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Gowa MA, Abidi SMA, Chandio B, Nawaz H. Case report of a child with spontaneous pneumomediastinum and subcutaneous emphysema. J Int Med Res 2023; 51:3000605231200269. [PMID: 37747498 PMCID: PMC10524063 DOI: 10.1177/03000605231200269] [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: 03/22/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Hamman's syndrome is a rare clinical entity that presents with spontaneous pneumomediastinum and subcutaneous emphysema. It is most commonly diagnosed in young men and pregnant women, and is rare in children. We report the case of a female toddler who presented to an emergency department with fever, cough and shortness of breath. Imaging studies revealed subcutaneous emphysema and pneumomediastinum. The patient was diagnosed with Hamman's syndrome after ruling out other possibilities. We discuss the underlying mechanisms of the disease, the diagnostic criteria and the treatment options. The purpose of this case report is to improve clinicians' awareness of the existence of this rare clinical entity in paediatric patients.
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Affiliation(s)
- Murtaza Ali Gowa
- Paediatric Critical Care Medicine, National Institute of Child Health, Karachi, Pakistan
- Paediatric Intensive Care Unit , National Institute of Child Health, Karachi, Pakistan
| | | | - Bakhtawer Chandio
- Paediatric Intensive Care Unit, National Institute of Child Health, Karachi, Pakistan
| | - Hira Nawaz
- Paediatric Intensive Care Unit, National Institute of Child Health, Karachi, Pakistan
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Bortoluzzi EM, White BJ, Schmidt PH, Mancke MR, Brown RE, Jensen M, Lancaster PA, Larson RL. Epidemiological Factors Associated with Gross Diagnosis of Pulmonary Pathology in Feedyard Mortalities. Vet Sci 2023; 10:522. [PMID: 37624309 PMCID: PMC10459163 DOI: 10.3390/vetsci10080522] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Respiratory disease continues to be the major cause of mortality in feedyard cattle, with bronchopneumonia (BP) and acute interstitial pneumonia (AIP) as the two most common syndromes. Recent studies described a combination of these pathological lesions with the presence of AIP in the caudodorsal lungs and BP in the cranioventral lungs of necropsied cattle. This pulmonary pathology has been described as bronchopneumonia with an interstitial pneumonia (BIP). The epidemiological characteristics of BIP in U.S. feedyard cattle are yet to be described. This study's objectives were to describe the agreement between feedyard clinical and necropsy gross diagnosis and to characterize epidemiological factors associated with four gross pulmonary diagnoses (AIP, BIP, BP, and Normal pulmonary tissue) observed during feedyard cattle necropsies. Systemic necropsies were performed at six feedyards in U.S. high plains region, and gross pulmonary diagnoses were established. Historical data were added to the dataset, including sex, days on feed at death (DOFDEATH), arrival weight, treatment count, and feedyard diagnosis. Generalized linear models were used to evaluate epidemiological factors associated with the probability of each pulmonary pathology. Comparing feedyard clinical diagnosis with gross pathological diagnosis revealed relatively low agreement and the frequency of agreement varied by diagnosis. The likelihood of AIP at necropsy was higher for heifers than steers and in the 100-150 DOFDEATH category compared with the 0-50 DOFDEATH (p = 0.05). The likelihood of BIP increased after the first treatment, whereas the DOFDEATH 0-50 category had a lower likelihood compared with the 150-200 category (p = 0.05). These findings highlight the importance of necropsy for final diagnosis and can aid the development of future diagnosis and therapeutic protocols for pulmonary diseases.
