day (HD) 9. After three days of pulse treatment, the patient's oxygen demand decreased. The patient was subsequently discharged on HD 41, and chest radiography and CT scans have almost normalized nine months after discharge.
CONCLUSION Glucocorticoid pulse therapy may be considered when the usual glucocorticoid dose is ineffective for patients with COVID-19 sequelae.
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Affiliation(s)
- Shinhee Park
- Division of Allergy and Pulmonary Medicine, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Youngeun Jang
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
| | - So-My Koo
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
| | - Bo Da Nam
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
| | - Hee-Young Yoon
- Division of Allergy and Respiratory Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
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Shevchenko YL, Plotnitsky AV, Ulbashev DS. Immobilizing Interstitial Cardiac Fibrosis. Cardiol Res 2023; 14:123-132. [PMID: 37091883 PMCID: PMC10116936 DOI: 10.14740/cr1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/03/2023] [Indexed: 04/25/2023] Open
Abstract
Background The alterations in the endomysium and perimysium might cause compaction and gradual mechanical compression of cardiomyocytes resulting in their immobilization. This process finally leads to severe stiffening, so that the newly formed frame around individual cardiomyocytes and their clusters hinders normal diastole, and later systole. This phenomenon is referred to as immobilizing interstitial cardiac fibrosis (IICF). Deciphering the molecular and structural elements of myocardial changes is the key to understanding the pathogenetic foundations of heart failure development. Methods The study included 69 patients. Group I (n = 32) included patients with IICF; group II (n = 37) was comparison group. We evaluated the clinical picture, anamnesis of the disease, the results of physical examination, laboratory and instrumental examination of patients and autopsy data. Results In the anamnesis, patients with IICF were more likely to have diseases than patients in the control group: arrhythmia and impaired conductivity (88% vs. 19%, odds ratio (OR): 30.0; 95% confidence interval (CI): 7.918 - 113.7, P < 0.001), systemic connective tissue diseases (78% vs. 5%, OR: 62.5; 95% CI: 11.9 - 326.5, P < 0.001), viral infections (including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) (53% vs. 19%, OR: 4.86; 95% CI: 1.66 - 14.25, P = 0.003), type 2 diabetes mellitus (47% vs. 8%, OR: 10.0; 95% CI: 2.54 - 39.34, P < 0.001), radiation therapy for mediastinal lymphoma and other oncological diseases (19% vs. 0%, P = 0.008), focal infections (sinusitis, osteomyelitis, periodontitis, nephritis, cystitis, pyelonephritis, pleurisy, etc.) within 12 months (31% vs. 11%, P = 0.069), chronic kidney disease (25% vs. 8%, P = 0.097), and tuberculosis (9% vs. 0%, P = 0.095). We have identified a statistically significant difference between the groups: the volume of the fibrosis zone (17.5±9.2% vs. 4.9±2.3%, P = 0.001), the expression of type I collagen (5,182 ± 1,301 vs. 2,189 ± 754 in 1 mm2, P = 0.0001), type III collagen (7,562 ± 1,405 vs. 2,320 ± 541 in 1 mm2, P = 0.0001), matrix metalloproteinase (MMP)-2 (12,850 ± 6,200 vs. 9,501 ± 7,145 in 1 mm2, P = 0.005), MMP-9 (15,745 ± 5,695 vs. 6,920 ± 3,125 in 1 mm2, P = 0.0001), connexin-43 (25,689 ± 14,871 vs. 37,523 ± 12,561 in 1 mm2, P = 0.001), fibronectin (3,448 ± 720 vs. 1,544 ± 610 in 1 mm2, P = 0.0001), and transforming growth factor β (TGF-β) (5,121 ± 1,243 vs. 2,531 ± 1,489 in 1 mm2, P = 0.001). Conclusion IICF is a separate pathological condition and one of the main causes of chronic heart failure. It is induced by changes in the myocardial connective tissue that prevent normal functioning of the myocardium.
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Affiliation(s)
- Yuriy L. Shevchenko
- St. George Clinic of Thoracic and Cardiovascular Surgery, Pirogov National Medical & Surgical Center, 105203 Moscow, Russia
| | - Alexey V. Plotnitsky
- St. George Clinic of Thoracic and Cardiovascular Surgery, Pirogov National Medical & Surgical Center, 105203 Moscow, Russia
| | - Daniil S. Ulbashev
- St. George Clinic of Thoracic and Cardiovascular Surgery, Pirogov National Medical & Surgical Center, 105203 Moscow, Russia
- Corresponding Author: Daniil S. Ulbashev, St. George Clinic of Thoracic and Cardiovascular Surgery, Pirogov National Medical & Surgical Center, 105203 Moscow, Russia.
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Anuja AK, Mehta P, Singh MK, Singh H, Nath A, Hashim Z, Khan A, Gupta M, Misra DP, Agarwal V, Gupta L. Peripheral T helper subset profiling in idiopathic inflammatory myositis: Proof of concept. Reumatol Clin (Engl Ed) 2023; 19:143-149. [PMID: 36906390 DOI: 10.1016/j.reumae.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/10/2022] [Indexed: 03/11/2023]
Abstract
INTRODUCTION There is a dearth of biomarkers in Idiopathic Inflammatory Myopathies (IIM) to recognize ongoing muscle inflammation and distinguish damage from activity. Since IIM is an autoantibody-mediated disease with tertiary lymphoid organogenesis reported in the diseased muscles, we aimed to study the peripheral blood T helper (Th) subset profiling as a plausible reflection of ongoing muscle inflammation. METHODS Fifty-six patients of IIM were compared with 21 healthy controls (HC) and 18 patients with sarcoidosis. Th1, Th17, Th17.1, and Treg cells were identified after stimulation assays (BD Biosciences). Myositis autoantibodies were tested by line immunoassay (Euroimmune, Germany). RESULTS All Th subsets were elevated in IIM as compared with HC. As compared to HC, PM had elevated Th1 and Treg while Th17 and Th17.1 populations were higher in OM. Patients with sarcoidosis had higher Th1 and Treg but lower Th17 population as compared to IIM {Th1(69.1% vs 49.65%, p<0.0001), {Treg (12.05% vs 6.2%, p<0.0001), {Th17 (2.49% vs 4.4%, p<0.0001)}. Similar results were obtained when sarcoidosis ILD was compared with IIM ILD with a higher Th1 and Treg population but lower Th17 population in the former. No difference in T cell profile was observed after stratification for MSA positivity, type of MSA, clinical features of IIM and disease activity. CONCLUSION Th subsets in IIM are distinct from sarcoidosis and HC with a TH17 predominant paradigm, creating a case of exploring Th17 pathway and IL-17 blockers for the treatment of IIM. However, cell profiling cannot distinguish active from inactive disease limiting its predictive potential as a biomarker of activity in IIM.
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Affiliation(s)
- Anamika Kumari Anuja
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pankti Mehta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mantabya Kumar Singh
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Harshit Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Zia Hashim
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajmal Khan
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Durga P Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Latika Gupta
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India; Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK.
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Bhalla D, Jana M, Naranje P, Bhalla AS, Kabra SK. Fibrosing Interstitial Lung Disease in Children: An HRCT-Based Analysis. Indian J Pediatr 2023; 90:153-9. [PMID: 35138571 DOI: 10.1007/s12098-021-04004-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine high resolution CT (HRCT) patterns of pulmonary fibrosis (PF) in children; and their etiological correlates. METHODS This was a retrospective study involving 149 children with diffuse lung disease (DLD). Patterns of involvement were classified based on dominant lung finding as ground glass opacity (GGO) dominant, nodule dominant, cystic lung disease, or PF. Patterns of PF were classified based on distribution and morphology into airway centric fibrosis (ACF), subpleural fibrosis (SPF), progressive massive fibrosis (PMF) and fibrocavitary. A comparison was made between the two dominant groups for apicobasal distribution, associated findings (GGO, nodules, cysts), and pulmonary artery hypertension (PAH). RESULTS Nineteen patients showed PF on HRCT. ACF was commonest (52.6%), followed by SPF (42.1%). The common etiology was sarcoidosis (30%) in ACF, and connective tissue disorders (CTD) (50%) in SPF. Significant difference was found between ACF and SPF in apicobasal distribution (p = 0.04), presence of nodules (p = 0.03), and cysts (p = 0.02). CONCLUSION PF may present as an end stage of several childhood lung diseases. PF on imaging has discernible morphological patterns that correlate with underlying etiology.
