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Guler S, Hull NC, Arteta M, Allen-Rhoades W, Shahi M, Ishitani MB, Demirel N. An unusual case of metastatic trophoblastic neoplasm presenting with diffuse cystic lung disease and pulmonary artery pseudoaneurysms in a teenager. Pediatr Pulmonol 2024; 59:1482-1486. [PMID: 38390771 DOI: 10.1002/ppul.26936] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/07/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
Diffuse cystic lung diseases (DCLDs) are a diverse group of lung disorders characterized by the presence of multiple air filled cysts within the lung tissue. These cysts are thin walled and surrounded by normal lung tissue. In adults, DCLD can be associated with various conditions such as lymphangioleiomyomatosis (LAM), Langerhans cell histiocytosis, cancers, and more. In children, DCLD is often linked to lung developmental abnormalities, with bronchopulmonary dysplasia being a common cause. Patients with pulmonary cysts are typically asymptomatic, but some may experience mild symptoms or pneumothorax. While DCLD in children is rarely due to malignancy, metastatic lung disease can be a cause. It is important for clinicians to be aware of the possibility of metastatic lung disease when encountering DCLD.
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Affiliation(s)
- Sevim Guler
- Istanbul University-Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Nathan C Hull
- Division of Pediatric Radiology, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Manuel Arteta
- Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wendy Allen-Rhoades
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Maryam Shahi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael B Ishitani
- Division of Pediatric Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Nadir Demirel
- Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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2
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Mullin ML, Fernandez G, Marinescu DC, Zheng B, Wong AW, Assayag D, Fisher JH, Johannson KA, Khalil N, Kolb M, Manganas H, Marcoux V, Morisset J, Min B, Farrand E, Ryerson CJ. Impact of Antigen Exposure on Outcomes and Treatment Response in Fibrotic Hypersensitivity Pneumonitis. Chest 2023:S0012-3692(23)05933-0. [PMID: 38128609 DOI: 10.1016/j.chest.2023.12.019] [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: 10/06/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Patients with fibrotic hypersensitivity pneumonitis (fHP) are frequently treated with immunosuppression to slow lung function decline; however, the impact of this treatment has not been studied across different types of antigen exposure. RESEARCH QUESTION In patients with fHP, do disease outcomes and response to treatment vary by antigen type?. STUDY DESIGN AND METHODS A multicenter interstitial lung disease database (Canadian Registry for Pulmonary Fibrosis) was used to identify patients with fHP. The causative antigen was categorized as avian, mold, unknown, or other. Treatment was defined as mycophenolate ≥ 1,000 mg/d or azathioprine ≥ 75 mg/d for ≥ 30 days. Statistical analysis included t tests, χ2 tests, and one-way analysis of variance. Unadjusted and adjusted competing risks and Cox proportional hazards models were used to assess survival. RESULTS A total of 344 patients were identified with the following causative antigens: avian (n = 93; 27%), mold (n = 88; 26%), other (n = 15; 4%), and unknown (n = 148; 43%). Patient characteristics and lung function were similar among antigen groups with a mean FVC % predicted of 75 ± 20. The percent of patients treated with immunosuppression was similar between antigens with 58% of patients treated. There was no change in lung function or symptom scores with the initiation of immunosuppression in the full cohort. Immunosuppression was not associated with a change in survival for patients with avian or mold antigen (avian: hazard ratio, 0.41; 95% CI, 0.11-1.59; P = .20; mold: hazard ratio, 1.13; 95% CI, 0.26-4.97; P = .88). For patients with unknown causative antigen, survival was worse when treated with immunosuppression (hazard ratio, 2.65; 95% CI, 1.01-6.92; P = .047). INTERPRETATION Response to immunosuppression varies by antigen type in patients with fHP. Additional studies are needed to test the role of immunosuppression in fHP, and particularly in those with an unknown antigen.
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Affiliation(s)
- Monica L Mullin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gustavo Fernandez
- Luis Razetti School of Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Daniel-Costin Marinescu
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada; Centre for Lung Health, Vancouver General Hospital, Vancouver, BC, Canada
| | - Boyang Zheng
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Alyson W Wong
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Helene Manganas
- Département de Médecine, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Julie Morisset
- Département de Médecine, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Bohyung Min
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erica Farrand
- Department of Medicine, University California San Francisco, San Francisco, CA
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
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Schütz K, Schmidt A, Schwerk N, Renz DM, Gerard B, Schaefer E, Antal MC, Peters S, Griese M, Rapp CK, Engels H, Cremer K, Bergmann AK, Schmidt G, Auber B, Kamp JC, Laenger F, von Hardenberg S. Variants in FGF10 cause early onset of severe childhood interstitial lung disease: A detailed description of four affected children. Pediatr Pulmonol 2023; 58:3095-3105. [PMID: 37560881 DOI: 10.1002/ppul.26627] [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: 05/22/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION Fibroblast growth factor 10 (FGF10) is a signaling molecule with a well-established role for lung branching morphogenesis. Rare heterozygous, deleterious variants in the FGF10 gene are known causes of the lacrimo-auriculo-dento-digital (LADD) syndrome and aplasia of lacrimal and salivary glands. Previous studies indicate that pathogenic variants in FGF10 can cause childhood Interstitial Lung Disease (chILD) due to severe diffuse developmental disorders of the lung, but detailed reports on clinical presentation and follow-up of affected children are lacking. METHODS We describe four children with postnatal onset of chILD and heterozygous variants in FGF10, each detected by exome or whole genome sequencing. RESULTS All children presented with postnatal respiratory failure. Two children died within the first 2 days of life, one patient died at age of 12 years due to right heart failure related to severe pulmonary hypertension (PH) and one patient is alive at age of 6 years, but still symptomatic. Histopathological analysis of lung biopsies from the two children with early postpartum demise revealed diffuse developmental disorder representing acinar dysplasia and interstitial fibrosis. Sequential biopsies of the child with survival until the age of 12 years revealed alveolar simplification and progressive interstitial fibrosis. DISCUSSION Our report extends the phenotype of FGF10-related disorders to early onset chILD with progressive interstitial lung fibrosis and PH. Therefore, FGF10-related disorder should be considered even without previously described syndromic stigmata in children with postnatal respiratory distress, not only when leading to death in the neonatal period but also in case of persistent respiratory complaints and PH.
