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Kates J, Stricker CT, Rising KL, Gentsch AT, Solomon E, Powers V, Salcedo VJ, Worster B. Perspectives from patients with chronic lung disease on a telehealth-facilitated integrated palliative care model: a qualitative content analysis study. BMC Palliat Care 2024; 23:103. [PMID: 38637806 PMCID: PMC11027367 DOI: 10.1186/s12904-024-01433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Chronic lung disease affects nearly 37 million Americans and often results in significant quality of life impairment and healthcare burden. Despite guidelines calling for palliative care (PC) integration into pulmonary care as a vital part of chronic lung disease management, existing PC models have limited access and lack scalability. Use of telehealth to provide PC offers a potential solution to these barriers. This study explored perceptions of patients with chronic lung disease regarding a telehealth integrated palliative care (TIPC) model, with plans to use findings to inform development of an intervention protocol for future testing. METHODS For this qualitative study, we conducted semi-structured interviews between June 2021- December 2021 with patients with advanced chronic lung disease. Interviews explored experiences with chronic lung disease, understanding of PC, and perceived acceptability of the proposed model along with anticipated facilitators and barriers of the TIPC model. We analyzed findings with a content analysis approach. RESULTS We completed 20 interviews, with two that included both a patient and caregiver together due to patient preference. Perceptions were primarily related to three categories: burden of chronic lung disease, pre-conceived understanding of PC, and perspective on the proposed TIPC model. Analysis revealed a high level of disease burden related to chronic lung disease and its impact on day-to-day functioning. Although PC was not well understood, the TIPC model using a shared care planning approach via telehealth was seen by most as an acceptable addition to their chronic lung disease care. CONCLUSIONS These findings emphasize the need for a patient-centered, shared care planning approach in chronic lung disease. The TIPC model may be one option that may be acceptable to individuals with chronic lung disease. Future work includes using findings to refine our TIPC model and conducting pilot testing to assess acceptability and utility of the model.
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Affiliation(s)
- Jeannette Kates
- College of Nursing, Thomas Jefferson University, 901 Walnut Street, Suite 702, Philadelphia, PA, 19107, USA.
| | - Carrie Tompkins Stricker
- College of Nursing, Thomas Jefferson University, 901 Walnut Street, Suite 702, Philadelphia, PA, 19107, USA
- Canopy Cancer Collective, P.O. Box 3141, Saratoga, CA, 95070, USA
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Ellen Solomon
- Department of Internal Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Victoria Powers
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Venise J Salcedo
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 925 Chestnut Street, Suite 420A, Philadelphia, PA, USA
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Aimo A, Tono I, Benelli E, Morfino P, Panichella G, Damone AL, Speltri MF, Airò E, Monti S, Passino C, Lazzarini M, De Rosis S, Nuti S, Morelli MS, Evangelista C, Poletti R, Emdin M, Bergamasco M. The Fondazione Toscana Gabriele Monasterio app: a digital health system to improve wellbeing of inpatients with heart or lung disease. J Cardiovasc Med (Hagerstown) 2024; 25:294-302. [PMID: 38305137 DOI: 10.2459/jcm.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND An app providing material for education and entertaining is a possible way to support patients and healthcare providers in achieving person-centered care. METHODS An app tailored on the Fondazione Toscana Gabriele Monasterio (FTGM), a research hospital treating cardiac and lung disorders, was created. A pilot evaluation project was conducted on consecutive patients hospitalized for heart or lung disorders. Patients were asked to complete an assessment questionnaire. RESULTS The FTGM app provides information on diagnostic and therapeutic investigations, hospital and healthcare personnel, and includes content for entertainment and learning. It was tested on 215 consecutive patients (75% men, 66% aged >60 years, and 40% with a primary or middle school degree). Sixty-nine percentage of patients used the FTGM app, including 67% of patients aged >80 years and 65% of those with an elementary education (65%). Patients gave positive feedback on the app layout. Many (76%) looked for information on doctors and nurses in the 'People' section. Sixty-five percent of responders had used at least one of the sections called 'Music' and 'Museum visits'. The app helped many patients perceive the hospital as a more liveable place (68%), and to feel less anxious (76%), and more engaged in the diagnostic and therapeutic workup (65%). Overall, the majority of responders (87%) rated the app as 'excellent' or 'good', and almost all (95%) would have recommended other patients to use the app. CONCLUSIONS The FTGM app is a possible tool to improve patient wellbeing during hospitalization.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | - Ilaria Tono