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20
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Etruw E, Fuhr D, Huynh V, Jourdain T, Deuchar L, Sharpe H, Dubois R, Damant R, Stickland MK. Short-Term Health Outcomes of a Structured Pulmonary Rehabilitation Program Implemented Within Rural Canadian Sites Compared With an Established Urban Site: A Pre-Post Intervention Observational Study. Arch Phys Med Rehabil 2022; 104:753-760. [PMID: 36400258 DOI: 10.1016/j.apmr.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/03/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate congruence in program delivery and short-term health outcomes of a structured pulmonary rehabilitation (S-PR) program implemented at 11 Canadian rural pulmonary rehabilitation (PR) sites compared with an urban reference site. DESIGN Multi-center, pre- and post-intervention, comparative, observational study. SETTING Eleven rural Canadian PR sites and 1 urban reference PR site. PARTICIPANTS Adults with chronic respiratory diseases (CRDs) referred to PR. INTERVENTION Clinicians at the reference site worked with local clinicians to implement the S-PR program in rural sites. A PR survey evaluated site congruence with the S-PR components, with congruence defined as delivering program components ≥80% in alignment with the S-PR program. Participants were enrolled in 16 sessions of group education and supervised exercise, offered twice or thrice a week. Health outcomes were tracked using a quality assurance database. OUTCOME MEASURES Main outcomes were congruence in program delivery and changes in the 6-minute walk (6MW) distance and COPD Assessment Test (CAT). RESULTS A total of 555 participants (rural n=204 and reference n=351) were included in the analyses. There was congruence in exercise and group education; however, individual education varied. Following the S-PR program, 6MW distance increased, with greater changes observed at rural sites (51±67 m at rural sites vs 30±46 m at the reference site). CAT score was reduced by -2.6±5.4 points with no difference between reference and rural sites. Changes in 6MW distance and CAT scores were similar for participants at sites that were congruent vs noncongruent with the individual education component, and similar for patients with COPD, asthma, bronchiectasis, and interstitial lung disease. CONCLUSION The S-PR program components can be implemented with good congruence in Canadian rural settings, resulting in similar short-term health outcomes as in an established urban site and across CRDs.
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Affiliation(s)
- Evelyn Etruw
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta; Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta; G.F. MacDonald Centre for Lung Health, Edmonton, Alberta
| | - Desi Fuhr
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Virginia Huynh
- G.F. MacDonald Centre for Lung Health, Edmonton, Alberta
| | - Tina Jourdain
- G.F. MacDonald Centre for Lung Health, Edmonton, Alberta
| | - Lesly Deuchar
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Heather Sharpe
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta
| | | | - Ron Damant
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta; G.F. MacDonald Centre for Lung Health, Edmonton, Alberta; Alberta Health Services, Edmonton, Alberta.
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21
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Locke GE, Mendez LC, Martell K, Weiss Y, Choi S, D'Alimonte L, Barnes E, Taggar A, Leung E. Opioid consumption and pain in patients with gynecological cancer who underwent spinal anesthesia vs. general anesthesia for interstitial brachytherapy. Brachytherapy 2022; 21:806-813. [PMID: 36220758 DOI: 10.1016/j.brachy.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 12/14/2022]
Abstract
AIMS Interstitial brachytherapy (ISBT) is an effective option for delivering conformal high dose radiation to the target volume with better organ-at risk sparing but is thought to be more invasive and painful than other methods. This study investigated pain levels and opioid consumption in patients who received spinal anesthesia (SA) or general anesthesia (GA) for their ISBT. MATERIALS AND METHODS Patients that underwent ISBT from April 2014 to September 2018 were analyzed from a prospective institutional database. The most prevalent malignancies were cervical (45%), recurrent endometrial (27%) and vaginal (20%) cancers. Baseline patient characteristics, radiation treatment details, anesthesia records, and inpatient charts were obtained. Opioid consumption was quantified as oral morphine equivalent per day (OMEq/day) from implantation until removal. Pain score levels were collected by using an 11-point scoring system. RESULTS Ninety nine patients received GA and 40 patients received SA as their anesthesia for ISBT. During their first admission, 76 patients (55%) required intravenous opioids. Patients receiving SA had significantly lower mean pain scores on the morning of their procedure 6 (Interquartile range [IQR] 2-8) vs. 0 (IQR: 0-1); p < 0.001]. Pain did not significantly differ between cohorts at any other time. During the first admission, SA patients had a lower median opioid usage of 23 (IQR: 9-47) mg/day compared to GA patients at 38 (IQR: 21-71) mg/day (p = 0.011). No difference in opioid consumption was seen during subsequent admissions. CONCLUSIONS In patients undergoing ISBT, SA provides better immediate pain control post insertion compared to GA. Patients who received SA used lower amounts of opioids during their first ISBT insertion.
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Affiliation(s)
- Gordon E Locke
- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Lucas C Mendez
- Division of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Kevin Martell
- Department of Radiation Oncology, University of Calgary, Alberta, Canada
| | - Yonatan Weiss
- University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Stephen Choi
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Laura D'Alimonte
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Elizabeth Barnes
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Amandeep Taggar
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Ontario, Canada.
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22
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Silva Queiroz D, Marques da Silva CCB, Franco Amaral A, Rodrigues Oliveira M, Salge JM, Ribeiro Carvalho CR, Guedes Baldi B, Carvalho CRF. Evaluation of maximal exercise capacity through the incremental shuttle walking test in lymphangioleiomyomatosis. Pulmonology 2022:S2531-0437(22)00117-9. [PMID: 35851263 DOI: 10.1016/j.pulmoe.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The cardiopulmonary exercise test (CPET) is the gold standard for assessing aerobic fitness; however, it is expensive, not widely available, and requires specialized equipment and staff. The incremental shuttle walking test (ISWT) is an exercise field test used to evaluate exercise capacity and may be an alternative to CPET in patients with lymphangioleiomyomatosis (LAM). OBJECTIVE To investigate whether the ISWT can be used to assess maximal aerobic capacity in patients with LAM. METHODS Forty-five women were evaluated on two days, and they randomly performed the CPET and ISWT. The maximum oxygen uptake (peak VO2) was evaluated using gas analyzers in both tests. The carbon dioxide production (VCO2), respiratory exchange ratio (RER), and heart rate (HR) were compared during peak exercise. Pearson's correlation and Bland-Altman assessed the association and agreement, respectively. The intraclass correlation coefficient (ICC) was used to assess the reliability of the data. RESULTS All patients (46.1 ± 10.2 years) presented similar peak VO2, RER, and peak HR during the CPET and ISWT (15.6 ± 4.6 vs. 15.7 ± 4.4 ml·kg-1·min-1; 1.15±0.09 vs. 1.17±0.12; and 142.2 ± 18.6 vs. 141.5 ± 22.2 bpm, respectively; p>0.05). A good linear correlation (r = 0.79; p<0.001) and ICC (0.86; 95%CI 0.74-0.93) were observed between the peak VO2 in both tests. Predictive peak VO2 equations based on the ISWT performance are also presented. CONCLUSION Our results suggest that the ISWT can be used to assess maximal exercise performance in patients with LAM, and it is a valuable option to be used as an alternative to the CPET and predict maximal exercise capacity.
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Affiliation(s)
- D Silva Queiroz
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - C C B Marques da Silva
- Departament of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - A Franco Amaral
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - M Rodrigues Oliveira
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - J M Salge
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - C R Ribeiro Carvalho
- Departament of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil
| | - B Guedes Baldi
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - C R F Carvalho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Departament of Physical Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil.
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Rogowski P, Rottler M, Walter F, Saicic S, Niyazi M, Well J, Nierer L, Trillsch F, Burges A, Mahner S, Belka C, Corradini S. Clinical outcome of combined intracavitary / interstitial brachytherapy using a hybrid applicator in locally advanced cervical cancer. Gynecol Oncol 2022; 166:576-581. [PMID: 35764443 DOI: 10.1016/j.ygyno.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical outcome in locally advanced cervical cancer (LACC) after image-guided adaptive brachytherapy (IGABT) with combined intracavitary and interstitial (IC/IS) techniques using the hybrid Venezia applicator (Elekta AB, Sweden). METHODS LACC patients (UICC Stage IIB - IVB) treated with radiochemotherapy followed by IGABT with the hybrid IC/IS Venezia applicator at a single institution were retrospectively analyzed. Treatment comprised EBRT of the pelvis with 45 Gy and concomitant weekly cisplatin chemotherapy (40 mg/m2) followed by MRI-based IGABT. Dosimetry, oncological outcome and toxicity were investigated. RESULTS Forty-six patients underwent a total of 184 fractions of IGABT between 2017 and 2020. Median follow-up was 24 months. Combined IC/IS techniques were used in 40 patients (87%). The median HRCTV volume was 31.2 cm3 and the median HRCTV D90% was 92.3 Gy (EQD210). The median D2cm3 was 74.8 Gy for bladder, 57.9 Gy for rectum, 60.0 Gy for sigmoid and 52.2 Gy for bowel (EQD23). The 3-yr actuarial rates were 97.6% for local control, 97.6% for pelvic control, 59.9% for distant metastasis-free survival and 81.6% for overall survival. The crude rate for G2 and G3 late toxicity was 21.7% and 4.3%. CONCLUSIONS IGABT with the hybrid Venezia applicator and a pronounced use of a combined IC/IS technique achieved high target doses, while maintaining low doses to organs at risk, leading to excellent local control and overall survival rates with acceptable toxicity.
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Affiliation(s)
- Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany.