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Affiliation(s)
- Katharina Schütz
- Clinic for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Axel Schmidt
- Institute of Human Genetics, School of Medicine & University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Nicolaus Schwerk
- Clinic for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL), Munich, Germany
| | - Diane Miriam Renz
- Department of Pediatric Radiology, Hannover Medical School, Institute of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Benedicte Gerard
- Laboratoires de Diagnostic Génétique, Unité de génétique moléculaire, Nouvel Hôpital Civil, Strasbourg, Cedex, France
| | - Elise Schaefer
- Laboratoires de Diagnostic Génétique, Unité de génétique moléculaire, Nouvel Hôpital Civil, Strasbourg, Cedex, France
| | - Maria Cristina Antal
- UF6349 fœtopathologie, Département de Pathologie, Hôpitaux Universitaires, Strasbourg, France
| | - Sophia Peters
- Institute of Human Genetics, School of Medicine & University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Matthias Griese
- Department of Pediatric Pneumology, German Center for Lung Research (DZL), Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Christina K Rapp
- Department of Pediatric Pneumology, German Center for Lung Research (DZL), Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Hartmut Engels
- Institute of Human Genetics, School of Medicine & University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Kirsten Cremer
- Institute of Human Genetics, School of Medicine & University Hospital Bonn, University of Bonn, Bonn, Germany
| | | | - Gunnar Schmidt
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Bernd Auber
- Department of Human Genetics, Hannover Medical School, Hannover, Germany
| | - Jan C Kamp
- German Center for Lung Research (DZL), Munich, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Florian Laenger
- Hannover Medical School, Institute of Pathology, Hannover, Germany
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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [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: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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5
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Patel P, Anamika F, Ali R. Pulmonary Langerhans Cell Histiocytosis Masquerading as Lymphangioleiomyomatosis. Cureus 2023; 15:e38486. [PMID: 37273350 PMCID: PMC10237305 DOI: 10.7759/cureus.38486] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is an uncommon lung disease that affects young adults aged 20 to 40 years with current or prior history of smoking. The pathologic cell type in PLCH is a dendritic cell of the monocyte-macrophage line that resembles cutaneous Langerhans cells. This report presents the case of a 42-year-old woman with PLCH. We discuss her clinical symptoms, diagnostic tests, and treatment plan, with a specific focus on the radiologic features. The patient exhibited a radiologic appearance similar to that of lymphangiomyomatosis with histologic evidence of PLCH.
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Affiliation(s)
- Priya Patel
- Sleep Medicine, Hackensack Meridian Health Ocean University Medical Center, Brick Township, USA
| | - Fnu Anamika
- Internal Medicine, Hackensack Meridian Health Ocean University Medical Center, Brick Township, USA
| | - Rana Ali
- Pulmonary and Sleep Medicine, Hackensack Meridian Health Ocean University Medical Center, Brick Township, USA
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6
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McKnight L, Schultz A, Vidic N, Palmer EE, Jaffe A. Learning to make a difference for chILD: Value creation through network collaboration and team science. Pediatr Pulmonol 2023. [PMID: 36855907 DOI: 10.1002/ppul.26377] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
Addressing the recognized challenges and inequalities in providing high quality healthcare for rare diseases such as children's interstitial lung disease (chILD) requires collaboration across institutional, geographical, discipline, and system boundaries. The Children's Interstitial Lung Disease Respiratory Network of Australia and New Zealand (chILDRANZ) is an example of a clinical network that brings together multidisciplinary health professionals for collaboration, peer learning, and advocacy with the goal of improving the diagnosis and management of this group of rare and ultra-rare conditions. This narrative review explores the multifaceted benefits arising from social learning spaces within rare disease clinical networks by applying the value creation framework. The operation of the chILDRANZ network is used as an example across the framework to highlight how value is generated, realized, and transferred within such collaborative clinical and research networks. The community of practice formed in the chILDRANZ multidisciplinary meetings provides a strong example of social learning that engages with the uncertainty inherent in rare disease diagnosis and management and pays attention to generate new knowledge and best practice to make a difference for children and families living with chILD. This review underscores international calls for further investment in, and support of, collaborative clinical networks and virtual centers of excellence for rare disease.
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Affiliation(s)
- Lauren McKnight
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - André Schultz
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Nada Vidic
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
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7
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Chua WC, Chen IC, Liu YC, Wu YH, Lo SH, Hsu JH, Liang PI, Chen HL, Dai ZK. Congenital Surfactant C Deficiency with Pulmonary Hypertension-A Case Report. Children (Basel) 2022; 9:1435. [PMID: 36291368 PMCID: PMC9601149 DOI: 10.3390/children9101435] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Interstitial lung diseases in children are a diverse group in terms of etiology and pathogenesis. With advances in genetic testing, mutations in surfactant protein have now been identified as the etiology for childhood interstitial lung disease of variable onset and severity, ranging from fatal acute respiratory distress syndrome (RDS) in neonates to chronic lung disease in adults. We presented an 11-month-old girl with surfactant protein C deficiency and secondary pulmonary hypertension, successfully treated with hydroxychloroquine, and provided a detailed discussion of the clinical and diagnostic approach and management.
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Affiliation(s)
- Wei Chard Chua
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - I-Chen Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Ching Liu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Yen-Hsien Wu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Shih-Hsing Lo
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Jong-Hau Hsu
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Zen-Kong Dai
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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8
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Mathew JL, Kumar K, Singhal KK, Mathew PJ, Sodhi KS, Bhatia A, Bal A, Gupta N, Menon P, Attri SV, Singh M. Protein estimation in whole lung lavage fluid in hereditary pulmonary alveolar proteinosis due to a novel GM-CSF receptor mutation. Pediatr Pulmonol 2022; 57:1802-1805. [PMID: 35438839 DOI: 10.1002/ppul.25932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/14/2022] [Revised: 03/15/2022] [Accepted: 04/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Joseph L Mathew
- Pediatric Pulmonology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ketan Kumar
- Pediatric Pulmonology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal K Singhal
- Pediatric Pulmonology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethy J Mathew
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit S Sodhi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prema Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita V Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- Pediatric Pulmonology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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9
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Dhooria S, Maturu VN, Talwar D, Kumar S, Handa A, Agrawal PN, Jindal A, Tampi PS, Goyal A, Maskey D, Aggarwal AN, Behera D, Jindal SK. A multicenter survey study of antifibrotic use for symptomatic patients with post-COVID-19 interstitial lung abnormalities. Lung India 2022; 39:254-260. [PMID: 35488683 PMCID: PMC9200209 DOI: 10.4103/lungindia.lungindia_568_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Little data exist on antifibrotic drugs for treating symptomatic patients with persistent interstitial lung abnormalities in the postacute phase of coronavirus disease 2019 (COVID-19). Herein, we describe the physician practices of prescribing pirfenidone and nintedanib for these patients and the physician-assessed response. Materials and Methods: This was a multicenter, retrospective survey study of subjects administered pirfenidone or nintedanib for post-COVID-19 interstitial lung abnormalities. Data on the demographic details, comorbidities, abnormalities on the computed tomography (CT) of the chest, treatment, antifibrotic drug use, and physician-assessed response were collected on a standard case record pro forma. We explored physician practices of prescribing antifibrotics (primary objective) and the physician-assessed response (secondary objective). Results: We included 142 subjects (mean age, 55.9 years; 16.2% women) at eight centers. The most common abnormalities on CT chest included ground glass opacities (75.7%), consolidation (49.5%), reticulation (43.9%), and parenchymal bands (16.8%). Of the 5701 patients discharged after hospitalization at six centers, 115 (2.0%) received antifibrotics. The drugs were prescribed an average of 26 days after symptom onset. One hundred and sixteen subjects were administered pirfenidone; 11 (9.5%) received the full dose (2400 mg/day). Thirty subjects were prescribed nintedanib; 23 (76.7%) received the full dose (300 mg/day). Of 76 subjects with available information, 27 (35.6%) and 26 (34.2%) had significant or partial radiologic improvement, respectively, according to the physician’s assessment. Conclusions: Antifibrotic agents were administered to a minority of patients discharged after recovery from acute COVID-19 pneumonia. Larger, randomized studies on the efficacy and safety of these agents are required.
