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Sreter KB, Jakopovic M, Janevski Z, Samarzija M, Zarogoulidis P, Kioumis I, Mparmpetakis N, Pataka A, Zarogoulidis K, Tsiouda T, Kosmidis C, Mpaka S, Huang H, Hohenforst-Schmidt W, Charalampidis C, Machairiotis N, Zaric B, Milovancev A. A pilot study-is there a role for mitoxantrone pleurodesis in the management of pleural effusion due to lung cancer? Ann Transl Med 2016; 4:162. [PMID: 27275475 DOI: 10.21037/atm.2016.04.15] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of malignant pleural effusion (MPE). Management of MPEs remains a clinical challenge due to recurrence and poor quality of life. An ideal sclerosing agent has yet to be found. The aim of this cohort pilot study was to evaluate the role of mitoxantrone pleurodesis (MP) as an alternative to talc sclerotherapy for managing MPEs in lung cancer patients. METHODS A retrospective chart review was conducted on consecutively admitted patients with MPE to the Department of Post-Intensive Care at the Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, in Croatia. RESULTS Of 34 patients with MPE, twenty-one (64.8±9.46 years; 47-84 years) with primary lung carcinoma who received MP (30 mg of mitoxantrone) between December 2003 and February 2009 were included in this study. Chest radiographs taken prior to sclerotherapy and at 1-, 2-, and 3-month follow-up were compared. At the post-sclerotherapy evaluation periods, overall success (OS) rates of MP were 88.2% [17.6%, complete response (CR); 70.6%, partial response (PR)], 53.9% (7.7% CR; 46.2% PR), and 45.5% (PR), respectively. Kaplan-Meier median survival from MP until death was 5.2 months, while that from diagnosis of primary lung cancer was 12.3 months. CONCLUSIONS MP may be a safe and effective method of managing MPE due to lung cancer. Future randomized controlled studies comparing mitoxantrone and talc pleurodesis in lung cancer patients are warranted to elucidate whether a significant difference exists between these agents. Factors affecting success, survival probability, and quality of life also require further investigation.
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Affiliation(s)
- Katherina-Bernadette Sreter
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Marko Jakopovic
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Zoran Janevski
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Miroslav Samarzija
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Paul Zarogoulidis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ioannis Kioumis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Mparmpetakis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Athanasia Pataka
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Konstantinos Zarogoulidis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Theodora Tsiouda
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Christoforos Kosmidis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Sofia Mpaka
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Haidong Huang
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Wolfgang Hohenforst-Schmidt
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Charalampos Charalampidis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nikolaos Machairiotis
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Bojan Zaric
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandar Milovancev
- 1 Department of Clinical Immunology, Pulmonology, and Rheumatology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia ; 2 Department of Post-Intensive Care, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, University of Zagreb, Faculty of Medicine, Zagreb, Croatia ; 3 Department of Thoracic Surgery, Clinic for Respiratory Diseases "Jordanovac", University Hospital Centre Zagreb, Zagreb, Croatia ; 4 Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 5 Thoracic Surgery Department, Theagenio Cancer Hospital, Thessaloniki, Greece ; 6 University Surgery Department, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 7 Oncology Department, "Interbalkan" European Medical Center, Thessaloniki, Greece ; 8 Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai 200003, China ; 9 Medical Clinic I, "Fuerth'' Hospital, University of Erlangen, Fuerth, Germany ; 10 Department of Anatomy, Democritus University of Thrace, Alexandroupolis, Greece ; 11 Obstetric - Gynecology Department, "Thriassio" General Hospital of Athens, George Genimata, Athens, Greece ; 12 Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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