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Affiliation(s)
- Eduarda M. Bortoluzzi
- Department of Anatomy and Physiology, Kansas State University, Manhattan, KS 66506, USA;
- Beef Cattle Institute, Kansas State University, Manhattan, KS 66506, USA; (P.H.S.); (M.R.M.); (R.E.B.); (M.J.); (P.A.L.); (R.L.L.)
| | - Brad J. White
- Beef Cattle Institute, Kansas State University, Manhattan, KS 66506, USA; (P.H.S.); (M.R.M.); (R.E.B.); (M.J.); (P.A.L.); (R.L.L.)
| | - Paige H. Schmidt
- Beef Cattle Institute, Kansas State University, Manhattan, KS 66506, USA; (P.H.S.); (M.R.M.); (R.E.B.); (M.J.); (P.A.L.); (R.L.L.)
| | - Maddie R. Mancke
- Beef Cattle Institute, Kansas State University, Manhattan, KS 66506, USA; (P.H.S.); (M.R.M.); (R.E.B.); (M.J.); (P.A.L.); (R.L.L.)
| | - Rachel E. Brown
- Beef Cattle Institute, Kansas State University, Manhattan, KS 66506, USA; (P.H.S.); (M.R.M.); (R.E.B.); (M.J.); (P.A.L.); (R.L.L.)
| | - Makenna Jensen
- Beef Cattle Institute, Kansas State University, Manhattan, KS 66506, USA; (P.H.S.); (M.R.M.); (R.E.B.); (M.J.); (P.A.L.); (R.L.L.)
| | - Phillip A. Lancaster
- Beef Cattle Institute, Kansas State University, Manhattan, KS 66506, USA; (P.H.S.); (M.R.M.); (R.E.B.); (M.J.); (P.A.L.); (R.L.L.)
| | - Robert L. Larson
- Beef Cattle Institute, Kansas State University, Manhattan, KS 66506, USA; (P.H.S.); (M.R.M.); (R.E.B.); (M.J.); (P.A.L.); (R.L.L.)
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Bortoluzzi EM, Schmidt PH, Brown RE, Jensen M, Mancke MR, Larson RL, Lancaster PA, White BJ. Image Classification and Automated Machine Learning to Classify Lung Pathologies in Deceased Feedlot Cattle. Vet Sci 2023; 10. [PMID: 36851417 DOI: 10.3390/vetsci10020113] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Bovine respiratory disease (BRD) and acute interstitial pneumonia (AIP) are the main reported respiratory syndromes (RSs) causing significant morbidity and mortality in feedlot cattle. Recently, bronchopneumonia with an interstitial pattern (BIP) was described as a concerning emerging feedlot lung disease. Necropsies are imperative to assist lung disease diagnosis and pinpoint feedlot management sectors that require improvement. However, necropsies can be logistically challenging due to location and veterinarians' time constraints. Technology advances allow image collection for veterinarians' asynchronous evaluation, thereby reducing challenges. This study's goal was to develop image classification models using machine learning to determine RS diagnostic accuracy in right lateral necropsied feedlot cattle lungs. Unaltered and cropped lung images were labeled using gross and histopathology diagnoses generating four datasets: unaltered lung images labeled with gross diagnoses, unaltered lung images labeled with histopathological diagnoses, cropped images labeled with gross diagnoses, and cropped images labeled with histopathological diagnoses. Datasets were exported to create image classification models, and a best trial was selected for each model based on accuracy. Gross diagnoses accuracies ranged from 39 to 41% for unaltered and cropped images. Labeling images with histopathology diagnoses did not improve average accuracies; 34-38% for unaltered and cropped images. Moderately high sensitivities were attained for BIP (60-100%) and BRD (20-69%) compared to AIP (0-23%). The models developed still require fine-tuning; however, they are the first step towards assisting veterinarians' lung diseases diagnostics in field necropsies.