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Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | - Sachin Kumar
- Department of Pulmonary Medicine, Sakra World Hospital, Bengaluru, Karnataka, India
| | - Ajay Handa
- Department of Pulmonary Medicine, Sakra World Hospital, Bengaluru, Karnataka, India
| | - Priya Nath Agrawal
- Department of Pulmonary Medicine, Agrawal Hospital, Bhopal, Madhya Pradesh, India
| | | | - P S Tampi
- Bombay Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Abhishek Goyal
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Dipesh Maskey
- Department of Pulmonary Medicine, MMI Narayana Multispeciality Hospital, Raipur, Chhattisgarh, India
| | - Ashutosh Nath Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Fortis Hospital, Chandigarh, India
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Shaw NC, Kicic A, Fletcher S, Wilton SD, Stick SM, Schultz A. Primary Nasal Epithelial Cells as a Surrogate Cell Culture Model for Type-II Alveolar Cells to Study ABCA-3 Deficiency. Front Med (Lausanne) 2022; 9:827416. [PMID: 35265641 PMCID: PMC8899037 DOI: 10.3389/fmed.2022.827416] [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: 12/02/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
ATP Binding Cassette Subfamily A Member 3 (ABCA-3) is a lipid transporter protein highly expressed in type-II alveolar (AT-II) cells. Mutations in ABCA3 can result in severe respiratory disease in infants and children. To study ABCA-3 deficiency in vitro, primary AT-II cells would be the cell culture of choice although sample accessibility is limited. Our aim was to investigate the suitability of primary nasal epithelial cells, as a surrogate culture model for AT-II cells, to study ABCA-3 deficiency. Expression of ABCA3, and surfactant protein genes, SFTPB and SFTPC, was detected in primary nasal epithelial cells but at a significantly lower level than in AT-II cells. ABCA-3, SP-B, and SP-C were detected by immunofluorescence microscopy in primary nasal epithelial cells. However, SP-B and SP-C were undetectable in primary nasal epithelial cells using western blotting. Structurally imperfect lamellar bodies were observed in primary nasal epithelial cells using transmission electron microscopy. Functional assessment of the ABCA-3 protein demonstrated that higher concentrations of doxorubicin reduced cell viability in ABCA-3 deficient nasal epithelial cells compared to controls in an assay-dependent manner. Our results indicate that there may be a role for primary nasal epithelial cell cultures to model ABCA-3 deficiency in vitro, although additional cell culture models that more effectively recapitulate the AT-II phenotype may be required.
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Affiliation(s)
- Nicole C Shaw
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.,Wal-yan Respiratory Research Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Anthony Kicic
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.,Wal-yan Respiratory Research Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia.,Occupation and Environment, School of Public Health, Curtin University, Perth, WA, Australia
| | - Sue Fletcher
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Sciences, The University of Western Australia, Perth, WA, Australia.,Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia
| | - Stephen D Wilton
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Sciences, The University of Western Australia, Perth, WA, Australia.,Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, WA, Australia
| | - Stephen M Stick
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.,Wal-yan Respiratory Research Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Centre for Cell Therapy and Regenerative Medicine, School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - André Schultz
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.,Wal-yan Respiratory Research Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, WA, Australia
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11
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Martin SS, Kolaneci D, Wichmann JL, Lenga L, Leithner D, Vogl TJ, Jacobi V. Development and evaluation of a computer-based decision support system for diffuse lung diseases at high-resolution computed tomography. Acta Radiol 2022; 63:328-335. [PMID: 33657848 DOI: 10.1177/0284185121995799] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND High-resolution computed tomography (HRCT) is essential in narrowing the possible differential diagnoses of diffuse and interstitial lung diseases. PURPOSE To investigate the value of a novel computer-based decision support system (CDSS) for facilitating diagnosis of diffuse lung diseases at HRCT. MATERIAL AND METHODS A CDSS was developed that includes about 100 different illustrations of the most common HRCT signs and patterns and describes the corresponding pathologies in detail. The logical set-up of the software facilitates a structured evaluation. By selecting one or more CT patterns, the program generates a ranked list of the most likely differential diagnoses. Three independent and blinded radiology residents initially evaluated 40 cases with different lung diseases alone; after at least 12 weeks, observers re-evaluated all cases using the CDSS. RESULTS In 40 patients, a total of 113 HRCT patterns were evaluated. The percentage of correctly classified patterns was higher with CDSS (96.8%) compared to assessment without CDSS (90.3%; P < 0.01). Moreover, the percentage of correct diagnosis (81.7% vs. 64.2%) and differential diagnoses (89.2% vs. 38.3%) were superior with CDSS compared to evaluation without CDSS (both P < 0.01). CONCLUSION Addition of a CDSS using a structured approach providing explanations of typical HRCT patterns and graphical illustrations significantly improved the performance of trainees in characterizing and correctly identifying diffuse lung diseases.
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Affiliation(s)
- Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Delina Kolaneci
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Julian L Wichmann
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lukas Lenga
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Doris Leithner
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Volkmar Jacobi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
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12
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Zhu D, Shen Y, Huang J, Zhao L. Intravascular large B-cell lymphoma with diffuse ground glass lesion on chest computed tomography diagnosed using transbronchial lung cryobiopsy: a case report. Transl Cancer Res 2022; 10:4571-4576. [PMID: 35116313 PMCID: PMC8798442 DOI: 10.21037/tcr-21-769] [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: 05/04/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022]
Abstract
A 68-year-old man was presented with high fever of unknown origin for 3 weeks and non-productive cough for 1 week. A chest computed tomography (CT) scan revealed multiple nodules and ground glass opacities (GGO) in both lungs. The patient was initially diagnosed with hypersensitivity pneumonitis based on the result of bronchoalveolar lavage fluids (BALF). After treatment with methylprednisolone for 2 weeks, the patient’s fever recurred, with no resolution of lesions on chest CT. The patient consented to positron emission tomography (PET)/CT. It showed that fluorodeoxyglucose (FDG) metabolism was significantly increased in the spleen, whole skeleton, and both lungs, suggesting a malignant hematological disease. Large B-cell lymphoma was diagnosed by bone marrow puncture and flow cytometry. Transbronchial lung cryobiopsy was performed to evaluate the diffuse lung lesion. Hematoxylin-eosin (HE) staining showed diffuse infiltration of heterotypic cells in the pulmonary interstitial capillaries. Furthermore, immunohistochemical examination results suggested lung infiltration of B lymphohematopoietic system tumors. The patient was finally diagnosed as intravascular large B-cell lymphoma (IVLBCL). IVLBCL with diffuse lung ground glass lesions is very rare and difficult to diagnose. Transbronchial lung cryobiopsy, as an emerging procedure, plays an important role in the diagnosis of interstitial lung disease and has gained popularity for a lower complication rate and acquisition of more tissue samples.