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Stefan Saicic
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Justus Well
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Fabian Trillsch
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Alexander Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany; German Cancer Consortium (DKTK), Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
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Terwiel M, Grutters JC, van Moorsel CHM. Clustering of lung diseases in the family of interstitial lung disease patients. BMC Pulm Med 2022; 22:134. [PMID: 35392870 PMCID: PMC8991662 DOI: 10.1186/s12890-022-01927-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background The presence of familial interstitial lung disease (ILD) has been found to predict development of progressive pulmonary fibrosis. However, the role of non-ILD lung diseases in ILD patients’ families has not yet been investigated. We aimed to identify associations between ILDs and non-ILD lung diseases from ILD patients’ self-reported family health history. Methods We analysed questionnaires on family health history of 1164 ILD patients for the occurrence of ILD and non-ILD lung disease in relatives. Logistic regression analysis was used to study associations with diagnosis groups. Results Familial pulmonary fibrosis was reported by 20% of patients with idiopathic pulmonary fibrosis (IPF; OR 9.2, 95% CI 4.7–17.9), and 15% of patients with unclassifiable pulmonary fibrosis (OR 4.1, 95% CI 2.0–8.2). Familial occurrence was reported by 14% of patients with sarcoidosis (OR 3.3, 95% CI 1.9–5.8). Regarding non-ILD lung disease, significantly more patients with IPF (36%) reported lung cancer in their family (OR 2.3, 95% CI 1.4–3.5), and patients with hypersensitivity pneumonitis (18%) mostly reported COPD (OR 2.3, 95% CI 1.3–4.2). Comparison of sporadic and familial ILD patients’ reports showed that emphysema (OR 4.6, 95% CI 1.8–11.6), and lung cancer (OR 2.4, 95% CI 1.2–4.9) were predictive for familial pulmonary fibrosis, particularly when reported both in a family (OR 16.7, 95% CI 3.2–86.6; p < 0.001). Conclusions Our findings provide evidence for clustering of ILD and non-ILD lung diseases in families and show that self-reported emphysema and lung cancer of relatives in this population predicts familial pulmonary fibrosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01927-x.
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Affiliation(s)
- Michelle Terwiel
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands.
| | - Jan C Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands.,Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Coline H M van Moorsel
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Nieuwegein, Netherlands.,Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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25
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Abstract
The glymphatic hypothesis proposes a mechanism for extravascular transport into and out of the brain of hydrophilic solutes unable to cross the blood-brain barrier. It suggests that there is a circulation of fluid carrying solutes inwards via periarterial routes, through the interstitium and outwards via perivenous routes. This review critically analyses the evidence surrounding the mechanisms involved in each of these stages. There is good evidence that both influx and efflux of solutes occur along periarterial routes but no evidence that the principal route of outflow is perivenous. Furthermore, periarterial inflow of fluid is unlikely to be adequate to provide the outflow that would be needed to account for solute efflux. A tenet of the hypothesis is that flow sweeps solutes through the parenchyma. However, the velocity of any possible circulatory flow within the interstitium is too small compared to diffusion to provide effective solute movement. By comparison the earlier classical hypothesis describing extravascular transport proposed fluid entry into the parenchyma across the blood-brain barrier, solute movements within the parenchyma by diffusion, and solute efflux partly by diffusion near brain surfaces and partly carried by flow along "preferred routes" including perivascular spaces, white matter tracts and subependymal spaces. It did not suggest fluid entry via periarterial routes. Evidence is still incomplete concerning the routes and fate of solutes leaving the brain. A large proportion of the solutes eliminated from the parenchyma go to lymph nodes before reaching blood but the proportions delivered directly to lymph or indirectly via CSF which then enters lymph are as yet unclear. In addition, still not understood is why and how the absence of AQP4 which is normally highly expressed on glial endfeet lining periarterial and perivenous routes reduces rates of solute elimination from the parenchyma and of solute delivery to it from remote sites of injection. Neither the glymphatic hypothesis nor the earlier classical hypothesis adequately explain how solutes and fluid move into, through and out of the brain parenchyma. Features of a more complete description are discussed. All aspects of extravascular transport require further study.
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Affiliation(s)
- Stephen B. Hladky
- Department of Pharmacology, University of Cambridge, Cambridge, CB2 1PD UK
| | - Margery A. Barrand
- Department of Pharmacology, University of Cambridge, Cambridge, CB2 1PD UK
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Krajnik M, Hepgul N, Wilcock A, Jassem E, Bandurski T, Tanzi S, Simon ST, Higginson IJ, Jolley CJ. Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians. BMC Pulm Med 2022; 22:41. [PMID: 35045847 PMCID: PMC8768441 DOI: 10.1186/s12890-022-01835-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/31/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Respiratory medicine (RM) and palliative care (PC) physicians' management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey. METHODS A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists. RESULTS 450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018). CONCLUSIONS These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled.
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Affiliation(s)
- Małgorzata Krajnik
- Department of Palliative Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland
| | - Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Andrew Wilcock
- Palliative Medicine, Hayward House Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Bandurski
- Department of Radiology, Informatics and Statistics, Medical University of Gdańsk, Gdańsk, Poland
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Caroline J Jolley
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, Shepherd's House, Rm 4.4, Guy's Campus, London, SE1 1UL, UK.
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27
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King EM, Hume PS, Janssen WJ, McCubbrey AL. Isolation and Analysis of Macrophage Subsets from the Mouse and Human Lung. Methods Mol Biol 2022; 2506:257-267. [PMID: 35771477 PMCID: PMC10978154 DOI: 10.1007/978-1-0716-2364-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Pulmonary macrophages are heterogeneous. Distinct populations of resident tissue macrophages exist in the lung airspace and tissue compartments during homeostasis. During inflammation, these are joined by monocyte-derived recruited macrophages. Flow cytometry can be used to identify and purify lung macrophage subsets. Here, we describe methods for identifying and isolating macrophages from bronchoalveolar lavage and digested lung tissues from mouse and human. We also describe basic staining for flow cytometry analysis of different macrophage subsets.
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Affiliation(s)
- Emily M King
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Patrick S Hume
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - William J Janssen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Alexandra L McCubbrey
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA.
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
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Chand MT, Zaka A, Qu H. Association of karyomegalic interstitial nephritis with focal segmental glomerulosclerosis. Autops Case Rep 2021; 11:e2021343. [PMID: 34805010 PMCID: PMC8597774 DOI: 10.4322/acr.2021.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
Karyomegalic interstitial nephritis (KIN), first described in 1974, is a rare form of chronic tubulointerstitial nephritis. It is defined by the presence of markedly enlarged, hyperchromatic nuclei with prominent nucleoli, mainly involving tubular epithelial cells of the kidney, accompanied by marked interstitial fibrosis. The disease presents as asymptomatic proteinuria, gradually progresses to chronic kidney disease and eventually leads to end-stage renal disease by 30-40 years. The etiology of the disease remains unclear; however, genetic risk factors and possible association with HLA (B27/35) is proposed by some. It has also been linked to FAN1 (FANCD2/FANC1- associated nuclease 1) mutation.
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Affiliation(s)
- Momal Tara Chand
- Ascension St John Hospital, Department of Pathology, Detroit, Michigan, USA
| | - Awais Zaka
- Ascension St John Hospital, Department of Nephrology, Detroit, Michigan, USA
| | - Hong Qu
- Ascension St John Hospital, Department of Pathology, Detroit, Michigan, USA
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29
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Inoue Y, Suda T, Kitamura H, Okamoto M, Azuma A, Inase N, Kuwana M, Makino S, Nishioka Y, Ogura T, Takizawa A, Ugai H, Stowasser S, Schlenker-Herceg R, Takeuchi T. Efficacy and safety of nintedanib in Japanese patients with progressive fibrosing interstitial lung diseases: Subgroup analysis of the randomised, double-blind, placebo-controlled, phase 3 INBUILD trial. Respir Med 2021; 187:106574. [PMID: 34564020 DOI: 10.1016/j.rmed.2021.106574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/28/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The efficacy of nintedanib in progressive fibrosing interstitial lung diseases (ILDs) was demonstrated in the randomised, double-blind, placebo-controlled INBUILD trial. This subgroup analysis evaluated the efficacy and safety of nintedanib in the Japanese population. METHODS Patients with progressive fibrosing ILDs (evaluated by physicians within 24 months of screening) were randomised (1:1) to twice-daily 150-mg nintedanib or placebo; treatment continued until the last patient completed 52 weeks. The primary endpoint was the annual rate of decline in forced vital capacity (FVC) over 52 weeks. Time-to-first acute ILD exacerbation or death and time-to-death up until the last patient had completed the week 52 visit were evaluated. This subgroup analysis included 108 Japanese patients. RESULTS The adjusted annual rates of FVC decline (mL/year) over 52 weeks for Japanese patients were -148.31 (nintedanib) and -240.36 (placebo), adjusted difference: 92.05 (95% CI: -10.69-194.80) and for non-Japanese patients were -67.41 (nintedanib) and -177.65 (placebo), adjusted difference: 110.24 (95% CI: 64.97-155.52). No heterogeneity in treatment effect between Japanese and non-Japanese subgroups was observed (treatment-by-subgroup interaction, p = 0.75). The risks of "acute exacerbation or death" (hazard ratio, 0.30 [95% CI: 0.10-0.91]) and mortality (hazard ratio, 0.54 [95% CI: 0.14-2.11]) in Japanese patients were numerically lower for nintedanib than placebo. There were no new or unexpected safety findings. CONCLUSIONS In Japanese patients, nintedanib slowed ILD progression, evidenced by a reduction in the annual rate of decline in FVC vs placebo. The efficacy and safety of nintedanib in Japanese patients were consistent with the overall INBUILD population. CLINICALTRIALS.GOV: NCT02999178 (21-Dec-2016).
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Affiliation(s)
- Yoshikazu Inoue
- National Hospital Organization Kinki-Chuo Chest Medical Center, Clinical Research Center, Osaka, Japan.
| | - Takafumi Suda
- Hamamatsu University School of Medicine, Second Division, Department of Internal Medicine, Shizuoka, Japan.
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan.
| | - Masaki Okamoto
- Kurume University School of Medicine, Division of Respirology, Neurology, and Rheumatology, Fukuoka, Japan.
| | - Arata Azuma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Naohiko Inase
- Department of Respiratory Medicine, Hiratsuka Kyosai Hospital, Kanagawa, Japan.