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Cheng F, Lu T, Wang Y, Yuan D, Wei Z, Li Y, Li J, Tang R. Expression of airway smooth muscle contractile proteins in children with acute interstitial pneumonia. Int J Exp Pathol 2022; 103:190-197. [PMID: 35527237 PMCID: PMC9482355 DOI: 10.1111/iep.12443] [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: 12/07/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022] Open
Abstract
The purpose of the present study was to investigate the expression of α-SMA and SM22α in airway smooth muscle (ASM) of bronchioles from children younger than 14 years who died of acute interstitial pneumonia (AIP). This is based upon the hypothesis that as contractile marker proteins α-SMA and SM22α can serve as an index of the overcontractile phenotype of ASM that is seen in AIP. Lung tissue samples of children were obtained from autopsies and divided into the AIP group (55.9% male and 44.1% female, between 0.4 and 132 months old, n = 34) and the control group (60% male and 40% female, between 2 and 156 months old, n = 10). We recorded the post-mortem interval (PMI), height, clinical symptoms and abdominal fat thickness (AFT) of each case. Haematoxylin-and-eosin-stained sections were used to examine the luminal area and observe the morphological changes in the bronchioles. Immunohistochemistry and Masson's trichrome staining were used to detect the expression of contractile marker proteins and the degree of pulmonary fibrosis respectively. Compared with the control group, the luminal areas of bronchioles in the AIP group were smaller (p < .001). The expression differences in α-SMA and SM22α between the two groups were statistically significant (p = .01 and p = .02 respectively). Also, there was no significant correlation of the contractile marker proteins expression with PMI, height, clinical symptoms and AFT. The collagen deposition difference in lung between the two groups was not statistically significant (p = .224). These findings suggest that enhancement of ASM contractile function appears to be involved in the death mechanism of children with AIP, which affords more insights into the understanding of AIP.
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Affiliation(s)
- Fang Cheng
- Department of Forensic Medicine, Faculty of Basic Medical ScienceChongqing Medical UniversityChongqingChina
| | - Tao Lu
- Department of Forensic Medicine, Faculty of Basic Medical ScienceChongqing Medical UniversityChongqingChina
| | - Yicheng Wang
- Department of Forensic Medicine, Faculty of Basic Medical ScienceChongqing Medical UniversityChongqingChina
| | - Didi Yuan
- Department of Forensic Medicine, Faculty of Basic Medical ScienceChongqing Medical UniversityChongqingChina
| | - Zehong Wei
- Department of Forensic Medicine, Faculty of Basic Medical ScienceChongqing Medical UniversityChongqingChina
| | - Yongguo Li
- Department of Forensic Medicine, Faculty of Basic Medical ScienceChongqing Medical UniversityChongqingChina
| | - Jianbo Li
- Department of Forensic Medicine, Faculty of Basic Medical ScienceChongqing Medical UniversityChongqingChina
| | - Renkuan Tang
- Department of Forensic Medicine, Faculty of Basic Medical ScienceChongqing Medical UniversityChongqingChina
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Haydock LAJ, Fenton RK, Sergejewich L, Squires EJ, Caswell JL. Acute interstitial pneumonia and the biology of 3-methylindole in feedlot cattle. Anim Health Res Rev 2022; 23:72-81. [PMID: 35833480 DOI: 10.1017/S1466252322000020] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Acute interstitial pneumonia (AIP) of cattle has been recognized for many decades. While the pathogenesis and risk factors for this condition in pastured cattle are relatively well characterized, there remains a poor understanding of the disease as it occurs in intensively fed cattle such as in beef feedlots. Specifically, in pastured cattle, AIP results from excessive ruminal production of the pneumotoxicant 3-methylindole (3-MI). In feedlot cattle, the evidence to substantiate the role of 3-MI is comparatively deficient and further investigations into the cause, pathogenesis, and control are sorely needed. This review highlights our current understanding of AIP with a focus on the disease as it occurs in feedlot cattle. Additionally, it illustrates the need for further work in understanding the specific animal factors (e.g. the ruminal microbiome, and the role of concurrent diseases), management factors (e.g. animal stocking and vaccination protocols), and dietary factors (e.g. dietary supplements) that may impact the development of AIP and which are relatively unique to the feedlot setting. All stakeholders in the beef industry stand to benefit from a greater understanding of what remains a pressing yet poorly understood issue in beef production.
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Abstract
Hamman-Rich syndrome is a rapidly progressive interstitial lung disease with acute respiratory distress syndrome physiology. It carries a grave prognosis and a high early mortality rate. It is often distinguished from other similar pulmonary pathologies based on the clinical course, laboratory findings, bronchoalveolar lavage testing, and pathology report. We detail a 77-year-old lady with no prior pulmonary disease, smoking history, or occupational and environmental exposures present to the emergency department found to be in acute hypoxic respiratory failure with impressive progressive radiographic findings. The presumptive diagnosis of Hamman-Rich syndrome was made based on a combination of factors after ruling out other similar clinical entities, especially in the setting of an ongoing COVID-19 pandemic.