- Fondazione Toscana Gabriele Monasterio
- Istituto di Management e Sanità
| | | | - Paolo Morfino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
| | - Giorgia Panichella
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
| | | | | | | | | | - Claudio Passino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | | | - Sabina De Rosis
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Istituto di Management e Sanità
| | - Sabina Nuti
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Istituto di Management e Sanità
| | | | - Chiara Evangelista
- Istituto di Intelligenza Meccanica, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | - Massimo Bergamasco
- Istituto di Intelligenza Meccanica, Scuola Superiore Sant'Anna, Pisa, Italy
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Frost F, Lip GYH. Cardiorespiratory Multimorbidity in People Living With Chronic Lung Disease: Challenges, Opportunities, and a Concept for Optimization via an Integrated Care Approach. Chest 2024; 165:500-502. [PMID: 38461015 DOI: 10.1016/j.chest.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 03/11/2024] Open
Affiliation(s)
- Freddy Frost
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, England; Department of Respiratory Medicine, Liverpool Heart & Chest Hospital, Liverpool, England.
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, England; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Danhaive O, Galambos C, Lakshminrusimha S, Abman SH. Pulmonary Hypertension in Developmental Lung Diseases. Clin Perinatol 2024; 51:217-235. [PMID: 38325943 DOI: 10.1016/j.clp.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Diverse genetic developmental lung diseases can present in the neonatal period with hypoxemic respiratory failure, often associated with with pulmonary hypertension. Intractable hypoxemia and lack of sustained response to medical management should increase the suspicion of a developmental lung disorder. Genetic diagnosis and lung biopsy are helpful in establishing the diagnosis. Early diagnosis can result in optimizing management and redirecting care if needed. This article reviews normal lung development, various developmental lung disorders that can result from genetic abnormalities at each stage of lung development, their clinical presentation, management, prognosis, and differential diagnoses.
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Affiliation(s)
- Olivier Danhaive
- Division of Neonatology, Saint-Luc University Hospital, UCLouvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium; Department of Pediatrics, University of California San Francisco, 530 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Csaba Galambos
- Department of Pathology and Laboratory Medicine, University of Colorado Anschutz School of Medicine, 13001 East 17th Place, Aurora, CO 80045, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics, University of California, UC Davis Children's Hospital, 2516 Stockton Boulevard, Sacramento CA 95817, USA
| | - Steven H Abman
- Department of Pediatrics, The Pediatric Heart Lung Center, University of Colorado Anschutz Medical Campus, Mail Stop B395, 13123 East 16th Avenue, Aurora, CO 80045, USA
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Tirelli C, Rondinone O, Italia M, Mira S, Belmonte LA, De Grassi M, Guido G, Maggioni S, Mondoni M, Miozzo MR, Centanni S. The Genetic Basis, Lung Involvement, and Therapeutic Options in Niemann-Pick Disease: A Comprehensive Review. Biomolecules 2024; 14:211. [PMID: 38397448 PMCID: PMC10886890 DOI: 10.3390/biom14020211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Niemann-Pick Disease (NPD) is a rare autosomal recessive disease belonging to lysosomal storage disorders. Three types of NPD have been described: NPD type A, B, and C. NPD type A and B are caused by mutations in the gene SMPD1 coding for sphingomyelin phosphodiesterase 1, with a consequent lack of acid sphingomyelinase activity. These diseases have been thus classified as acid sphingomyelinase deficiencies (ASMDs). NPD type C is a neurologic disorder due to mutations in the genes NPC1 or NPC2, causing a defect of cholesterol trafficking and esterification. Although all three types of NPD can manifest with pulmonary involvement, lung disease occurs more frequently in NPD type B, typically with interstitial lung disease, recurrent pulmonary infections, and respiratory failure. In this sense, bronchoscopy with broncho-alveolar lavage or biopsy together with high-resolution computed tomography are fundamental diagnostic tools. Although several efforts have been made to find an effective therapy for NPD, to date, only limited therapeutic options are available. Enzyme replacement therapy with Olipudase α is the first and only approved disease-modifying therapy for patients with ASMD. A lung transplant and hematopoietic stem cell transplantation are also described for ASMD in the literature. The only approved disease-modifying therapy in NPD type C is miglustat, a substrate-reduction treatment. The aim of this review was to delineate a state of the art on the genetic basis and lung involvement in NPD, focusing on clinical manifestations, radiologic and histopathologic characteristics of the disease, and available therapeutic options, with a gaze on future therapeutic strategies.