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Shigeki Makino
- Osaka Medical and Pharmaceutical University, Mishima-Minami Hospital, Osaka, Japan.
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan.
| | | | | | | | | | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
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Leroy HA, Guérin L, Lecomte F, Baert G, Vignion AS, Mordon S, Reyns N. Is interstitial photodynamic therapy for brain tumors ready for clinical practice? A systematic review. Photodiagnosis Photodyn Ther 2021; 36:102492. [PMID: 34419674 DOI: 10.1016/j.pdpdt.2021.102492] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Interstitial photodynamic therapy (iPDT), inserting optical fibers inside brain tumors, has been proposed for more than 30 years. While a promising therapeutic option, it is still an experimental treatment, with different ways of application, depending on the team performing the technique. OBJECTIVE In this systematic review, we reported the patient selection process, the treatment parameters, the potential adverse events and the oncological outcomes related to iPDT treatment applied to brain tumors. METHODS We performed a search in PubMed, Embase and Medline based on the following Mesh terms: "interstitial" AND "photodynamic therapy" AND "brain tumor" OR "glioma" OR glioblastoma" from January 1990 to April 2020. We screened 350 studies. Twelve matched all selection criteria. RESULTS 251 patients underwent iPDT. Tumors were mainly de novo or recurrent high-grade gliomas (171 (68%) of glioblastomas), located supratentorial, with a median volume of 12 cm3. Hematoporphyrin derive agent (HpD) or protoporphyrin IX (PpIX) induced by 5-aminolevulinic acid (5-ALA) was used as a photosensitizer. Up to 6 optical fibers were introduced inside the tumor, delivering 200 mW/cm at a wavelength of 630 nm. Overall mortality was 1%. Transient and persistent morbidity were both 5%. No permanent deficit occurred using 5-ALA PDT. Tumor response rate after iPDT was 92% (IQR, 67; 99). Regarding glioblastomas, progression-free-survival was respectively 14.5 months (IQR, 13.8; 15.3) for de novo lesions and 14 months (IQR, 7; 30) for recurrent lesions, while overall survival was respectively 19 months (IQR, 14; 20) and 8 months (IQR, 6.3; 8.5). In patients harboring high-grade gliomas, 33 (13%) were considered long-term survivors (> 2 years) after iPDT. CONCLUSION Regardless of heterogeneity in its application, iPDT appears safe and efficient to treat brain tumors, especially high-grade gliomas. Stand-alone iPDT (i.e., without combined craniotomy and intracavitary PDT) using 5-ALA appears to be the best option in terms of controlling side effects: it avoids the occurrence of permanent neurological deficits while reducing the risks of hemorrhage and sepsis.
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Affiliation(s)
- Henri-Arthur Leroy
- CHU Lille, Department of Neurosurgery, F-59000 Lille, France; INSERM, CHU-Lille, U1189-ONCOTHAI-Assisted Laser Therapy and Immunotherapy for Oncology, Univ-Lille, F-59000 Lille, France.
| | - Laura Guérin
- INSERM, CHU-Lille, U1189-ONCOTHAI-Assisted Laser Therapy and Immunotherapy for Oncology, Univ-Lille, F-59000 Lille, France
| | - Fabienne Lecomte
- INSERM, CHU-Lille, U1189-ONCOTHAI-Assisted Laser Therapy and Immunotherapy for Oncology, Univ-Lille, F-59000 Lille, France
| | - Grégory Baert
- INSERM, CHU-Lille, U1189-ONCOTHAI-Assisted Laser Therapy and Immunotherapy for Oncology, Univ-Lille, F-59000 Lille, France
| | - Anne-Sophie Vignion
- INSERM, CHU-Lille, U1189-ONCOTHAI-Assisted Laser Therapy and Immunotherapy for Oncology, Univ-Lille, F-59000 Lille, France
| | - Serge Mordon
- INSERM, CHU-Lille, U1189-ONCOTHAI-Assisted Laser Therapy and Immunotherapy for Oncology, Univ-Lille, F-59000 Lille, France
| | - Nicolas Reyns
- CHU Lille, Department of Neurosurgery, F-59000 Lille, France; INSERM, CHU-Lille, U1189-ONCOTHAI-Assisted Laser Therapy and Immunotherapy for Oncology, Univ-Lille, F-59000 Lille, France
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31
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Bruand M, Renard S, Salleron J, Meknaci E, Charra-Brunaud C, Peiffert D. Interstitial multi-catheter breast brachytherapy: Technical aspects and experience feedback in a comprehensive cancer center. Cancer Radiother 2021; 26:450-457. [PMID: 34147341 DOI: 10.1016/j.canrad.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/08/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To focus on technical aspects of the implementation of interstitial high dose rate brachytherapy, with a step-by-step approach. MATERIALS AND METHODS Patients were selected during multidisciplinary tumor boards, according to inclusion criteria adapted from GEC-ESTRO guidelines. A CT scan was performed a few days before implantation. On pre-implant CT, using surgical scar and clips, surgical and pathological reports, and preoperative images, we delineated the tumor bed to be included in the Clinical Target Volume (CTV), according to GEC ESTRO Recommendations. A 3D virtual implant simulation of the best catheter positions was performed in order to cover the target volume. Implantation was then carried out under local anaesthetic using 3D projections of the catheter inlets and outlets. Dosimetry was performed on post-implantation CT scan. A dose of 34Gy was delivered in 10 fractions. Acute and late side effects, and local control were evaluated 2 and 8 months after treatment. RESULTS Between July 2017 and January 2020, 20 patients were treated with accelerated partial breast irradiation. Dose constraints regarding target volume coverage, overdose, dose homogeneity, conformation index and organs at risk were met in 94.7%, 100%, 63.2%, 0% and 89.5% of the treatment plans, respectively. Grade 1-2 acute adverse events were observed in 21% of patients, with no grade 3-4 events. CONCLUSION The first dosimetric results and early clinical tolerance and efficacy achieved by the implementation of breast interstitial multicatheter brachytherapy in routine clinical practice are very encouraging, and confirm the interest of extending this practice.
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Affiliation(s)
- M Bruand
- Department of radiotherapy, institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France; Faculté de médecine de Nancy, université de Lorraine, 9, avenue de la Forêt de Haye, 54505 Vandœuvre-lès-Nancy, France.
| | - S Renard
- Department of radiotherapy, institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | - J Salleron
- Biostatistic unit, institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | - E Meknaci
- Department of radiotherapy, institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | - C Charra-Brunaud
- Department of radiotherapy, institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
| | - D Peiffert
- Department of radiotherapy, institut de cancérologie de Lorraine, 54519 Vandœuvre-lès-Nancy, France
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Dutra LRDV, Silva-Filho E, Oliveira MC, Paiva Tavares BN, Pegado R, Micussi MTBAC. Transcranial direct current electrical stimulation for the treatment of interstitial cystitis: A study protocol. Eur J Obstet Gynecol Reprod Biol 2021; 262:198-202. [PMID: 34062307 DOI: 10.1016/j.ejogrb.2021.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interstitial cystitis or painful bladder syndrome is a chronic disorder that presents an unknown etiology, with no generally accepted treatment. Although there is no gold standard treatment, transcranial direct current stimulation (tDCS) has shown efficacy in several chronic pain syndromes with decrease in pain, and improved functionality and mood. tDCS could be a safe, ease to use, and low-cost complementary intervention for patients with interstitial cystitis. AIM This study will investigate the effects of a tDCS protocol on pain, functionality, and mood in patients with interstitial cystitis. METHODS A randomized controlled clinical trial with two arms. Women will be randomized into two groups: active or sham. Anodal tDCS over the primary motor cortex will be performed for 5 consecutive days with an intensity of 2 mA for 20 min. Participants will be evaluated five times: 1 week before intervention; on the 5th day of tDCS; and 1, 6, and 12 months after the last day of tDCS. The outcomes will be assessed using the numeric rating scale, McGill pain questionnaire, positive and negative affect scale, international consultation on incontinence questionnaire for female lower urinary tract symptoms, Hamilton anxiety scale, six-minute walk test, patient global impression of change, and voiding diary. DISCUSSION Only the active group will be expected to show decreased pain. The results of this trial will be the first step in the use of neuromodulation in interstitial cystitis and will provide additional data to support new studies with tDCS.
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Affiliation(s)
| | - Edson Silva-Filho
- Graduate Program in Rehabilitation Science, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil.
| | - Maiara Costa Oliveira
- Undergraduate in Physiotherapy, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil
| | | | - Rodrigo Pegado
- Graduate Program in Rehabilitation Science, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil; Graduate Program in Health Science, Federal University of Rio Grande do Norte, Rio Grande do Norte, Brazil
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Barnes H, Lu J, Glaspole I, Collard HR, Johannson KA. Exposures and associations with clinical phenotypes in hypersensitivity pneumonitis: A scoping review. Respir Med 2021; 184:106444. [PMID: 33991845 DOI: 10.1016/j.rmed.2021.106444] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 01/01/2023]
Abstract
Antigen identification is important for establishing a confident diagnosis of hypersensitivity pneumonitis (HP). There are no systematically curated lists of HP-associated exposures that inform clinical relevance or disease phenotype. We sought to systematically identify all reported causes of HP in the literature and evaluate their clinical relevance. A scoping review was performed to identify all publications describing HP cases and their associated exposures (even if unknown) from Jan 1990-June 2020. Frequencies of exposures and meta-analysis of proportions for registry-based studies were determined for specific exposure categories, and associations with fibrotic and non-fibrotic HP were assessed. 24,138 publications were identified, with 967 publications included in the final analysis, representing 62 unique exposures associated with HP. Certain exposures were more frequently reported than others, including birds (comprising 32% of HP cases in registry-based studies) and mould (17% registry study HP cases). Antigen-indeterminate HP comprised 15-24% of registry-based studies. Limited data found contaminated metal-working fluids, isocyanate exposure, and hot tub lung were rarely associated with fibrotic features, whereas antigen-indeterminate HP cases were more frequently associated with fibrosis. There was heterogeneity in HP case definition and how causative exposures were identified. We identified 62 unique exposures associated with HP, with specific exposures associated with clinical phenotypes. These data may inform clinical assessment and the development of questionnaires to identify antigens in the diagnostic evaluation of suspected HP. OPEN SCIENCES FRAMEWORK REGISTRATION: osf.io/4aq5m.