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Affiliation(s)
- Qian Zhang
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Ahmad Raza
- Internal Medicine, Abington Hospital- Jefferson Health, Abington, USA
| | - Vincent Chan
- Internal Medicine, Abington Hospital- Jefferson Health, Abington, USA
| | - Artem Minalyan
- Internal Medicine, Abington Hospital- Jefferson Health, Abington, USA
| | - John Madara
- Pulmonary and Critical Care, Abington Hospital- Jefferson Health, Abington, USA
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Sakamoto N, Ishimoto H, Nakashima S, Yura H, Miyamura T, Okuno D, Hara A, Kitazaki T, Kakugawa T, Ishimatsu Y, Satoh M, Mukae H. Clinical Features of Anti-MDA5 Antibody-positive Rapidly Progressive Interstitial Lung Disease without Signs of Dermatomyositis. Intern Med 2019; 58:837-841. [PMID: 30449789 PMCID: PMC6465029 DOI: 10.2169/internalmedicine.1516-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Indexed: 11/17/2022] Open
Abstract
Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody is associated with rapidly progressive interstitial lung disease (RP-ILD) in patients with clinically amyopathic dermatomyositis (CADM) or dermatomyositis (DM). We herein report three Japanese cases of anti-MDA5 antibody-positive RP-ILD without signs of CADM or DM. High-resolution computed tomography revealed patchy or subpleural distribution of consolidations and/or ground-glass opacities accompanied by traction bronchiectasis. All patients succumbed to respiratory failure within two months. Anti-MDA5 antibody-positive RP-ILD without signs of CADM or DM should be included in the differential diagnosis of acute/subacute ILD. Measurement of anti-MDA5 antibody and an intensive immunosuppressive regimen might rescue these patients from RP-ILD.
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Affiliation(s)
- Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shota Nakashima
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hirokazu Yura
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takuto Miyamura
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Daisuke Okuno
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsuko Hara
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takeshi Kitazaki
- Department of Respiratory Medicine, The Japanese Red Cross Nagasaki Genbaku Hospital, Japan
| | - Tomoyuki Kakugawa
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yuji Ishimatsu
- Department of Cardiopulmonary Rehabilitation Science, Unit of Rehabilitation Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Chen L, Tang RZ, Ruan J, Zhu XB, Yang Y. Up-regulation of THY1 attenuates interstitial pulmonary fibrosis and promotes lung fibroblast apoptosis during acute interstitial pneumonia by blockade of the WNT signaling pathway. Cell Cycle 2019; 18:670-681. [PMID: 30829553 DOI: 10.1080/15384101.2019.1578144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Acute interstitial pneumonia (AIP) is an idiopathic pulmonary disease featuring rapid progressive dyspnea and respiratory failure. These symptoms typically develop within several days or weeks in patients without any pre-existing lung disease or external chest disease. Thymocyte differentiation antigen-1 (THY1) has been reported to have an effect on lung fibroblast proliferation and fibrogenic signaling. In this study, the mechanism of THY1 in AIP in influencing pulmonary fibrosis in terms of lung fibroblast proliferation and apoptosis was examined. An AIP mouse model with the pathological changes of lung tissues observed was established to identify the role of THY1 in the pathogenesis of AIP. The expression of THY1, a key regulator of the WNT pathway β-catenin and fibroblasts markers MMP-2, Occludin, α-SMA and Vimentin were determined. Lung fibroblasts of mice were isolated, in which THY1 expression was altered to identify roles THY1 plays in cell viability and apoptosis. A TOP/TOPflash assay was utilized to determine the activation of WNT pathway. Decrement of pulmonary fibrosis was achieved through THY1 up-regulation. The expression of MMP-2, Occludin, α-SMA, Vimentin and β-catenin, and the extent of β-catenin phosphorylation, significantly decreased, thereby indicating that THY1 overexpression inactivated WNT. Cell proliferation was inhibited and apoptosis was accelerated in lung fibroblasts transfected with vector carrying overexpressed THY1. Altogether, this study defines the potential role of THY1 in remission of AIP, via the upregulation of THY1, which renders the WNT pathway inactive. This inactivation of the WNT signaling pathway could alleviate pulmonary fibrosis by reducing lung fibroblast proliferation in AIP. Abbreviations: AIP: Acute interstitial pneumonia; ILDs: interstitial lung diseases; DAD: diffuse alveolar damage; SPF: specific-pathogen-free; NC: negative control; HCMV: human cytomegalovirus; HE: Hematoxylin-eosin; RIPA: radio-immunoprecipitation assay; SDS-PAGE: sodium dodecyl sulfate-polyacrylamide gel electrophoresis; BSA: bovine serum albumin; HRP: horseradish peroxidase; ECL: electrochemiluminescence; FBS: fetal bovine serum; DMSO: dimethyl sulfoxide; OD: optical density.