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Affiliation(s)
- Claudio Tirelli
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
| | - Ornella Rondinone
- Medical Genetics Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (O.R.); (M.R.M.)
| | - Marta Italia
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
| | - Sabrina Mira
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
| | - Luca Alessandro Belmonte
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
| | - Mauro De Grassi
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
| | - Gabriele Guido
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
| | - Sara Maggioni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
| | - Monica Rosa Miozzo
- Medical Genetics Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (O.R.); (M.R.M.)
| | - Stefano Centanni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20142 Milan, Italy; (M.I.); (S.M.); (L.A.B.); (M.D.G.); (G.G.); (S.M.); (M.M.); (S.C.)
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Erçen Diken Ö, Kaya Ş, Bektaş Aksoy H, Ekici A, Çapraz A, Tabaru A, Şengören Dikiş Ö, Arpağ H, Yildiz H, Kiliç T, Özdemir T, Gülhan PY, Arslan S, Ogan N, Doğan C, Tutar Ü, Başlilar Ş, Esendağli D, Kirkil G, Doğan ÖT, Toru Erbay Ü, Ayvaci A, Tosun M, Uğur Chousein EG, Niksarlioğlu EY, Olcay SS, Özkisa T, Hocanli İ, Karadağ M, Özçelik N, Oktay N, Şentürk E, Arslan S, Pekcan Özyurt S, Cerit A, Nennicioğlu Y, Atilla N, Üney İH, Elverişli MF, Berk S, Baha A, Erik N, Ölmez H, Kaçmaz B, Erzurumluoğlu H, Demirdöğen Çetinoğlu E, Özlü T. Pulmonary Physician Consultancy in Emergency Services in Turkiye (PuPCEST) - a cross-sectional multicenter study. Medicine (Baltimore) 2024; 103:e37165. [PMID: 38335404 PMCID: PMC10860966 DOI: 10.1097/md.0000000000037165] [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: 09/11/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.