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Affiliation(s)
- Dongyi Zhu
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Shen
- Department of Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianhao Huang
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liming Zhao
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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13
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Ugajin M, Kani H, Hattori H. Anticoagulant Use as an Independent Risk Factor and Higher In-Hospital Mortality in Patients Showing Alveolar Hemorrhage in Diffuse Lung Disease. ACTA ACUST UNITED AC 2021; 57:medicina57101094. [PMID: 34684131 PMCID: PMC8538906 DOI: 10.3390/medicina57101094] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 01/15/2023]
Abstract
Background and objectives: Bronchoalveolar lavage (BAL) is commonly performed to evaluate diffuse lung disease and occasionally to identify alveolar hemorrhage. However, the clinical impact of alveolar hemorrhage and its risk factors in patients with diffuse lung disease have not been clarified. Materials and Methods: We retrospectively analyzed the medical records of all patients who underwent BAL to evaluate diffuse lung disease from January 2017 to December 2020. Alveolar hemorrhage was defined as progressive hemorrhagic BAL fluid or the presence of ≥20% hemosiderin-laden macrophages in the BAL fluid. Logistic regression analysis was performed to assess the association between alveolar hemorrhage and other factors. Results: Sixty subjects were enrolled in this study. Alveolar hemorrhage was observed in 19 subjects (31.7%) with idiopathic interstitial pneumonia, acute respiratory distress syndrome, interstitial pneumonia with autoimmune features, drug-induced lung injury, eosinophilic pneumonia, adenocarcinoma, and systemic lupus erythematosus. The use of anticoagulants was a significant risk factor for alveolar hemorrhage (odds ratio 7.57, p = 0.049). Patients with alveolar hemorrhage required intubated mechanical ventilation more frequently (63.2% vs. 24.4%, p = 0.005) and had higher in-hospital mortality rates (26.3% vs. 4.9%, p = 0.028) than those without alveolar hemorrhage. Conclusions: Alveolar hemorrhage was observed in various etiologies. The use of anticoagulants was a significant risk factor for alveolar hemorrhage. Patients with alveolar hemorrhage showed more severe respiratory failure and had higher in-hospital mortality than those without alveolar hemorrhage.
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Affiliation(s)
- Motoi Ugajin
- Department of Respiratory Medicine, Nagoya Tokushukai General Hospital, 2-52 Kouzouji-cho Kita, Kasugai City 487-0016, Japan
- Department of Respiratory Medicine and Allergology, Aichi Medical University Hospital, Nagakute City 480-1195, Japan
- Correspondence: ; Tel.: +81-568-51-8711; Fax: +81-568-51-7115
| | - Hisanori Kani
- Department of Thoracic Surgery, Nagoya Tokushukai General Hospital, Kasugai City 487-0016, Japan;
| | - Hideo Hattori
- Department of Pathology, Nagoya Tokushukai General Hospital, Kasugai City 487-0016, Japan;
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14
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Yoshizumi Y, Tomioka H, Katsuyama E, Kawabata Y. Diffuse Pulmonary Ossification with Connective Tissue Weakness Potentially Due to Vascular Ehlers-Danlos Syndrome. Intern Med 2021; 60:2847-2851. [PMID: 33776002 PMCID: PMC8479231 DOI: 10.2169/internalmedicine.6673-20] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 30-year-old non-smoking man was referred to our hospital for the further examination of abnormal shadows revealed by chest X-ray. He had mild shortness of breath. Chest computed tomography revealed a fine-grained dendritic shadow with diffuse calcification in both lungs and as well as emphysematous changes in the upper lung lobes. A surgical lung biopsy histology revealed diffuse pulmonary ossification complicated with lung laceration, vascular disruption, hemosiderosis, and emphysema, suggesting vascular Ehlers-Danlos syndrome (vEDS). However, the patient had no external physical signs or family history of vEDS and no COL3A1 gene mutations. We are closely monitoring this patient in the clinic.
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Affiliation(s)
- Yuko Yoshizumi
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Japan
| | - Hiromi Tomioka
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Japan
| | - Eiji Katsuyama
- Department of Pathology, Kobe City Medical Center West Hospital, Japan
| | - Yoshinori Kawabata
- Division of Diagnostic Pathology, Saitama Prefectural Cardiovascular and Respiratory Center, Japan
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15
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Zhang Q, Li H, An Y, Cheng D, Sun G, Qi Y, Xuan W, Wang Z, Zhang X. Combination of the Archimedes Navigation System and cryobiopsy in diagnosis of diffuse lung disease. J Int Med Res 2021; 49:3000605211016665. [PMID: 34275377 PMCID: PMC8293853 DOI: 10.1177/03000605211016665] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of the Archimedes Navigation System (Broncus Medical, San Jose, CA, USA) for guidance during transbronchial cryobiopsy and the incidence of complications in patients with diffuse lung disease. METHODS High-resolution computed tomography and transbronchial cryobiopsy were used to evaluate eight patients with diffuse lung disease. The Archimedes Navigation System was used before cryobiopsy to obtain the best path with which to avoid large vessels. Three to five cryobiopsy specimens were taken from each sampled segment. RESULTS Preoperative planning using the Archimedes Navigation System was successfully performed on all eight patients. The probe-to-pleura distance was approximately 10 mm. No cases of pneumothorax occurred, one patient developed moderate bleeding, two developed minor bleeding, and five developed minimal bleeding that stopped spontaneously. A final diagnosis was obtained for seven patients, and ongoing follow-up was being conducted for the last patient at the time of this writing. CONCLUSIONS This is the first report of combining navigation technology with cryobiopsy to diagnose diffuse lung disease. The Archimedes Navigation System, which provides real-time guidance, is helpful in pre-cryobiopsy planning and diagnosis of diffuse lung disease. Moreover, this system can reduce the pneumothorax rate and bleeding risk by avoiding large vessels.