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Affiliation(s)
- Lin Chen
- a Department of Respiratory and Critical Care Medicine , Sichuan Academy of Medical Sciences & Sichuan Province People's Hospital , Chengdu , P.R. China
| | - Rong-Zhen Tang
- b Department of Aged Infectious Diseases , Sichuan Academy of Medical Sciences & Sichuan Province People's Hospital , Chengdu , P.R. China
| | - Jia Ruan
- c Department of Respiratory Diseases , Sichuan West China Hospital Geriatric Center-Fifth People's Hospital of Sichuan Province , Chengdu , P.R. China
| | - Xiao-Bo Zhu
- d Department of Respiratory Diseases , Ziyang City People's Hospital , Ziyang , P.R. China
| | - Yang Yang
- a Department of Respiratory and Critical Care Medicine , Sichuan Academy of Medical Sciences & Sichuan Province People's Hospital , Chengdu , P.R. China
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Vieira A, Vale A, Melo N, Caetano Mota P, Jesus J, Cunha R, Guimarães S, Souto Moura C, Morais A. Organizing pneumonia revisited: insights and uncertainties from a series of 67 patients. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35:129-138. [PMID: 32476892 PMCID: PMC7170093 DOI: 10.36141/svdld.v35i2.6860] [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] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/08/2018] [Indexed: 12/23/2022]
Abstract
Background: Organizing pneumonia (OP) is classified as an acute/subacute pneumonia according to the American Thoracic Society/European Respiratory Society statement (2013 update). Although its clinical presentation, radiologic and histologic features are well established, data on the relevance of potential causes, corticosteroid doses and length, or management of relapses are based on heterogeneous series of patients. Objectives: The aims of this study were to describe clinical presentation, diagnosis and treatment of OP, explore potential causes, discuss strategies for managing relapses, and analyze prognostic factors. We also discuss our findings in relation to relevant data in the literature. Methods: We performed a cross-sectional study of all patients diagnosed with OP at a tertiary referral center in northern Portugal between 2008 and 2015. Results: Sixty-seven patients were diagnosed with OP over the 7-year study period. Dyspnea and cough were the most common presenting symptoms and approximately 30% of patients were hospitalized at the time of diagnosis. Approximately half of the patients were receiving drugs described as potential causes of OP. Microorganisms were isolated in approximately one-third of patients. Other potential causes identified were hematologic disorders, neoplasms, connective tissue diseases, myelodysplastic syndromes, immunodeficiencies, radiotherapy, and bird exposure. Cryptogenic OP was diagnosed in just 16 patients (23.8%). Corticosteroids were the most common treatment and 11 patients (16.4%) experienced relapse. Conclusions: The findings for this series of patients confirm the extreme variability of the contexts in which OP can occur and suggest that rather than a distinct, homogeneous clinicopathologic entity, OP is a non-specific reaction whose outcomes are dependent on the cause. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 129-138).