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Affiliation(s)
- Hayley Barnes
- Department of Medicine, University of California, San Francisco, USA; Central Clinical School, Monash University, Melbourne, Australia; Department of Respiratory Medicine, Alfred Health, Melbourne, Australia.
| | - Jesse Lu
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Ian Glaspole
- Central Clinical School, Monash University, Melbourne, Australia; Department of Respiratory Medicine, Alfred Health, Melbourne, Australia
| | - Harold R Collard
- Department of Medicine, University of California, San Francisco, USA
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. https://twitter.com/KerriBerriKerri
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Chauvin P, Kerjouan M, Jégo P, Jouneau S, Lescoat A. [Hypersensitivity Pneumonitis: An update]. Rev Med Interne 2021:S0248-8663(21)00413-6. [PMID: 33941410 DOI: 10.1016/j.revmed.2021.03.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/21/2021] [Accepted: 03/27/2021] [Indexed: 12/23/2022]
Abstract
Hypersensitivity Pneumonitis (HP) is a common immune-mediated interstitial lung disease (ILD) induced by repeated exposure to environmental antigens in susceptible individuals. The most commonly known forms are bird fancier's disease and farmer's lung. However, the antigens involved are widely diverse. Therefore, the list of causes of HP is frequently expanding. HP seems to be under-diagnosed owing to its highly heterogeneous presentation in both the non-fibrotic and fibrotic subtypes and could represent up to 15% of all ILDs encountered in clinical practice. However, the recognition of HP cases is essential to ensure appropriate therapy for the patient. Home health care workers' intervention is sometimes critical in this context. In case of confirmed exposure, the diagnosis could be considered with high confidence if the high-resolution computed tomography (HR-CT) shows a typical HP pattern associated with a lymphocytosis over 30% in the broncho-alveolar lavage (BAL). In all other situations, the patients should undergo further investigations and additional histopathological sampling should be considered and submitted to a multidisciplinary team discussion. After diagnosis, antigenic eviction is the rule whenever possible. Corticosteroid treatment is the first-line medical treatment for severe forms and aims to prevent the development of fibrosis. Anti-fibrotic therapy is now an option for patients with progressive ILD and failure of immunomodulatory/immunosuppressive therapies.
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Lee SI. Effectiveness of polymyxin B hemoperfusion in acute exacerbation of interstitial pneumonia: a retrospective analysis. Sarcoidosis Vasc Diffuse Lung Dis 2021; 38:e2021012. [PMID: 33867795 PMCID: PMC8050624 DOI: 10.36141/svdld.v38i1.9734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 02/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Acute exacerbation (AE) of interstitial pneumonia (IP) occurs commonly and has a poor prognosis. Polymyxin B hemoperfusion (PMX-DHP) has a beneficial effect on AE of some types of IPs, particularly idiopathic pulmonary fibrosis (IPF). However, little is known about the efficacy of PMX-DHP in the Korean population. The aim of this study was to examine the effectiveness of PMX-DHP in AE of IP. METHODS We conducted a retrospective study of 12 patients with AE of IP, including two patients with AE of IPF, who were treated with PMX-DHP at our center. Treatment with PMX-DHP was carried out once or twice. We collected and analyzed data on changes in oxygenation with PMX-DHP and survival after AE. RESULTS In patients with AE of IP, the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, or the P/F ratio, had significantly improved at the end of the treatment with PMX-DHP (87.0 [80.3 - 130.9] to 200.6 [105.0 - 245.5] mmHg, p = 0.019). The white blood cell (WBC) count had significantly reduced at the end of the treatment (12,400 [8,860 - 20,287] to 6,800 [3,950 - 15,775]/mm3, p = 0.050). The 28-day and in-hospital mortality rates of patients after AE of IP were 41.7 % and 75.0 %, respectively. CONCLUSION PMX-DHP improved oxygenation and reduced the WBC count in patients with AE, with either steroids alone or steroids and cyclophosphamide. Further studies are required to verify the potential benefits of PMX-DHP for patients with AE of IP.
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Affiliation(s)
- Song-I Lee
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
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Kamrava M, Alrashidi SM, Leung E. Interstitial brachytherapy for gynecologic malignancies: Complications, toxicities, and management. Brachytherapy 2021:S1538-4721(20)30298-1. [PMID: 33789823 DOI: 10.1016/j.brachy.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022]
Abstract
From both a disease and management perspective, locally advanced gynecologic cancers present a significant challenge. Dose escalation with brachytherapy serves as a key treatment, providing conformal radiation while sparing at-risk organs. Intracavitary brachytherapy techniques have been shown to be effective, with improving tumor control and toxicity profiles with the advent of three-dimensional image planning. Despite this, the variations in tumor size, location, and pelvic anatomy may lead to suboptimal dosimetry with standard intracavitary applicators in some clinical scenarios. The addition of interstitial needles (interstitial brachytherapy (ISBT)) can improve the conformality of brachytherapy treatments by adding needles to peripheral (and central) regions of the target volume, improving the ability to escalate doses in these undercovered regions while sparing organs at risk. Interstitial brachytherapy can be delivered by intracavitary and interstitial hybrid applicators (ICBT/ISBT), perineal template (P-ISBT), or by free-hand technique. ISBT has however yet to be widely available because of concerns of complications and toxicities from this specialized treatment. However, with the increasing use of three-dimensional image-guided brachytherapy, there is an opportunity to increase the level of expertise in the gynecologic radiation oncology community with an improved understanding of the potential complications and morbidity. In this article, we review the acute and long-term toxicity in both ICBT/ISBT and P-ISBT using image-guided brachytherapy.
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Howie A, Poder J, Brown R, Schreiber K, Bece A, Graham P, Chin YS. Comparison of TG43 and Hounsfield Unit-based TG186 brachytherapy dose metrics in Oncentra Brachy for 100 patients receiving interstitial partial breast irradiation. Brachytherapy 2021; 20:655-663. [PMID: 33358142 DOI: 10.1016/j.brachy.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the study was to conduct a retrospective analysis of 100 patients who received interstitial accelerated partial breast irradiation at a single institution, comparing the standard American Association of Physicists in Medicine Task Group (TG) 43 dose calculation algorithm to the model-based dose calculation algorithms (MBDCAs) available in the Oncentra Brachy treatment planning system. METHODS AND MATERIALS Dose-volume histogram parameters were compared between the different dose calculation algorithms for the planning target volume and organs at risk. and a statistical analysis was performed. The resulting changes in isodose distribution were assessed, with the worst-case data presented. RESULTS The TG43 algorithm calculated higher doses to all structures compared with the MBDCAs. The largest discrepancy was observed for the skin, with maximum doses on average 2.0% lower with the MBDCA. The newly released Hounsfield Unit-based algorithm further decreased the skin dose compared with TG43 by <0.5%. CONCLUSIONS This study demonstrates that the differences between TG43 and MBDCA as implemented in Oncentra Brachy for accelerated partial breast irradiation are clinically insignificant in the treatment area and nearby organs at risk. Justification for investing in MBDCAs for this treatment site is limited when considering the additional calculation time, introduced uncertainties, and cost.
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Affiliation(s)
- Andrew Howie
- St George Cancer Care Centre, Kogarah, New South Wales, Australia.
| | - Joel Poder
- St George Cancer Care Centre, Kogarah, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ryan Brown
- St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | | | - Andrej Bece
- St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Peter Graham
- St George Cancer Care Centre, Kogarah, New South Wales, Australia; School of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Yaw Sinn Chin
- St George Cancer Care Centre, Kogarah, New South Wales, Australia; School of Medicine, University of New South Wales, Randwick, New South Wales, Australia
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Tabatabaei P, Asklund T, Bergström P, Björn E, Johansson M, Bergenheim AT. Intratumoral retrograde microdialysis treatment of high-grade glioma with cisplatin. Acta Neurochir (Wien) 2020; 162:3043-3053. [PMID: 32666378 DOI: 10.1007/s00701-020-04488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study evaluates the application of a microdialysis technique for interstitial chemotherapy using cisplatin in high-grade glioma. METHOD An in vitro study demonstrated that cisplatin can be administered through retrograde microdialysis and defined the recovery for cisplatin. In a subsequent phase I study, 1-4 microdialysis catheters were implanted in tumor tissue, brain adjacent to tumor (BAT) tissue, and subcutaneous tissue in 10 patients with recurrent high-grade glioma. Cisplatin was administered continuously in daily doses between 0.3 and 3.9 mg for 4 to12 days. Microdialysis samples were continuously collected and analyzed for glucose metabolites, glutamate, glycerol, and cisplatin concentrations. Treatment tolerability was evaluated through clinical monitoring. Quality of life was assessed using the EORTC-QLQ-C30 questionnaire for up to 3 months after treatment. RESULTS This in vitro study showed that cisplatin could be administrated with a recovery of 41-97%, depending on flowrate, type of catheter, and cisplatin concentration. During the treatment, patients were exposed to a total dose of 1.2-36.8 mg cisplatin. The concentration of cisplatin in BAT, serum, and subcutaneous tissue was close to detection level in all but two patients. A transient neurologic deterioration due to edema was commonly observed, but no systemic side effects were recorded. After onset of treatment, concentrations of glutamate and glycerol were significantly increased in tumor tissue but not in BAT, with a peak after 3 days, and consistent for the rest of the treatment. Five of the patients survived between 153 and 492 days after treatment. CONCLUSION This phase I study demonstrates that retrograde microdialysis can be used to administer cisplatin interstitially into high-grade glioma tissue. A high cytotoxicity was detected in tumor tissue, but not in the surrounding brain. Retrograde microdialysis appears to be a clinically useful method for intratumoral drug administration in high-grade glioma.