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Affiliation(s)
- Quncheng Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Huili Li
- Department of Medical Equipment, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Yunxia An
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Dongjun Cheng
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Guannan Sun
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Yong Qi
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Weixia Xuan
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Zheng Wang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, Henan, China
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16
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Dhooria S, Agarwal R, Sehgal IS, Prasad KT, Muth V, Garg M, Bal A, Aggarwal AN, Behera D. A real-world study of the dosing and tolerability of pirfenidone and its effect on survival in idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis 2020; 37:148-157. [PMID: 33093778 PMCID: PMC7569556 DOI: 10.36141/svdld.v37i2.8718] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/20/2020] [Indexed: 02/05/2023]
Abstract
Background: Patients with idiopathic pulmonary fibrosis (IPF) often do not tolerate pirfenidone in the recommended dose of 2400 mg/day. The proportion of patients requiring dose reduction and its impact on survival in the real-world remain unclear. Methods: Consecutive subjects with IPF were enrolled between March 2017 and June 2019. The maximum tolerated dose of pirfenidone (primary outcome) and adverse drug reactions (ADRs) were recorded. A post hoc logistic regression analysis was performed to evaluate the predictors of drug discontinuation due to ADRs. We also compared survival between the full-dose (2400 mg/day), reduced-dose (< 2400 mg/day), and the no-pirfenidone groups, with age and percentage of the predicted forced vital capacity (%pred FVC) as covariates. Results: Of the 128 subjects (mean age, 67.4 years; 77.3% men) included, 115 were initiated on pirfenidone. Forty-nine (42.6%) and 51 (44.3%) subjects tolerated the full dose and reduced doses, respectively. Ninety-six (83.5%) subjects developed at least one ADR; anorexia dyspepsia, and nausea being the most common. Twenty-two subjects discontinued the drug; 15 of them due to ADRs. Body mass index < 20 kg/m2 was the only predictor of drug discontinuation due to ADRs. Among subjects newly initiated on treatment during the study period (n = 80), survival was longer (hazard ratio [interquartile range], 0.19 [0.04-0.96]; p = 0.045) in the full-dose but not the reduced-dose group (p = 0.08) compared with the no-pirfenidone group, after adjusting for covariates. Conclusion: Pirfenidone was tolerated in the full dose in a minority of patients with IPF and appears to improve survival only with the full dose. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 148-157)
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Affiliation(s)
| | | | | | | | | | | | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Batzlaff C, Koroscil M. Nitrofurantoin-Induced Pulmonary Toxicity: Always Review the Medication List. Cureus 2020; 12:e9807. [PMID: 32953319 PMCID: PMC7494418 DOI: 10.7759/cureus.9807] [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] [Indexed: 11/06/2022] Open
Abstract
Use of nitrofurantoin for uncomplicated cystitis and recurrent urinary tract infections is common practice. While the majority of patients tolerate this medication without issue, it is important to be cognizant of adverse reactions, as these can impact patient’s quality of life. Nitrofurantoin-induced pulmonary toxicity is a rare side effect that can present with various clinical manifestations, imaging abnormalities, and pathologic findings. We describe a case of chronic pneumonitis in a patient on suppressive nitrofurantoin therapy presenting with dyspnea and hypoxemia.
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Affiliation(s)
- Caitlin Batzlaff
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Matt Koroscil
- Department of Pulmonary and Critical Care Medicine, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam Houston, USA
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18
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Saunders LC, Eaden JA, Bianchi SM, Swift AJ, Wild JM. Free breathing lung T 1 mapping using image registration in patients with idiopathic pulmonary fibrosis. Magn Reson Med 2020; 84:3088-3102. [PMID: 32557890 DOI: 10.1002/mrm.28342] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess the use of image registration for correcting respiratory motion in free breathing lung T1 mapping acquisition in patients with idiopathic pulmonary fibrosis (IPF). THEORY AND METHODS The method presented used image registration to synthetic images during postprocessing to remove respiratory motion. Synthetic images were generated from a model of the inversion recovery signal of the acquired images that incorporated a periodic lung motion model. Ten healthy volunteers and 19 patients with IPF underwent 2D Look-Locker T1 mapping acquisition at 1.5T during inspiratory breath-hold and free breathing. Eight healthy volunteers and seven patients with IPF underwent T1 mapping acquisition during expiratory breath-hold. Fourteen patients had follow-up scanning at 6 months. Dice similarity coefficient (DSC) was used to evaluate registration efficacy. RESULTS Image registration increased image DSC (P < .001) in the free breathing inversion recovery images. Lung T1 measured during a free breathing acquisition was lower in patients with IPF when compared with healthy controls (inspiration: P = .238; expiration: P = .261; free breathing: P = .021). Measured lung T1 was higher in expiration breath-hold than inspiration breath-hold in healthy volunteers (P < .001) but not in patients with IPF (P = .645). There were no other significant differences between lung T1 values within subject groups. CONCLUSIONS The registration technique significantly reduced motion in the Look-Locker images acquired during free breathing and may improve the robustness of lung T1 mapping in patients who struggle to hold their breath. Lung T1 measured during a free breathing acquisition was significantly lower in patients with IPF when compared with healthy controls.
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Affiliation(s)
- Laura C Saunders
- POLARIS, Imaging Sciences, Department of IICD, University of Sheffield, Sheffield, United Kingdom
| | - James A Eaden
- POLARIS, Imaging Sciences, Department of IICD, University of Sheffield, Sheffield, United Kingdom
| | - Stephen M Bianchi
- Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Andrew J Swift
- POLARIS, Imaging Sciences, Department of IICD, University of Sheffield, Sheffield, United Kingdom
| | - Jim M Wild
- POLARIS, Imaging Sciences, Department of IICD, University of Sheffield, Sheffield, United Kingdom
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Sweiss NJ, Korsten P, Syed HJ, Syed A, Baughman RP, Yee AMF, Culver DA, Sosenko T, Azuma A, Bonella F, Costabel U, Drake WP, Drent M, Lower EE, Israel-Biet D, Mostard RLM, Nunes H, Rottoli P, Spagnolo P, Wells AU, Wuyts WA, Judson MA. When the Game Changes: Guidance to Adjust Sarcoidosis Management During the Coronavirus Disease 2019 Pandemic. Chest 2020; 158:892-895. [PMID: 32360495 PMCID: PMC7189863 DOI: 10.1016/j.chest.2020.04.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Nadera J Sweiss
- Division of Rheumatology, University of Illinois at Chicago, Chicago, IL.
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | | | - Aamer Syed
- Department of Internal Medicine, VCU Health, Richmond, VA
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Arthur M F Yee
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY
| | - Daniel A Culver
- Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH
| | - Teresa Sosenko
- Division of Rheumatology, University of Illinois at Chicago, Chicago, IL
| | | | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Ruhrlandklinik, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Wonder P Drake
- Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN
| | - Marjolein Drent
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | | | - Remy L M Mostard
- Department of Respiratory Medicine, Zuyderland Medical Center, Heerlen/Sittard, The Netherlands
| | - Hilario Nunes
- Department of Pulmonology, Avicenne Hospital, Paris, France
| | - Paola Rottoli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Paolo Spagnolo
- Respiratory Disease Unit, University of Padova, Padova, Italy
| | | | - Wim A Wuyts
- Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY
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20
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Hafezi N, Heimberger MA, Lewellen KA, Maatman T, Montgomery GS, Markel TA. Lung biopsy in children's interstitial and diffuse lung disease: Does it alter management? Pediatr Pulmonol 2020; 55:1050-1060. [PMID: 32040887 DOI: 10.1002/ppul.24683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/28/2019] [Accepted: 01/27/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Pediatric patients with acute life-threatening consequences of interstitial and diffuse lung disease are often treated with empiric systemic corticosteroids, immune modulators, and/or broad antibiotic therapy. Histological evaluation of lung tissue represents the final necessary step in diagnosis-however, a definitive diagnosis may still remain elusive and medical therapies may not be changed following biopsy. We hypothesized that lung biopsy from pediatric patients with children's interstitial and diffuse lung disease (chILD) without a defined lesion on computed tomography (CT) imaging would guide diagnosis, but not substantially alter clinical management. METHODS After IRB approval, patients who underwent a lung biopsy at a single large children's hospital between 2013 and 2018 were retrospectively reviewed. Patients without a defined lesion were included. Demographics, length of stay, oxygen-requirements, steroid, unique number of immune modulators, and antibiotics prebiopsy and postbiopsy were reviewed. Nonparametric data were compared by the Mann Whitney U and Kruskal Wallace tests and expressed as median with interquartile range. Decision tree alterations were analyzed by t test. P < .05 was significant. RESULTS Sixty-four patients underwent lung biopsy during the period. Nineteen (30%) did not have a defined lesion on CT scan, and were included. A significant difference was seen between prebiopsy, 2 weeks, and 2 months postbiopsy prednisone dosing (P = .03), while the number of unique immune modulators, antibiotics, type of oxygen support and FiO2 were not significantly different before or after obtaining biopsy results. Pathology results provided additional information in 12 of 19 (63%) patients which resulted in management changes. CONCLUSIONS Lung biopsy in chILD may guide clinical management, especially influencing the management of steroid dosing. Although on aggregate the number of antibiotics, immune modulators, mode of oxygen support and FiO2 did not differ significantly before and after biopsy, the pathologic evaluation provided diagnostic information that led to a variety of changes in therapeutic management in greater than half of the population.