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Affiliation(s)
- Özlem Erçen Diken
- University of Health Sciences, Adana City Training and Research Hospital, Department of Chest Disease, Adana, Turkiye
| | - Şerife Kaya
- University of Pamukkkale, Department of Chest Disease, Pamukkale, Turkiye
| | - Hayriye Bektaş Aksoy
- Samsun Training and Research Hospital, Department of Chest Disease, Samsun, Turkiye
| | - Aydanur Ekici
- University of Kirikkale, Department of Chest Disease, Kirikkale, Turkiye
| | - Aylin Çapraz
- University of Amasya, Department of Chest Disease, Amasya, Turkiye
| | - Ali Tabaru
- University of Ömer Halisdemir, Department of Chest Disease, Niğde, Turkiye
| | - Özlem Şengören Dikiş
- University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Department of Chest Disease, Bursa, Turkiye
| | - Hüseyin Arpağ
- University of Kahramanmaraş, Department of Chest Disease, Kahramanmaraş, Turkiye
| | - Hanifi Yildiz
- Universitesi of Yüzüncü Yil, Department of Chest Disease, Van, Turkiye
| | - Talat Kiliç
- University of İnönü, Department of Chest Disease, Malatya, Turkiye
| | - Tarkan Özdemir
- Abdurrahman Yurtaslan Ankara Onkoloji Training and Research Hospital, Department of Chest Disease, Ankara, Turkiye
| | | | - Sulhattin Arslan
- University of Cumhuriyet, Department of Chest Disease, Sivas, Turkiye
| | - Nalan Ogan
- University of Ufuk, Department of Chest Disease, Ankara, Turkiye
| | - Canan Doğan
- Isparta City Training and Research Hospital, Department of Chest Disease, Isparta, Turkiye
| | - Ümit Tutar
- Samsun Chest Disease and Thoracic Surgery Hospital, Samsun, Turkiye
| | - Şeyma Başlilar
- University of Health Sciences, İstanbul Ümraniye Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | | | - Gamze Kirkil
- University of Firat, Department of Chest Disease, Elaziğ, Turkiye
| | - Ömer Tamer Doğan
- University of Cumhuriyet, Department of Chest Disease, Sivas, Turkiye
| | - Ümran Toru Erbay
- University of Dumlupinar, Department of Chest Disease, Kütahya, Turkiye
| | - Aysun Ayvaci
- Kanuni Sultan Süleyman Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | - Mustafa Tosun
- University of Erzincan, Department of Chest Disease, Erzincan, Turkiye
| | - Efsun Gonca Uğur Chousein
- Yediküle Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | - Elif Yelda Niksarlioğlu
- Yediküle Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | | | - Tuncer Özkisa
- Gülhane Training and Research Hospital, Department of Chest Disease, Ankara, Turkiye
| | - İclal Hocanli
- University of Harran, Department of Chest Disease, Burdur, Turkiye
| | - Mehmet Karadağ
- University of Uludağ, Department of Chest Disease, Bursa, Turkiye
| | - Neslihan Özçelik
- Kaçkar State Hospital, Department of Chest Disease, Rize, Turkiye
| | - Nuray Oktay
- İzzet Baysal State Hospital, Department of Chest Disease, Bolu, Turkiye
| | - Elvan Şentürk
- University of Karadeniz Teknik, Farabi Hospital, Department of Chest Disease, Trabzon, Turkiye
| | - Sertaç Arslan
- University of Hitit, Department of Chest Disease, Çorum, Turkiye
| | | | - Ahu Cerit
- University of Kirikkale, Department of Chest Disease, Kirikkale, Turkiye
| | - Yasemin Nennicioğlu
- University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Department of Chest Disease, Bursa, Turkiye
| | - Nurhan Atilla
- University of Kahramanmaraş, Department of Chest Disease, Kahramanmaraş, Turkiye
| | | | | | - Serdar Berk
- University of Cumhuriyet, Department of Chest Disease, Sivas, Turkiye
| | - Ayşe Baha
- University of Ufuk, Department of Chest Disease, Ankara, Turkiye
| | - Nur Erik
- University of Health Sciences, İstanbul Ümraniye Training and Research Hospital, Department of Chest Disease, İstanbul, Turkiye
| | - Hasan Ölmez
- University of Erzincan, Department of Chest Disease, Erzincan, Turkiye
| | - Berat Kaçmaz
- Gülhane Training and Research Hospital, Department of Chest Disease, Ankara, Turkiye
| | | | | | - Tevfik Özlü
- University of Karadeniz Teknik, Farabi Hospital, Department of Chest Disease, Trabzon, Turkiye
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Hernandez-Quiles C, Bernabeu-Wittel M, Barón-Franco B, Palacios AA, Garcia-Serrano MR, Lopez-Jimeno W, Antonio Perez-de-Leon-Serrano J, Gómez-Barranco JM, Ruiz-Cantero A, Quero-Haro M, Cubiles-Montero E, Vergara-Lopez S, Ollero-Baturone M. A randomized clinical trial of home telemonitoring in patients with advanced heart and lung diseases. J Telemed Telecare 2024; 30:356-364. [PMID: 34851202 DOI: 10.1177/1357633x211059707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BRIEF SUMMARY The addition of home monitoring to an integrated care model in patients with advanced chronic heart/lung diseases decreases mortality, hospital and emergency admissions, improves functional status, HRQoL, and is cost-effective. BACKGROUND Telemonitoring is a promising implement for medicine, but