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Affiliation(s)
- A.L. Vieira
- Pulmonology Department, Hospital de Braga, Braga, Portugal
| | - A. Vale
- Pulmonology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - N. Melo
- Pulmonology Department and Diffuse Lung Diseases Study Group, Centro Hospitalar de São João, Porto, Portugal
| | - P. Caetano Mota
- Pulmonology Department and Diffuse Lung Diseases Study Group, Centro Hospitalar de São João, Porto, Portugal
- Faculdade de Medicina do Porto, Universidade do Porto, Porto, Portugal
| | - J.M. Jesus
- Radiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - R. Cunha
- Radiology Department, Centro Hospitalar de São João, Porto, Portugal
| | - S. Guimarães
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - C. Souto Moura
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
| | - A. Morais
- Pulmonology Department and Diffuse Lung Diseases Study Group, Centro Hospitalar de São João, Porto, Portugal
- Pathology Department, Centro Hospitalar de São João, Porto, Portugal
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Sehgal IS, Agarwal R, Dhooria S, Prasad KT, Aggarwal AN, Behera D. Acute respiratory failure due to diffuse parenchymal lung diseases in a respiratory intensive care unit of North India. Sarcoidosis Vasc Diffuse Lung Dis 2018; 35:363-370. [PMID: 32476924 PMCID: PMC7170122 DOI: 10.36141/svdld.v35i4.7066] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 11/02/2022]
Abstract
Background: Acute respiratory failure (ARF) due to diffuse parenchymal lung diseases (DPLDs) is associated with high mortality. Whether ARF due to acute interstitial pneumonia (AIP), idiopathic pulmonary fibrosis (IPF) and non-IPF DPLDs behaves differently remains unclear. Methods: A retrospective analysis of consecutive DPLD subjects with ARF admitted to respiratory intensive care unit (RICU). The baseline clinical, demographic characteristics, cause of ARF and mortality were compared between the groups. Results: 145 (5.8% of RICU admission) subjects (mean [SD] age, 51.6 [14.7] years, 406% males) with DPLD-related ARF (17 AIP; 32 IPF; 96 non-IPF DPLD) were admitted. Common causes of ARF were acute exacerbation of the underlying DPLD (n=59, 40.4%) followed by infections (n=48, 37.5%). There was no difference in the peak, plateau and driving pressures across groups. The mortality rate was 45.5% (66/145) and was highest in AIP (82%) followed by IPF (59%) and non-IPF DPLD (34%). On multivariate logistic regression analysis, baseline APACHE II score, PaO2:FiO2 ratio, delta SOFA, and the use of invasive mechanical ventilation were independent predictors of mortality. The type of underlying DPLD however, did not affect survival. Conclusions: DPLD-related ARF is an uncommon cause of admission even in a RICU, and is associated with a high mortality. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 363-370).
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Affiliation(s)
- Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
A wide variety of insults can produce acute lung damage, inclusive of those that injure the lungs directly. The clinical syndrome of acute onset respiratory distress, dyspnea, and bilateral infiltrates is referred to as acute respiratory distress syndrome. The histologic counterpart of acute respiratory distress syndrome is diffuse alveolar damage, classically characterized by hyaline membranes. Other histologic features of acute lung injury include intraalveolar fibrin, organization, interstitial edema, and reactive pneumocytes. Diffuse alveolar damage and other histologic features of acute lung injury are nonspecific as to etiology, and once identified require the pathologist to search the biopsy for further features that may help identify a specific etiology. This chapter reviews the temporal sequence of acute lung injury and explores the large variety of specific etiologic causes with emphasis on helpful histologic features to identify.