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Affiliation(s)
- Niloufar Hafezi
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mark A Heimberger
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kyle A Lewellen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Gregory S Montgomery
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
| | - Troy A Markel
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.,Riley Hospital for Children, Indiana University Health, Indianapolis, Indiana
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Weinberger M, Lesser D. Diffuse panbronchiolitis: A progressive fatal lung disease that is curable with azithromycin, but only if diagnosed! Pediatr Pulmonol 2019; 54:457-462. [PMID: 30609307 DOI: 10.1002/ppul.24226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/02/2018] [Accepted: 11/21/2018] [Indexed: 11/08/2022]
Abstract
Diffuse panbronchiolitis (DPB) is a rare progressive and eventually fatal pulmonary disease first identified in Japan and initially seen predominantly in Southeast Asia. Macrolide antibiotics rapidly reverse symptoms and pathology, and their use increased the 5 and 10-year survival from 50 and 30 percent, respectively, to over 90%. Review of 181 case reports from previous publications found patients with DPB commonly had their pulmonary symptoms preceded by rhinosinusitis, frequently by many years. Long delays in diagnosis for many years were common. The review further identified DPB in all ethnic groups and multiple areas outside of Southeast Asia. Although diagnosis was most commonly made in adults, 13% of the diagnoses were made in children and nine of the adult cases described onset in childhood. Few cases of relapse were reported, but extended periods of monitoring after treatment were not generally present.
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Affiliation(s)
- Miles Weinberger
- Visiting Clinical Professor of Pediatrics, University of California San Diego, Rady Children's Hospital, San Diego, California
| | - Daniel Lesser
- Associate Professor of Pediatrics, University of California San Diego, Rady Children's Hospital, San Diego, California
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22
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Affiliation(s)
- Keisuke Anan
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Japan
| | - Jumpei Hisanaga
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Japan
| | - Kodai Kawamura
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Japan
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23
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Sisman Y, Buchvald FF, Ring AM, Wassilew K, Nielsen KG. Long-Term Lung Function and Exercise Capacity in Postinfectious chILD. Pediatr Allergy Immunol Pulmonol 2019; 32:4-11. [PMID: 31032143 PMCID: PMC6484343 DOI: 10.1089/ped.2018.0973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/10/2019] [Indexed: 11/12/2022]
Abstract
Background: Severe postinfectious diffuse pulmonary disease may clinically mimic other entities of children's interstitial lung disease and is clinically challenging comprising various disease severities despite treatment. Long-term lung function trend and physical capacity in children with postinfectious diffuse pulmonary disease are rarely reported. We investigated trends in pulmonary function by long-term follow-up and assessed physical capacity in such patients. Methods: We performed a descriptive, single-center follow-up study in children with biopsy-verified postinfectious diffuse pulmonary disease. Patients with completed primary treatment course were eligible for follow-up, including pulmonary function and exercise (VO2peak) testing. Results: Thirty patients with postinfectious diffuse pulmonary disease were identified and included. Median (range) age at diagnose was 27.5 (2–172) months after a mean lag time of 23 months. H. influenzae and rhinovirus were the most frequent pathogens. Fifteen patients were available for follow-up after mean (range) 7.6 (2–15) years of treatment completion. Lung clearance index (LCI2.5), forced expiratory volume in 1 second (FEV1), and bronchodilator responsiveness were abnormal in 80%, 53%, and 44%, respectively. Diffusion capacity for monoxide was abnormal in 7% and total lung capacity in 33%. Only 8% demonstrated low VO2peak, while 40% reported difficulties during physical exertion. Longitudinal data on spirometry (n = 14) remained unchanged from end of treatment throughout follow-up. A significant association was found between zLCI2.5 and zFEV1 (multiple linear regression; r2 = 0.61; P = 0.0003). Conclusion: Postinfectious diffuse pulmonary disease in children carries a varying degree of chronic pulmonary impairment with onset of symptoms in the first months of life and a typical considerable lag time before diagnosis. Follow-up several years after the initial injury demonstrated moderate-to-severe peripheral airway impairment although no further lung function decline was found years after completion of treatment. Despite acceptable VO2peak, a considerable proportion struggled during heavy exercise.
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Affiliation(s)
- Yagmur Sisman
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frederik F Buchvald
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Astrid Madsen Ring
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katharina Wassilew
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim Gjerum Nielsen
- Danish chILD Centre, Paediatric Pulmonary Service, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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24
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Edahiro R, Kurebe H, Nakatsubo S, Hosono Y, Sawa N, Nishida K, Ohara Y, Oshitani Y, Kagawa H, Tsujino K, Yoshimura K, Miki K, Miki M, Kitada S, Mori M. Three Cases of Idiopathic Diffuse Pulmonary Ossification. Intern Med 2019; 58:545-551. [PMID: 30333390 PMCID: PMC6421151 DOI: 10.2169/internalmedicine.0929-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 11/23/2022] Open
Abstract
Diffuse pulmonary ossification (DPO) is an uncommon diffuse lung disease characterized by metaplastic bone formation in the lung parenchyma and is rarely diagnosed in life. While DPO usually occurs as a secondary disease, idiopathic cases are extremely rare. We describe three cases of idiopathic DPO, two of which were definitively diagnosed by surgical lung biopsy. One case was observed in a 43-year-old man with a history of recurrent pneumothorax who developed pneumothorax after the surgical biopsy. Few reports have described cases of DPO with recurrent pneumothorax; however, pneumothorax should be considered as a potential complication when such patients are encountered.