its efficacy is unknown in patients with advanced heart and lung failure (AHLF). OBJECTIVE To determine the efficacy of a telemonitoring system added to coordinated clinical care in patients with AHLF. DESIGN Randomized phase 3 multicenter clinical trial with parallel groups in adult patients. PARTICIPANTS Five spanish centers including patients with AHLF at discharge or in out-patient clinics. INTERVENTION Patients were randomly assigned to receive a remote bio-parameters telemonitoring system (TELECARE) or best usual care (UCARE). TELECARE patients were provided with devices that collected symptoms and bio-parameters, and transferred them synchronously to a call-center, with a real-time health-care response. MAIN MEASURES Primary end point was the need of admissions/emergency room visits at 45, 90, 180 days. Secondary end points included health care requirements, mortality, functional assessment, health related quality of life (HRQoL), perceived satisfaction, and cost-efficacy. RESULTS 510 patients were included (54.5% women, median age 76.5 years; 63.1% suffered heart failure, 13.9% lung failure, and 22.9% both conditions). Clinical and functional features were comparable in both arms. TELECARE globally needed less admissions with respect UCARE after 45 days of inclusion (35.4% vs. 46.9%, p < 0.05). This tendency was maintained in the subgroups of patients with multimorbidity (34.2% vs. 46.9%, p < 0.05), intermediate risk of mortality (36.5% vs. 51.1%, p < 0.05), and those included after hospital discharge (34.9% vs. 50.5%, p < 0.01). HRQoL significantly improved (TELECARE/UCARE EuroQol baseline of 56.2 ± 18.2/55.1 ± 19.7, p = 0.054, and 64 ± 19.9/56.3 ± 21.6; p < 0.01 at the end), and perceived satisfaction was also higher (6.77 ± 0.52 vs. 6.62 ± 0.81, p < 0.001; highest possible score = 7). A trend to mortality decrease was also observed (12.9% vs. 19.3%, p = 0.13). TELECARE was cost-efficacious (TELECARE/UCARE QALY 3.94 Euros/0.81Euros). CONCLUSIONS The addition of a telemonitoring system to an integrated care model in patients with AHLF decreases hospital and emergency admissions, improves functional status as well as HRQoL, and is cost-efficacious.
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Affiliation(s)
| | | | - Bosco Barón-Franco
- Internal Medicine Department, Complejo Hospitalario Virgen del Rocío, Seville, Spain
| | | | | | | | | | | | | | - Manuel Quero-Haro
- Salud Responde, Empresa Pública de Emergencias Sanitarias, Jaén, Spain
| | - Elisa Cubiles-Montero
- Unidad de Investigación Clínica y Ensayos Clínicos, Complejo Hospitalario Virgen del Rocío, Seville, Spain
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Abbew ET, Lorent N, Mesic A, Wachinou AP, Obiri-Yeboah D, Decroo T, Rigouts L, Lynen L. Challenges and knowledge gaps in the management of non-tuberculous mycobacterial pulmonary disease in sub-Saharan African countries with a high tuberculosis burden: a scoping review. BMJ Open 2024; 14:e078818. [PMID: 38238184 PMCID: PMC10806640 DOI: 10.1136/bmjopen-2023-078818] [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: 08/14/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION In sub-Saharan African (SSA) countries endemic for tuberculosis (TB), previous TB is a significant risk factor for non-tuberculous mycobacterial pulmonary disease (NTM-PD). The deployment of GeneXpert MTB/RIF in pulmonary TB diagnostic work-up regularly identifies symptomatic patients with a positive smear microscopy but negative GeneXpert, indicative of NTM presence. This scoping review outlines recent evidence for NTM-PD diagnosis and management in SSA. OBJECTIVE The review's objective was to outline the risk factors, available diagnostics, management options and outcomes of NTM-PD in high-burden TB settings in SSA using the population-concept-context framework. DESIGN AND DATA SOURCES We searched existing literature from PubMed, Web of Science, African Journals Online, Google Scholar and grey literature. Studies published between January 2005 and December 2022 were retained. Data were extracted into Rayyan software and Mendeley and summarised using Excel. RESULTS We identified 785 potential articles, of which 105 were included in the full-text review, with 7 papers retained. Included articles used international criteria for diagnosing NTM-PD. Multiple papers were excluded due to non-application of the criteria, suggesting challenging application in the SSA setting. Identified risk factors include previous TB, smoking and mining. Most commonly, chest radiography and not CT was used for the radiological diagnosis of PD, which may miss early changes related to NTM-PD. Molecular methods for NTM species identification were employed in research settings, usually at referral centres, but were unavailable for routine care. Most studies did not report a standardised approach to treatment and they were not offered treatment for the specific disease, marking a lack of guidance in treatment decision-making. When treatment was provided, the outcome was often not reported due to the lack of implementation of standardised outcome definitions. CONCLUSIONS These outlined challenges present a unique opportunity for researchers to undertake further studies in NTM-PD and proffer solutions more applicable to SSA.