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Laurenzi A, Caretto A, Barrasso M, Bolla AM, Dozio N, Molinari C, Meneghini E, Bosi E, Scavini M. Frequency of flash glucose monitoring readings, hemoglobin A1c and time in range: a real life study in adults with type 1 diabetes. Acta Diabetol 2020; 57:1395-1397. [PMID: 32715323 DOI: 10.1007/s00592-020-01577-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Andrea Laurenzi
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Amelia Caretto
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Mariluce Barrasso
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Mario Bolla
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Chiara Molinari
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Meneghini
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuele Bosi
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marina Scavini
- Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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40
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Raupp D, Fernandes RS, Antunes KH, Perin FA, Rigatto K. Impact of angiotensin II type 1 and G-protein-coupled Mas receptor expression on the pulmonary performance of patients with idiopathic pulmonary fibrosis. Peptides 2020; 133:170384. [PMID: 32777324 PMCID: PMC7411382 DOI: 10.1016/j.peptides.2020.170384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 12/24/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a severe interstitial disease with a mean survival of about 2.5-5 years after diagnosis. Its pathophysiology is still a major challenge for science. It is known that angiotensin II (Ang-II) binds AT1 receptor (AT1R) and its overactivation induces fibrosis, inflammation and oxidative stress. In contrast, activation of the Mas receptor (Mas-R) by angiotensin 1-7 opposes the harmful effects induced by Ang-II. Thus, our innovative objective was to analyze, in patients' lung with IPF, the balance between AT1R and Mas-R expression and their possible association with pulmonary spirometric parameters: forced expiratory volume in the first second (FEV1%) and forced vital capacity (FVC%). One cubic centimeter of lung tissue was obtained from IPF patients (n = 6) and from patients without IPF (n = 6) who underwent bronchial carcinoma resection. Receptor expression was quantified using western blot. AT1R expression was significantly higher (34 %) in patients with IPF (P = 0.006), whereas Mas-R was significantly less expressed (54 %) in these patients' lungs (P = 0.046). There was also a positive correlation between Mas-R expression and FEV1% (r = 0.62, P = 0.03) and FVC% (r = 0.58, P = 0.05). Conversely, AT1R expression was negatively correlated with FEV1% (r = 0.80, P = 0.002) and FVC% (r = 0.74, P = 0.006). In conclusion, our results demonstrated an increased expression of AT1R and reduced expression of Mas-R in the lung of patients with IPF. The dominance of AT1R expression is associated with reduced lung function, highlighting the role of the renin-angiotensin system peptides in the pathophysiology of IPF.
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Affiliation(s)
- Débora Raupp
- Laboratório de Fisiologia Translacional, Curso de Pós-Graduaçao em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Renata Streck Fernandes
- Laboratório de Fisiologia Translacional, Curso de Pós-Graduaçao em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Krist Helen Antunes
- Laboratório de Imunologia Clínica e Experimental da Pontifícia, Universidade Católica do Rio Grande do Sul, Brazil
| | - Fabíola Adélia Perin
- Complexo Hospitalar da Irmandade Santa Casa de Misericórdia de Porto Alegre, Brazil
| | - Katya Rigatto
- Laboratório de Fisiologia Translacional, Curso de Pós-Graduaçao em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil.
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Lancaster L, Goldin J, Trampisch M, Kim GH, Ilowite J, Homik L, Hotchkin DL, Kaye M, Ryerson CJ, Mogulkoc N, Conoscenti CS. Effects of Nintedanib on Quantitative Lung Fibrosis Score in Idiopathic Pulmonary Fibrosis. Open Respir Med J 2020; 14:22-31. [PMID: 33088361 PMCID: PMC7539538 DOI: 10.2174/1874306402014010022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Nintedanib slows disease progression in patients with Idiopathic Pulmonary Fibrosis (IPF) by reducing decline in Forced Vital Capacity (FVC). The effects of nintedanib on abnormalities on high-resolution computed tomography scans have not been previously studied. Objective: We conducted a Phase IIIb trial to assess the effects of nintedanib on changes in Quantitative Lung Fibrosis (QLF) score and other measures of disease progression in patients with IPF. Methods: 113 patients were randomized 1:1 to receive nintedanib 150 mg bid or placebo double-blind for ≥6 months, followed by open-label nintedanib. The primary endpoint was the relative change from baseline in QLF score (%) at month 6. Analyses were descriptive and exploratory. Results: Adjusted mean relative changes from baseline in QLF score at month 6 were 11.4% in the nintedanib group (n=42) and 14.6% in the placebo group (n=45) (difference 3.2% [95% CI: −9.2, 15.6]). Adjusted mean absolute changes from baseline in QLF score at month 6 were 0.98% and 1.33% in these groups, respectively (difference 0.35% [95% CI: −1.27, 1.96]). Adjusted mean absolute changes from baseline in FVC at month 6 were −14.2 mL and −83.2 mL in the nintedanib (n=54) and placebo (n=54) groups, respectively (difference 69.0 mL [95% CI: −8.7, 146.8]). Conclusion: Exploratory data suggest that in patients with IPF, 6 months’ treatment with nintedanib was associated with a numerically smaller degree of fibrotic change in the lungs and reduced FVC decline versus placebo. These data support previous findings that nintedanib slows the progression of IPF.
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Affiliation(s)
- Lisa Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, California, USA
| | | | - Grace Hyun Kim
- Department of Radiology, University of California, Los Angeles, California, USA.,Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Jonathan Ilowite
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York
| | - Lawrence Homik
- Department of Respiratory Medicine and Bronchoscopy, Winnipeg Clinic, Winnipeg, Manitoba, Canada
| | - David L Hotchkin
- The Oregon Clinic, Division of Pulmonary, Critical Care & Sleep Medicine, Portland, Oregon, USA
| | - Mitchell Kaye
- Department of Pulmonary Medicine, Minnesota Lung Center, Ltd., Minneapolis, Minnesota, USA
| | - Christopher J Ryerson
- Department of Medicine & Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Bornova, Izmir, Turkey
| | - Craig S Conoscenti
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
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McKernan LC, Bonnet KR, Finn MTM, Williams DA, Bruehl S, Reynolds WS, Clauw D, Dmochowski RR, Schlundt DG, Crofford LJ. Qualitative Analysis of Treatment Needs in Interstitial Cystitis/Bladder Pain Syndrome: Implications for Intervention. Can J Pain 2020; 4:181-198. [PMID: 33367196 PMCID: PMC7751614 DOI: 10.1080/24740527.2020.1785854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/26/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating condition carrying substantial psychosocial burden. Psychological treatment for IC/BPS is little studied, and there are barriers to its use in clinical management. Whether psychological treatments benefit patients with IC/BPS is unclear and we do not know if such treatments would meet patient needs. AIMS Incorporating patient-reported needs and acknowledging diversity in pain experiences can inform patient-centered interventions for IC/BPS. This project characterized the experience of living with IC/BPS and patient perceptions of needs in its treatment, with the goal of informing patient-centered treatment for IC/BPS. METHODS Using both quantitative and qualitative methods, 27 females with IC/BPS participated in a focus group and completed validated self-report assessments evaluating urinary symptoms, pain, and emotional functioning. Focus groups were audio recorded and transcribed, then coded and analyzed using an iterative inductive/deductive approach. Linear regression models evaluated the relationship between psychological functioning and symptom severity. RESULTS We conducted six focus groups between 8/2017-12/2017. Five major themes emerged from qualitative analysis: managing physical symptoms, emotional symptoms, impact on daily life and socio-contextual factors, responding to illness, and addressing needs in treatment. The physiological and emotional consequences of IC/BPS were reported, highlighting their impact on interpersonal relationships and challenges obtaining appropriate treatment for IC/BPS. Quantitative analysis showed depression levels were significantly associated with worsened IC/BPS symptomology, after controlling for known confounding factors. CONCLUSION Individuals with IC/BPS could benefit from tailored psychological interventions focusing on pain management, emotion regulation, communications skills, along with sexual dysfunction and intimacy fears.