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Taniguchi H, Kondoh Y. Acute and subacute idiopathic interstitial pneumonias. Respirology 2016; 21:810-20. [PMID: 27123874 DOI: 10.1111/resp.12786] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 11/30/2015] [Revised: 02/07/2016] [Accepted: 02/09/2016] [Indexed: 12/12/2022]
Abstract
Idiopathic interstitial pneumonias (IIPs) may have an acute or subacute presentation, or acute exacerbation may occur in a previously subclinical or unrecognized chronic IIP. Acute or subacute IIPs include acute interstitial pneumonia (AIP), cryptogenic organizing pneumonia (COP), nonspecific interstitial pneumonia (NSIP), acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) and AE-NSIP. Interstitial lung diseases (ILDs) including connective tissue disease (CTD) associated ILD, hypersensitivity pneumonitis, acute eosinophilic pneumonia, drug-induced lung disease and diffuse alveolar haemorrhage need to be differentiated from acute and subacute IIPs. Despite the severe lack of randomized controlled trials for the treatment of acute and subacute IIPs, the mainstream treatment remains corticosteroid therapy. Other potential therapies reported in the literature include corticosteroids and immunosuppression, antibiotics, anticoagulants, neutrophil elastase inhibitor, autoantibody-targeted treatment, antifibrotics and hemoperfusion therapy. With regard to mechanical ventilation, patients in recent studies with acute and subacute IIPs have shown better survival than those in previous studies. Therefore, a careful value-laden decision about the indications for endotracheal intubation should be made for each patient. Noninvasive ventilation may be beneficial to reduce ventilator associated pneumonia.
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Affiliation(s)
- Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
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Della Latta V, Cabiati M, Rocchiccioli S, Del Ry S, Morales MA. The role of the adenosinergic system in lung fibrosis. Pharmacol Res 2013; 76:182-9. [PMID: 23994158 DOI: 10.1016/j.phrs.2013.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 06/06/2013] [Revised: 08/05/2013] [Accepted: 08/14/2013] [Indexed: 12/15/2022]
Abstract
Adenosine (ADO) is a retaliatory metabolite that is expressed in conditions of injury or stress. During these conditions ATP is released at the extracellular level and is metabolized to adenosine. For this reason, adenosine is defined as a "danger signal" for cells and organs, in addition to its important role as homeostatic regulator. Its physiological functions are mediated through interaction with four specific transmembrane receptors called ADORA1, ADORA2A, ADORA2B and ADORA3. In the lungs of mice and humans all four adenosine receptors are expressed with different roles, having pro- and anti-inflammatory roles, determining bronchoconstriction and regulating lung inflammation and airway remodeling. Adenosine receptors can also promote differentiation of lung fibroblasts into myofibroblasts, typical of the fibrotic event. This last function suggests a potential involvement of adenosine in the fibrotic lung disease processes, which are characterized by different degrees of inflammation and fibrosis. Idiopathic pulmonary fibrosis (IPF) is the pathology with the highest degree of fibrosis and is of unknown etiology and burdened by lack of effective treatments in humans.
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Key Words
- 1-deoxy-1,6[[(3-iodophenyl)methyl]amino]-9H-purin-9yl-N-methyl-B-d-ribofuronamide