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Affiliation(s)
- Elizabeth Tabitha Abbew
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
- Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Central, Ghana
- Biomedical Sciences, University of Antwerp, Antwerp, Antwerpen, Belgium
| | - Natalie Lorent
- Respiratory Diseases, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
- Chronic Diseases and Metabolism, BREATHE Laboratory, Katholieke Universiteit Leuven, Leuven, Flanders, Belgium
| | - Anita Mesic
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | | | - Dorcas Obiri-Yeboah
- Microbiology and Immunology, University of Cape Coast School of Medical Sciences, Cape Coast, Central, Ghana
| | - Tom Decroo
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Leen Rigouts
- Biomedical Sciences, University of Antwerp, Antwerp, Antwerpen, Belgium
- Biomedical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Lutgarde Lynen
- Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
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9
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Bekelman DB, Feser W, Morgan B, Welsh CH, Parsons EC, Paden G, Baron A, Hattler B, McBryde C, Cheng A, Lange AV, Au DH. Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease: The ADAPT Randomized Clinical Trial. JAMA 2024; 331:212-223. [PMID: 38227034 PMCID: PMC10792473 DOI: 10.1001/jama.2023.24035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 11/01/2023] [Indexed: 01/17/2024]
Abstract
Importance Many patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. Palliative care approaches may benefit this population prior to end of life. Objective Determine the effect of a nurse and social worker palliative telecare team on quality of life in outpatients with COPD, HF, or ILD compared with usual care. Design, Setting, and Participants Single-blind, 2-group, multisite randomized clinical trial with accrual between October 27, 2016, and April 2, 2020, in 2 Veterans Administration health care systems (Colorado and Washington), and including community-based outpatient clinics. Outpatients with COPD, HF, or ILD at high risk of hospitalization or death who reported poor quality of life participated. Intervention The intervention involved 6 phone calls with a nurse to help with symptom management and 6 phone calls with a social worker to provide psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician and as needed, a pulmonologist, and cardiologist. Usual care included an educational handout developed for the study that outlined self-care for COPD, ILD, or HF. Patients in both groups received care at the discretion of their clinicians, which could include care from nurses and social workers, and specialists in cardiology, pulmonology, palliative care, and mental health. Main Outcomes and Measures The primary outcome was difference in change in quality of life from baseline to 6 months between the intervention and usual care groups (FACT-G score range, 0-100, with higher scores indicating better quality of life, clinically meaningful change ≥4 points). Secondary quality-of-life outcomes at 6 months included disease-specific health status (Clinical COPD Questionnaire; Kansas City Cardiomyopathy Questionnaire-12), depression (Patient Health Questionnaire-8) and anxiety (Generalized Anxiety Disorder-7) symptoms. Results Among 306 randomized patients (mean [SD] age, 68.9 [7.7] years; 276 male [90.2%], 30 female [9.8%]; 245 White [80.1%]), 177 (57.8%) had COPD, 67 (21.9%) HF, 49 (16%) both COPD and HF, and 13 (4.2%) ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% (intervention, 117 of 154; usual care, 116 of 152) at 6 months for both groups. Mean (SD) length of intervention was 115.1 (33.4) days and included a mean of 10.4 (3.3) intervention calls per patient. In the intervention group, 112 of 154 (73%) patients received the intervention as randomized. At 6 months, mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P = .001; standardized mean difference, 0.41). The intervention also improved COPD health status (standardized mean difference, 0.44; P = .04), HF health status (standardized mean difference, 0.41; P = .01), depression (standardized mean difference, -0.50; P < .001), and anxiety (standardized mean difference, -0.51; P < .001) at 6 months. Conclusions and Relevance For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care. Trial Registration ClinicalTrials.gov Identifier: NCT02713347.