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Affiliation(s)
- Lindsey C. McKernan
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Michael T. M. Finn
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David A. Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - W. Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Daniel Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Roger R. Dmochowski
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Leslie J Crofford
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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43
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Nathan SD, Brown AW, Mogulkoc N, Soares F, Collins AC, Cheng J, Peterson J, Cannon B, King CS, Barnett SD. The association between white blood cell count and outcomes in patients with idiopathic pulmonary fibrosis. Respir Med 2020; 170:106068. [PMID: 32843183 DOI: 10.1016/j.rmed.2020.106068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The course of idiopathic pulmonary fibrosis (IPF) is uncertain with variable patterns of disease progression. We sought to evaluate the prognostic utility of the WBC, a routinely performed lab test, in a well-defined cohort of outpatient IPF subjects. METHODS We reviewed IPF patient records from two independent ILD centers (Inova Fairfax in Falls Church, VA, USA and Ege University Hospital in Izmir, Turkey) between 2007 and 2018. Demographics, CBC data, and patient outcomes were obtained. Survival differences were analyzed. RESULTS There were 436 IPF outpatients in the cohort with a median WBC of 8.9 × 109 cells per liter. For pragmatic purposes, patients were categorized into two groups, WBC ≥9 or WBC <9. Patients with WBC <9 had a median transplant-free survival of 50.5 months from the time of the CBC, compared to 32.4 months for those with WBC ≥9 (p < 0.0001). The association between WBC and attenuated survival remained significant after adjusting for GAP stage, steroid use, and antifibrotic use when WBC was analyzed both as a continuous (HR: 1.11; 95% CI: 1.05-1.17) and a dichotomized variable (high (WBC ≥9) vs. low (WBC <9), (HR: 1.53; 95% CI:1.09-2.15). WBC and absolute neutrophil count (ANC) were highly correlated suggesting that PMNs account for most of this association (r = 0.92). CONCLUSIONS Baseline WBC may impart important and readily available prognostic information in outpatients with IPF. Further studies are warranted to validate this as a potential biomarker for IPF, as well as to define the biologic basis for the association.
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Affiliation(s)
- Steven D Nathan
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA.
| | - A Whitney Brown
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Bornova, Izmir, Turkey
| | - Flavia Soares
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA; Department of Internal Medicine, Federal University of Espirito Santo (UFES), Vitoria, ES, Brazil
| | - Ashley C Collins
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Joyce Cheng
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Jake Peterson
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Brenna Cannon
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Christopher S King
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Scott D Barnett
- Advanced Lung Disease Program, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
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44
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Fisher JH, Kolb M, Algamdi M, Morisset J, Johannson KA, Shapera S, Wilcox P, To T, Sadatsafavi M, Manganas H, Khalil N, Hambly N, Halayko AJ, Gershon AS, Fell CD, Cox G, Ryerson CJ. Baseline characteristics and comorbidities in the CAnadian REgistry for Pulmonary Fibrosis. BMC Pulm Med 2019; 19:223. [PMID: 31771541 PMCID: PMC6880596 DOI: 10.1186/s12890-019-0986-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background The CAnadian REgistry for Pulmonary Fibrosis (CARE-PF) is a multi-center, prospective registry designed to study the natural history of fibrotic interstitial lung disease (ILD) in adults. The aim of this cross-sectional sub-study was to describe the baseline characteristics, risk factors, and comorbidities of patients enrolled in CARE-PF to date. Methods Patients completed study questionnaires and clinical measurements at enrollment and each follow-up visit. Environmental exposures were assessed by patient self-report and comorbidities by the Charlson Comorbidity Index (CCI). Baseline characteristics, exposures, and comorbidities were described for the overall study population and for incident cases, and were compared across ILD subtypes. Results The full cohort included 1285 patients with ILD (961 incident cases (74.8%)). Diagnoses included connective tissue disease-associated ILD (33.3%), idiopathic pulmonary fibrosis (IPF) (24.7%), unclassifiable ILD (22.3%), chronic hypersensitivity pneumonitis (HP) (7.5%), sarcoidosis (3.2%), non-IPF idiopathic interstitial pneumonias (3.0%, including idiopathic nonspecific interstitial pneumonia (NSIP) in 0.9%), and other ILDs (6.0%). Patient-reported exposures were most frequent amongst chronic HP, but common across all ILD subtypes. The CCI was ≤2 in 81% of patients, with a narrow distribution and range of values. Conclusions CTD-ILD, IPF, and unclassifiable ILD made up 80% of ILD diagnoses at ILD referral centers in Canada, while idiopathic NSIP was rare when adhering to recommended diagnostic criteria. CCI had a very narrow distribution across our cohort suggesting it may be a poor discriminator in assessing the impact of comorbidities on patients with ILD.
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Affiliation(s)
- J H Fisher
- Department of Medicine, University of Toronto, Toronto, Canada. .,University Health Network, 9N-945 585 University Avenue, Toronto, M5G 2N2, Canada.
| | - M Kolb
- Firestone Institute for Respiratory Health, Department of Medicine, McMaster University, Hamilton, Canada
| | - M Algamdi
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - J Morisset
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - K A Johannson
- Department of Medicine, University of Calgary, Calgary, Canada
| | - S Shapera
- Department of Medicine, University of Toronto, Toronto, Canada
| | - P Wilcox
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - T To
- Institute for Clinical Evaluative Sciences, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - M Sadatsafavi
- Institute for Heart and Lung Health, Department of Medicine, University of British Columbia, Vancouver, Canada.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - H Manganas
- Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - N Khalil
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - N Hambly
- Firestone Institute for Respiratory Health, Department of Medicine, McMaster University, Hamilton, Canada
| | - A J Halayko
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - A S Gershon
- Department of Medicine, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - C D Fell
- Department of Medicine, University of Calgary, Calgary, Canada
| | - G Cox
- Firestone Institute for Respiratory Health, Department of Medicine, McMaster University, Hamilton, Canada
| | - C J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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Solomon JJ, Danoff SK, Goldberg HJ, Woodhead F, Kolb M, Chambers DC, DiFranco D, Spino C, Haynes-Harp S, Hurwitz S, Peters EB, Dellaripa PF, Rosas IO. The Design and Rationale of the Trail1 Trial: A Randomized Double-Blind Phase 2 Clinical Trial of Pirfenidone in Rheumatoid Arthritis-Associated Interstitial Lung Disease. Adv Ther 2019; 36:3279-3287. [PMID: 31515704 DOI: 10.1007/s12325-019-01086-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is the most common of the connective tissue diseases (CTD), affecting up to 0.75% of the United States (U.S.) population with an increasing prevalence. Interstitial lung disease is prevalent and morbid condition in RA (RA-ILD), affecting up to 60% of patients with RA, leading to premature death in 10% and accruing an average of US$170,000 in healthcare costs per patient over a 5-year period. Although there have been significant advances in the management of this joint disease, there are no ongoing randomized clinical trials looking at pharmacologic treatments for RA-ILD, and there currently are no U.S. Food and Drug Administration-approved drugs for RA-ILD. METHODS/DESIGN We describe the Treatment for Rheumatoid Arthritis and Interstitial Lung Disease 1 (TRAIL1) trial, a multicenter randomized, double-blind, placebo-controlled, phase 2 study of the safety, tolerability and efficacy of pirfenidone in patients with RA-ILD. The study will enroll approximately 270 subjects across a network of sites who have RA and ILD as defined by a fibrotic abnormality involving greater than 10% of the lung parenchyma. The primary endpoint of the study is the incidence of the composite endpoint of decline in percent predicted forced vital capacity of 10 or greater or death during the 52-week study period. A number of secondary and exploratory endpoints have been chosen to evaluate the safety and efficacy in different domains. DISCUSSION The TRAIL1 trial is designed to evaluate the safety and efficacy of pirfenidone in RA-ILD, a disease with significant impact on patients' quality of life and outcome. In addition to investigating the safety and efficacy of pirfenidone, this trial looks at a number of exploratory endpoints in an effort to better understand the impact of therapy on areas such as changes in quantitative high-resolution computed tomography scores and a patient's quality of life. Biospecimens will be collected in order to investigate biomarkers that could potentially predict the subtype of disease, its behavior over time, and its response to therapy. Finally, by creating a network of institutions and clinician investigators with an interest in RA-ILD, this trial will pave the way for future studies of investigational agents in an effort to reduce or eliminate the burden of disease for those suffering from RA-ILD. TRIAL FUNDING Genentech, a member of the Roche Group. TRIAL REGISTRATION Clinicaltrials.gov, identifier NCT02808871.
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Holland AE, Watson A, Glaspole I. Comprehensive pulmonary rehabilitation for interstitial lung disease: A consensus approach to identify core education topics. Patient Educ Couns 2019; 102:1125-1130. [PMID: 30683609 DOI: 10.1016/j.pec.2019.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To achieve consensus amongst health professionals and people with interstitial lung disease (ILD) on core educational topics for pulmonary rehabilitation (PR) in ILD. METHODS Health professionals with expertise in ILD and/or PR took part in a 2-round online Delphi process. Potential educational topics for PR were rated on a 4-point Likert scale with anchors of 'completely unimportant' and 'very important'. Results of each Delphi round were discussed and refined by focus groups of people with ILD, to achieve final approval of topics. RESULTS Health professional participants (n = 43) represented six disciplines from five continents. Focus group participants (n = 10) had a range of ILDs and disease severity. Consensus was reached on six core education topics: (1) Staying well with ILD; (2) Keeping fit and strong after PR; (3) Oxygen Therapy; (4) Managing breathlessness and cough; (5) Overcoming fatigue; (6) Managing anxiety, depression and panic. CONCLUSION This study has identified core educational topics for people with ILD who undertake PR, incorporating the perspectives of both patients and health professionals. This is a step towards comprehensive PR for people with ILD. PRACTICE IMPLICATIONS This study provides PR clinicians with guidance on ILD-specific education topics that can be delivered in existing PR programs.