- 1-propyl-8-p-sulfophenulxanthine
- 2 hexynyl-5′-N ethylcarboxamidoadenosine
- 2-(2-phenyl)ethynyl-N-ethylcarboxamido-adenosine
- 2-CI-IB MECA
- 2-chloro-N6-cyclopentyladenosine
- 2-cloro-N6-(3-iodobenzyl)-adenosine-50-N methyluronamide
- 2-methyl-6-phenyl-4-phenylethynyl-1,4-dihydro-pyridine-3,5-dicarboxylicacid-3-ethyl ester-5-(4-nitro-benzyl)ester
- 2-p-(2-carboxyethyl) phenethylamino-50-N-ethyl-carboxamidoadenosine
- 2-phenyl hydroxypropynyl-5′-N-ethylcarboxamido adenosine phosphoinositide 3
- 3-ethyl-1-propyl-8-(1-(3-(trifluoromethyl) benzyl)-1H-pyrazol-4-yl)-1H-purine-2,6(3H,7H)-dione
- 3-ethyl-5-benzyl-2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate
- 3-propyl-6-ethyl-5-[(ethylthio)carbonyl]-2-phenyl-4-propyl-3-pyridinecarboxylate
- 4-(2-[7-amino-2-(2-furyl)-{1,2,4}-triazolo{2,3-a}{1,3,5}triazin-5-ylamino]ethyl)pieno
- 5-[[(4-methoxyphenyl)amino]carbonyl]amino-8-methyl-2-(2-furyl)pyra-zolo[4,3-e]1,2,4-triazolo[1,5-c]pyrimidine
- 7-methyl-[11C]-(E)-8-(3-bromostyryl)-3,7-dimethyl-1-propargylxanthin
- 8-[4-[[[[(2-aminoethyl)amino]carbonyl]methyl]oxy]phenyl]-l,3-dipropylxanthine
- 8-cyclopentyl-1,3-dipropylxanthine
- 9-chloro-2-(2-furanyl)-5-[(phenylacetyl) amino] [1,2,4]-triazolo[1,5-c]quinazoline
- 9-chloro-2-(2-furanyl)-[1,2,4]triazolo[1,5-c]quinazolin-5-amine
- A(1)R
- A(2A)R
- A(2B)R
- A(3)R
- AB-MECA
- ADA
- ADO
- ADORA 1 receptor
- ADORA 2A receptor
- ADORA 2B receptor
- ADORA 3 receptor
- ADP
- AIP
- AK
- AMP
- ARs
- ATP
- Adenosine
- Adenosine receptors
- Bleomycin
- CCPA
- CD39
- CD73
- CGS 15943
- CGS21680
- CHA
- CNS
- CNT-1
- CNT-2
- COP
- COPD
- CPA
- CVT6883
- DAG
- DIP
- DPCPX
- E-8-(3,4-dimethoxystyryl)-1,3-dipropyl-7-methylxanthine
- ECM
- ENT-1
- ENT-2
- ET-1
- FITC
- HE-NECA
- IB-MECA
- IIPs
- ILD
- INO
- IPF
- Idiopathic pulmonary fibrosis
- KF17837
- LIP
- Lung disease
- MAP
- MRE3008-F207
- MRS 1191
- MRS 1220
- MRS 1334
- MRS 1523
- MRS 1754
- N-(4-cyanophenyl)-2-[4-(2,3,6,7-tetrahydro-2,6-dioxo-1,3-dipropyl-1H-purin-8-yl)-phenoxy]acetamide
- N-ethylcarboxamido-adenosine
- N6-(2-phenylisopropyl)adenosine
- N6-(4-aminobenzyl)-adenosine-5′-N-methyluronamidedihydrochloride
- N6-cyclohexyl adenosine
- N6-cyclopentyladenosine
- NECA
- NSPI
- PAH
- PENECA
- PHPNECA
- PIA
- PKC
- PLA2
- PLC
- PLD
- PSB1115
- RB-ILD
- ROS
- SCH-58261
- UIP
- XAC
- ZM 241385
- [11C]BS-DMPX
- [7-(2-phenylethyl)-5-amino-2-(2-furyl)-pyrazolo-(4,3-e)-1,2,4-triazolo(1,5-c) pyrimidine]
- acute interstitial pneumonia
- adenosine
- adenosine deaminase
- adenosine diphosphate
- adenosine kinase
- adenosine monophosphate
- adenosine receptors
- adenosine triphosphate
- cAMP
- central nervous system
- chronic obstructive pulmonary diseases
- concentrative nucleoside transporters-1
- concentrative nucleoside transporters-2
- cryptogenic organizing pneumonia
- cyclic adenosine monophosphate
- desquamative interstitial pneumonia
- diacylglycerol
- ecto-5′-nucleotidase
- ectonucleoside triphosphate diphosphohydrolase
- endothelin 1
- equilibrative nucleoside transporters-1
- equilibrative nucleoside transporters-2
- extracellular matrix
- fluorescein isothiocyanate
- idiopathic interstitial pneumonias
- idiopathic pulmonary fibrosis
- inosine
- interstitial lung disease
- lymphocytic interstitial pneumonia
- mitogen-activated protein
- nonspecific interstitial pneumonia
- phospholipase A2
- phospholipase C
- phospholipase D
- protein kinase C
- pulmonary arterial hypertension
- reactive oxygen specie
- respiratory bronchiolitis-associated interstitial lung disease
- usual interstitial pneumonia
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