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Affiliation(s)
- David B. Bekelman
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - William Feser
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora
| | - Brianne Morgan
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
| | - Carolyn H. Welsh
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Elizabeth C. Parsons
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | - Grady Paden
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Anna Baron
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora
| | - Brack Hattler
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Connor McBryde
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Andrew Cheng
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Allison V. Lange
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - David H. Au
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
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10
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Grom AA, Canna SW, Abu-Arja RF, Sinha R, Peixoto L, Cannizzaro E, Chandrakasan S, Driest K, Marsh R, Neven B, Onel K, Prahalad S, Prockop S, Quartier P, Roth J, Schulert G, Silva JMF, Wall D, Zeilhofer U. Part 5: Allogeneic HSCT in refractory SJIA with lung disease; recent cases from centers in North America & Europe. Pediatr Rheumatol Online J 2024; 21:86. [PMID: 38183096 PMCID: PMC10768073 DOI: 10.1186/s12969-023-00868-x] [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] [Indexed: 01/07/2024] Open
Abstract
It has been increasingly recognized that there is a subset of patients with refractory systemic JIA, who have failed all available medications and may benefit from HSCT. The increasing experience with HSCT in SJIA, suggests that despite the complicated post-HSCT course, short-term, the transplanted patients either achieved SJIA remission or reduced burden of disease. Longer follow-up, however, is needed to better define the long-term outcomes. The discussion at the NextGen 2022 conference was focused on the optimal timing for the procedure, the need for a good control of inflammatory SJIA activity prior to HSCT, and the role of the reduced intensity conditioning regimens as there was a remote concern that such regimens might increase the risk of SJIA relapse after the transplantation. There was unanimous agreement about the importance of long-term registries to address these questions.