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Affiliation(s)
- Ryuya Edahiro
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Hiroyuki Kurebe
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Saeko Nakatsubo
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Yuki Hosono
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Nobuhiko Sawa
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Kohei Nishida
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Yuko Ohara
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Yohei Oshitani
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Hiroyuki Kagawa
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Kazuyuki Tsujino
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Kenji Yoshimura
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Keisuke Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Mari Miki
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Seigo Kitada
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
| | - Masahide Mori
- Department of Respiratory Medicine, National Hospital Organization Toneyama National Hospital, Japan
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25
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Burrage LC, Guillerman RP, Das S, Singh S, Schady DA, Morris SA, Walkiewicz M, Schecter MG, Heinle JS, Lotze TE, Lalani SR, Mallory GB. Lung Transplantation for FLNA-Associated Progressive Lung Disease. J Pediatr 2017; 186:118-123.e6. [PMID: 28457522 PMCID: PMC5534178 DOI: 10.1016/j.jpeds.2017.03.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 11/23/2016] [Revised: 01/10/2017] [Accepted: 03/17/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe a series of patients with pathogenic variants in FLNA and progressive lung disease necessitating lung transplantation. STUDY DESIGN We conducted a retrospective chart review of 6 female infants with heterozygous presumed loss-of-function pathogenic variants in FLNA whose initial presentation was early and progressive respiratory failure. RESULTS Each patient received lung transplantation at an average age of 11 months (range, 5-15 months). All patients had pulmonary arterial hypertension and chronic respiratory failure requiring tracheostomy and escalating levels of ventilator support before transplantation. All 6 patients survived initial lung transplantation; however, 1 patient died after a subsequent heart-lung transplant. The remaining 5 patients are living unrestricted lives on chronic immunosuppression at most recent follow-up (range, 19 months to 11.3 years post-transplantation). However, in all patients, severe ascending aortic dilation has been observed with aortic regurgitation. CONCLUSIONS Respiratory failure secondary to progressive obstructive lung disease during infancy may be the presenting phenotype of FLNA-associated periventricular nodular heterotopia. We describe a cohort of patients with progressive respiratory failure related to a pathogenic variant in FLNA and present lung transplantation as a viable therapeutic option for this group of patients.
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Affiliation(s)
- Lindsay C. Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine,Texas Children’s Hospital
| | | | - Shailendra Das
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine
| | - Shipra Singh
- Division of Pulmonology, Department of Pediatrics, State University of New York - Buffalo
| | | | - Shaine A. Morris
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine
| | | | - Marc G. Schecter
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati School of Medicine
| | - Jeffrey S. Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine
| | - Timothy E. Lotze
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine
| | - Seema R. Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine,Texas Children’s Hospital
| | - George B. Mallory
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine
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26
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Bromley S, Vizcaya D. Pulmonary hypertension in childhood interstitial lung disease: A systematic review of the literature. Pediatr Pulmonol 2017; 52:689-698. [PMID: 27774750 DOI: 10.1002/ppul.23632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 06/30/2016] [Revised: 09/30/2016] [Accepted: 10/05/2016] [Indexed: 12/16/2022]
Abstract
Childhood interstitial lung disease (chILD) comprises a wide heterogeneous group of rare parenchymal lung disorders associated with substantial morbidity and mortality. Pulmonary hypertension is a common comorbidity in adults with interstitial lung disease (ILD) and associated with poor survival. We aimed to systematically review the literature regarding the occurrence of pulmonary hypertension (PH) in chILD, its effect on prognosis and healthcare use, and its treatment in clinical practice. Searches of PubMed and EMBASE databases (up to February 2016), and American Thoracic Society conference abstracts (2009-2015) were conducted using relevant keywords. References from selected articles and review papers were scanned to identify further relevant articles. A total of 20 articles were included; estimates of PH in chILD ranged from 1% to 64% with estimates among specific chILD entities ranging from 0% to 43%. Comparisons between studies were limited by differences in the study populations, including the size, age range, and heterogeneous composition of the ILD case series in terms of the nature and severity of the clinical entities, and also the methods used to diagnose PH. Three studies found that among patients with chILD, those with PH had a significantly higher risk (up to sevenfold) of death compared with those without PH. Information on the treatment of pulmonary hypertension in chILD or the effect of PH on healthcare use was not available. Data on the use and effectiveness of treatments for pulmonary hypertension in chILD are required to address this area of unmet need. Pediatr Pulmonol. 2017;52:689-698. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Susan Bromley
- EpiMed Communications Ltd, 121 South Avenue, Abingdon, Oxford, OX14 1QS, United Kingdom.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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27
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Abstract
Hypersensitivity pneumonitis (HSP) is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary.
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Affiliation(s)
| | - Andréa Gimenez
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
| | - Lilian Kuranishi
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
| | - Karin Storrer
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
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28
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Raoof S, Bondalapati P, Vydyula R, Ryu JH, Gupta N, Raoof S, Galvin J, Rosen MJ, Lynch D, Travis W, Mehta S, Lazzaro R, Naidich D. Cystic Lung Diseases: Algorithmic Approach. Chest 2016; 150:945-965. [PMID: 27180915 DOI: 10.1016/j.chest.2016.04.026] [Citation(s) in RCA: 78] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 02/16/2016] [Accepted: 04/06/2016] [Indexed: 12/14/2022] Open
Abstract
Cysts are commonly seen on CT scans of the lungs, and diagnosis can be challenging. Clinical and radiographic features combined with a multidisciplinary approach may help differentiate among various disease entities, allowing correct diagnosis. It is important to distinguish cysts from cavities because they each have distinct etiologies and associated clinical disorders. Conditions such as emphysema, and cystic bronchiectasis may also mimic cystic disease. A simplified classification of cysts is proposed. Cysts can occur in greater profusion in the subpleural areas, when they typically represent paraseptal emphysema, bullae, or honeycombing. Cysts that are present in the lung parenchyma but away from subpleural areas may be present without any other abnormalities on high-resolution CT scans. These are further categorized into solitary or multifocal/diffuse cysts. Solitary cysts may be incidentally discovered and may be an age related phenomenon or may be a remnant of prior trauma or infection. Multifocal/diffuse cysts can occur with lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, tracheobronchial papillomatosis, or primary and metastatic cancers. Multifocal/diffuse cysts may be associated with nodules (lymphoid interstitial pneumonia, light-chain deposition disease, amyloidosis, and Langerhans cell histiocytosis) or with ground-glass opacities (Pneumocystis jirovecii pneumonia and desquamative interstitial pneumonia). Using the results of the high-resolution CT scans as a starting point, and incorporating the patient's clinical history, physical examination, and laboratory findings, is likely to narrow the differential diagnosis of cystic lesions considerably.