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Affiliation(s)
- Anne E Holland
- Department of Physiotherapy, Alfred Health, Melbourne, Australia; Discipline of Physiotherapy, La Trobe University, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia.
| | - Alice Watson
- Discipline of Physiotherapy, La Trobe University, Melbourne, Australia
| | - Ian Glaspole
- Department of Medicine, Monash University, Melbourne, Australia; Department of Respiratory and Sleep Medicine, Alfred Health, Melbourne, Australia
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Baumann KY, Church MK, Clough GF, Quist SR, Schmelz M, Skov PS, Anderson CD, Tannert LK, Giménez-Arnau AM, Frischbutter S, Scheffel J, Maurer M. Skin microdialysis: methods, applications and future opportunities-an EAACI position paper. Clin Transl Allergy 2019; 9:24. [PMID: 31007896 PMCID: PMC6456961 DOI: 10.1186/s13601-019-0262-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
Skin microdialysis (SMD) is a versatile sampling technique that can be used to recover soluble endogenous and exogenous molecules from the extracellular compartment of human skin. Due to its minimally invasive character, SMD can be applied in both clinical and preclinical settings. Despite being available since the 1990s, the technique has still not reached its full potential use as a tool to explore pathophysiological mechanisms of allergic and inflammatory reactions in the skin. Therefore, an EAACI Task Force on SMD was formed to disseminate knowledge about the technique and its many applications. This position paper from the task force provides an overview of the current use of SMD in the investigation of the pathogenesis of chronic inflammatory skin diseases, such as atopic dermatitis, chronic urticaria, psoriasis, and in studies of cutaneous events during type 1 hypersensitivity reactions. Furthermore, this paper covers drug hypersensitivity, UVB-induced- and neurogenic inflammation, and drug penetration investigated by SMD. The aim of this paper is to encourage the use of SMD and to make the technique easily accessible by providing an overview of methodology and applications, supported by standardized operating procedures for SMD in vivo and ex vivo.
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Affiliation(s)
- Katrine Y Baumann
- RefLab ApS, Copenhagen, Denmark.,2Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin K Church
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Sven Roy Quist
- 5Clinic of Dermatology, Otto-von-Guericke University, Magdeburg, Germany.,Skin Center MDZ, Mainz, Germany
| | - Martin Schmelz
- 7Department of Experimental Pain Research, CBTM, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Per Stahl Skov
- RefLab ApS, Copenhagen, Denmark.,8Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Chris D Anderson
- 9Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Line Kring Tannert
- 8Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Ana Maria Giménez-Arnau
- 10Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autònoma, Barcelona, Spain
| | - Stefan Frischbutter
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jörg Scheffel
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Marcus Maurer
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Guler SA, Hur SA, Lear SA, Camp PG, Ryerson CJ. Body composition, muscle function, and physical performance in fibrotic interstitial lung disease: a prospective cohort study. Respir Res 2019; 20:56. [PMID: 30866948 PMCID: PMC6417197 DOI: 10.1186/s12931-019-1019-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with fibrotic interstitial lung disease (ILD) are frequently physically inactive and many ILD subtypes are characterized by risk factors for myopathy; however, the importance of body composition, muscle strength, and physical performance in this population is largely unknown. METHODS Patients were prospectively recruited from a specialized ILD clinic, baseline characteristics were collected from the clinical record, pulmonary function tests were performed per established protocols, and dyspnea was measured using the University of California San Diego Shortness of Breath Questionnaire. Dual-energy X-ray absorptiometry (DXA) was used to assess body composition; handgrip strength to determine muscle strength, and 4-m gait speed to measure physical performance. RESULTS One hundred and fifteen patients with fibrotic ILD including 40 patients with idiopathic pulmonary fibrosis were recruited. The mean age was 69+/- 10 years in men (62% of the cohort), and 66+/- 9 years in women, with mild and moderate reduction in FVC and DLCO, respectively, for both sexes. ILD severity (measured by FVC %-predicted, DLCO %-predicted, or the Composite Physiologic Index in separate models) significantly predicted muscle mass and percent body fat including with adjustment for age, sex, and weight. ILD severity was associated with grip strength and gait speed independent from body composition. CONCLUSIONS ILD severity has an important impact on body composition, particularly in men. Future studies are needed to confirm and further explore the possibility of additional pathways through which ILD directly impacts limb muscle function and physical performance.
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Affiliation(s)
- Sabina A Guler
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada.,Department of Pulmonary Medicine, University Hospital and University of Bern, Bern, Switzerland
| | - Seo Am Hur
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Scott A Lear
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Pat G Camp
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, Canada. .,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada. .,St. Paul's Hospital, 1081 Burrard St, Ward 8B, Vancouver, BC, V6Z 1Y6, Canada.
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Brusca RM, Pinal-Fernandez I, Psoter K, Paik JJ, Albayda J, Mecoli C, Tiniakou E, Mammen AL, Christopher-Stine L, Danoff S, Johnson C. The ILD-GAP risk prediction model performs poorly in myositis-associated interstitial lung disease. Respir Med 2019; 150:63-65. [PMID: 30961952 DOI: 10.1016/j.rmed.2019.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/09/2019] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Myositis-associated interstitial lung disease (MA-ILD) is associated with increased mortality, but no prognostic model exists in this population. The ILD-GAP index was developed to predict mortality risk across all subtypes of chronic ILD. The purpose of this study was to validate the ILD-GAP risk prediction model in patients with MA-ILD. PROCEDURES We completed a retrospective cross-sectional study of patients enrolled in the Johns Hopkins Myositis Center database between 2006 and 2017. Cumulative mortality rates were estimated using the Kaplan-Meier test. Model calibration was determined by using standardized mortality ratios of observed versus expected deaths. MAIN FINDINGS 179 participants with MA-ILD were included. The mean baseline percent predicted forced vital capacity was 65.2 ± 20.6%, forced expiratory volume in the first second 65.4 ± 20.4%, and carbon monoxide diffusing capacity 61.6 ± 20.0%. Thirty-two participants died (17.9%). The ILD-GAP model had poor discriminative performance and calibration. CONCLUSIONS The ILD-GAP risk prediction model is a poor predictor of mortality among individuals with MA-ILD. The identification of a better predictive model for MA-ILD is needed to help guide care in this patient population.
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Affiliation(s)
- Rebeccah M Brusca
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA
| | - Iago Pinal-Fernandez
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA; National Institute of Arthritis and Musculoskeletal and Skin Disease, National Institute of Health, Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, 9000 Rockville Pike Building 50, Bethesda, MD, 20892, USA
| | - Kevin Psoter
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA
| | - Julie J Paik
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA
| | - Jemima Albayda
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA
| | - Christopher Mecoli
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA
| | - Eleni Tiniakou
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA
| | - Andrew L Mammen
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA; National Institute of Arthritis and Musculoskeletal and Skin Disease, National Institute of Health, Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, 9000 Rockville Pike Building 50, Bethesda, MD, 20892, USA
| | - Lisa Christopher-Stine
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA
| | - Sonye Danoff
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA
| | - Cheilonda Johnson
- Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 500, Baltimore, MD, 21224, USA.
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Wee YM, Lee HW, Choi MY, Jung HR, Choi JY, Kwon HW, Jung JH, Kim YH, Han DJ, Shin S. A composite of urinary biomarkers for differentiating between tubulo interstitial inflammation and interstitial fibrosis/tubular atrophy in kidney allografts. Ann Hepatobiliary Pancreat Surg 2018; 22:310-320. [PMID: 30588521 PMCID: PMC6295379 DOI: 10.14701/ahbps.2018.22.4.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 10/20/2018] [Accepted: 10/20/2018] [Indexed: 01/28/2023] Open
Abstract
Backgrounds/Aims Compared with a single urinary biomarker, a composite of multiple urinary biomarkers may be more helpful for differentiating tubulointerstitial inflammation from interstitial fibrosis/tubular atrophy (IFTA) in kidney allografts. Methods In this cross-sectional cohort study, we collected urine samples from 115 patients with for-cause biopsy, 53 patients with stable allografts, and 50 living kidney donors. We measured the urinary levels of transglutaminase 2 (TG2), syndecan-4 (SDC4), alpha 1 microglobulin (A1M), interferon-inducible protein 10 (IP-10), interleukin 6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1). Results The for-cause biopsy group showed significantly higher levels of logeTG2/Cr, logeA1M/Cr, logeIL-6/Cr, and logeMCP-1/Cr compared with other groups. In the for-cause biopsy group, logeTG2/Cr level was positively correlated with the severity of IFTA. After adjusting for age, sex, body mass index, diabetes, hypertension, cardiovascular disease, and the interval between kidney transplant and biopsy, TG2 and the interval between transplant and biopsy were significantly correlated variables for the severity of IFTA. Regarding tubulointerstitial inflammation, Body mass index, TG2, SDC4, and IP-10 were positively-correlated variables, and MCP-1 and the interval between transplant and biopsy were negatively-correlated variables. Conclusions Our results show that post-transplant urinary levels of TG2, SDC4, MCP-1 and IP-10 may be a useful biomarker for tubulointerstitial inflammation and IFTA.
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Affiliation(s)
- Yu-Mee Wee
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hae-Won Lee
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Monica Young Choi
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hey Rim Jung
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yoon Choi
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Wook Kwon
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joo Hee Jung
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Duck Jong Han
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Shin
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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