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Affiliation(s)
| | | | | | | | - Nishant Gupta
- Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati
| | | | - Jeff Galvin
- Department of Radiology, University of Maryland
| | - Mark J Rosen
- Pulmonary, Critical Care and Sleep Medicine, North Shore University Hospital
| | - David Lynch
- Department of Radiology, National Jewish Health
| | - William Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center
| | | | - Richard Lazzaro
- Department of Thoracic Surgery, Lenox Hill Hospital, Northwell Health
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29
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Kitazawa H, Kure S. Interstitial Lung Disease in Childhood: Clinical and Genetic Aspects. Clin Med Insights Circ Respir Pulm Med 2015; 9:57-68. [PMID: 26512209 PMCID: PMC4603523 DOI: 10.4137/ccrpm.s23282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 12/16/2022]
Abstract
Interstitial lung disease (ILD) in childhood is a heterogeneous group of rare pulmonary conditions presenting chronic respiratory disorders. Many clinical features of ILD still remain unclear, making the treatment strategies mainly investigative. Guidelines may provide physicians with an overview on the diagnosis and therapeutic directions. However, the criteria used in different clinical studies for the classification and diagnosis of ILDs are not always the same, making the development of guidelines difficult. Advances in genetic testing have thrown light on some etiologies of ILD, which were formerly classified as ILDs of unknown origins. The need of genetic testing for unexplained ILD is growing, and new classification criteria based on the etiology should be adopted to better understand the disease. The purpose of this review is to give an overview of the clinical and genetic aspects of ILD in children.
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Affiliation(s)
- Hiroshi Kitazawa
- Department of General Pediatrics, Division of Allergy, Miyagi Children's Hospital, Sendai, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
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30
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O'Reilly R, Kilner D, Ashworth M, Aurora P. Diffuse lung disease in infants less than 1 year of age: Histopathological diagnoses and clinical outcome. Pediatr Pulmonol 2015; 50:1000-8. [PMID: 25603783 DOI: 10.1002/ppul.23124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 08/07/2013] [Revised: 08/18/2014] [Accepted: 09/28/2014] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Interstitial lung disease (ILD) in infants is rare. Clinical and radiological features are often non-specific, and overlap with growth disorders and infection. In infants with severe respiratory compromise, lung biopsy is often necessary to guide acute management, but the risk and diagnostic yield of this procedure is incompletely understood. AIMS To retrospectively review infants undergoing open lung biopsy for suspected ILD at a large referral center; to determine morbidity and mortality related to the procedure; and to describe subsequent diagnosis and outcome. METHODS Lung biopsies performed in infants (aged <1 year) between January 1, 2005 and March 31, 2012 were identified and clinical data were collected. Biopsies were reclassified using the ChILD classification for diffuse lung disorders in infants. RESULTS Twenty-seven infants were identified, with the number of biopsies performed increasing each year over the study period. There was no mortality and negligible morbidity associated with biopsy. Diagnoses seen were similar to those reported by the ChILD network. Histopathological diagnosis was not compatible with life in the absence of lung transplant in 6/27 (22%) of infants. Of the 14 children longitudinally followed up (median 0.5 (0.4 - 5.81) years), only four continued to require supplemental oxygen. CONCLUSION Lung biopsy in infants with suspected ILD is safe, and histopathological diagnosis frequently assists treatment decisions, particularly with regard to withdrawal of care.
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Affiliation(s)
- Ruth O'Reilly
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - David Kilner
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Michael Ashworth
- Department of Pathology, Great Ormond Street Hospital for Children, London, UK
| | - Paul Aurora
- Department of Paediatric Respiratory Medicine, Great Ormond Street Hospital for Children, London, UK.,Portex Respiratory Unit, UCL Institute of Child Health, London, UK
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31
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Lord A, Shapiro AJ, Saint-Martin C, Claveau M, Melançon S, Wintermark P. Filamin A mutation may be associated with diffuse lung disease mimicking bronchopulmonary dysplasia in premature newborns. Respir Care 2014; 59:e171-7. [PMID: 25053830 DOI: 10.4187/respcare.02847] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 11/05/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a common long-term complication in premature newborns requiring ventilatory support and is the most common cause of chronic diffuse lung disease in this population. We present the clinical course of a premature newborn with a complicated neonatal respiratory course that was initially thought to be related to BPD, but it did not respond to the typical therapies for this condition. Due to the findings of periventricular nodular heterotopia, the diagnosis of a filamin A gene mutation was eventually made, which explained the respiratory pathology of this patient. When time of onset and clinical course do not correlate with typical BPD, one should consider alternative diagnoses in premature infants, including neonatal diffuse lung disease.
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Affiliation(s)
| | - Adam J Shapiro
- Division of Pediatric Respirology, Department of Pediatrics
| | | | | | - Serge Melançon
- Division of Genetics, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
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32
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Hamvas A, Deterding R, Balch WE, Schwartz DA, Albertine KH, Whitsett JA, Cardoso WV, Kotton DN, Kourembanas S, Hagood JS. Diffuse lung disease in children: summary of a scientific conference. Pediatr Pulmonol 2014; 49:400-9. [PMID: 23798474 PMCID: PMC4145861 DOI: 10.1002/ppul.22805] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 01/03/2013] [Accepted: 02/24/2013] [Indexed: 12/14/2022]
Abstract
A multi-disciplinary scientific conference focused on diffuse and interstitial lung diseases in children was held in La Jolla, CA in June 2012. The conference brought together clinicians (including Pediatric and Adult Pulmonologists, Neonatologists, Pathologists, and Radiologists), clinical researchers, basic scientists, government agency representatives, patient advocates, as well as children affected by diffuse lung disease (DLD) and their families, to review recent scientific developments and emerging concepts in the pathophysiology of childhood DLD. Invited speakers discussed translational approaches, including genetics and proteomics, epigenetics and epigenomics, models of DLD, including animal models and induced pluripotent stem cells, and regenerative medicine approaches. The presentations of the invited speakers are summarized here.
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Affiliation(s)
- Aaron Hamvas
- Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri
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33
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Manna A, Caffarelli C, Varini M, Dascola CP, Montella S, Maglione M, Sperlì F, Santamaria F. Clinical application of exhaled nitric oxide measurement in pediatric lung diseases. Ital J Pediatr 2012; 38:74. [PMID: 23273317 PMCID: PMC3545741 DOI: 10.1186/1824-7288-38-74] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/19/2012] [Indexed: 12/18/2022] Open
Abstract
Fractional exhaled nitric oxide (FeNO) is a non invasive method for assessing the inflammatory status of children with airway disease. Different ways to measure FeNO levels are currently available. The possibility of measuring FeNO levels in an office setting even in young children, and the commercial availability of portable devices, support the routine use of FeNO determination in the daily pediatric practice. Although many confounding factors may affect its measurement, FeNO is now widely used in the management of children with asthma, and seems to provide significantly higher diagnostic accuracy than lung function or bronchial challenge tests. The role of FeNO in airway infection (e.g. viral bronchiolitis and common acquired pneumonia), in bronchiectasis, or in cases with diffuse lung disease is less clear. This review focuses on the most recent advances and the current clinical applications of FeNO measurement in pediatric lung disease.
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Affiliation(s)
- Angelo Manna
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Carlo Caffarelli
- Department of Pediatrics, University Hospital of Parma, Parma, Italy
| | - Margherita Varini
- Department of Pediatrics, University Hospital of Parma, Parma, Italy
| | | | - Silvia Montella
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Marco Maglione
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Francesco Sperlì
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Francesca Santamaria
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
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