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Affiliation(s)
- Alexei A Grom
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
| | - Scott W Canna
- Rheumatology & Immune Dysregulation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rolla F Abu-Arja
- Department of BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | - Elvira Cannizzaro
- Department of Rheumatology, University Children's Hospital, Zurich, Switzerland
| | - Shanmuganathan Chandrakasan
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Kyla Driest
- Department of Rheumatology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Rebecca Marsh
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bénédicte Neven
- Pediatric Hematology-Immunology and Rheumatology Department, Necker-Enfants- Malades University Hospital, Paris, France
- Université Paris-Cité, Paris, France
| | - Karen Onel
- Department of Rheumatology, HSS, New York City, NY, USA
| | - Sampath Prahalad
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Susan Prockop
- Dana Farber/Boston Childrens Hospital Center for Cancer and Blood Disorders, Boston, MA, USA
| | - Pierre Quartier
- Pediatric Hematology-Immunology and Rheumatology Department, Necker-Enfants- Malades University Hospital, Paris, France
- Université Paris-Cité, Paris, France
| | - Johannes Roth
- Kantonsspital Luzern, University of Luzern, Luzern, Switzerland
| | - Grant Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Juliana M F Silva
- Department of BMT, Great Ormond Street Hospital for Children, London, UK
| | - Donna Wall
- 16. Blood and Marrow Transplant/Cellular Therapy, Division of Haematology/Oncology, Hospital for Sick Children Toronto, Toronto, Canada
| | - Ulrike Zeilhofer
- Department of BMT, University Children's Hospital, Zurich, Switzerland
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11
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Feng Y, Guo K, Jiang J, Lin S. Mesenchymal stem cell-derived exosomes as delivery vehicles for non-coding RNAs in lung diseases. Biomed Pharmacother 2024; 170:116008. [PMID: 38071800 DOI: 10.1016/j.biopha.2023.116008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
The burden of lung diseases is gradually increasing with an increase in the average human life expectancy. Therefore, it is necessary to identify effective methods to treat lung diseases and reduce their social burden. Currently, an increasing number of studies focus on the role of mesenchymal stem cell-derived exosomes (MSC-Exos) as a cell-free therapy in lung diseases. They show great potential for application to lung diseases as a more stable and safer option than traditional cell therapies. MSC-Exos are rich in various substances, including proteins, nucleic acids, and DNA. Delivery of Non-coding RNAs (ncRNAs) enables MSC-Exos to communicate with target cells. MSC-Exos significantly inhibit inflammatory factors, reduce oxidative stress, promote normal lung cell proliferation, and reduce apoptosis by delivering ncRNAs. Moreover, MSC-Exos carrying specific ncRNAs affect the proliferation, invasion, and migration of lung cancer cells, thereby playing a role in managing lung cancer. The detailed mechanisms of MSC-Exos in the clinical treatment of lung disease were explored by developing standardized culture, isolation, purification, and administration strategies. In summary, MSC-Exo-based delivery methods have important application prospects for treating lung diseases.
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Affiliation(s)
- Yuqian Feng
- Hangzhou School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Kaibo Guo
- Department of Oncology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310003, China
| | - Jing Jiang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Shengyou Lin
- Department of Oncology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang 310006, China.
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12
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Zhai Z, Cui T, Chen J, Mao X, Zhang T. Advancements in engineered mesenchymal stem cell exosomes for chronic lung disease treatment. J Transl Med 2023; 21:895. [PMID: 38071321 PMCID: PMC10709966 DOI: 10.1186/s12967-023-04729-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
Chronic lung diseases include an array of conditions that impact airways and lung structures, leading to considerable societal burdens. Mesenchymal stem cells (MSCs) and their exosomes (MSC-exos) can be used for cell therapy and exhibit a diverse spectrum of anti-inflammatory, antifibrotic, and immunomodulatory properties. Engineered MSC-exos possesses enhanced capabilities for targeted drug delivery, resulting in more potent targeting effects. Through various engineering modifications, these exosomes can exert many biological effects, resulting in specific therapeutic outcomes for many diseases. Moreover, engineered stem cell exosomes may exhibit an increased capacity to traverse physiological barriers and infiltrate protected lesions, thereby exerting their therapeutic effects. These characteristics render them a promising therapeutic agent for chronic pulmonary diseases. This article discusses and reviews the strategies and mechanisms of engineered MSC-exos in the treatment of chronic respiratory diseases based on many studies to provide new solutions for these diseases.
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Affiliation(s)
- Zhengyao Zhai
- The First School of Medicine, School of Information and Engineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Tairong Cui
- The First School of Medicine, School of Information and Engineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Jialiang Chen
- The First School of Medicine, School of Information and Engineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China
| | - Xulong Mao
- Key Laboratory of Heart and Lung, Division of Pulmonary Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China.
| | - Ting Zhang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang, China.
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13
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Miller JL, Baschat AA, Rosner M, Blumenfeld YJ, Moldenhauer JS, Johnson A, Schenone MH, Zaretsky MV, Chmait RH, Gonzalez JM, Miller RS, Moon-Grady AJ, Bendel-Stenzel E, Keiser AM, Avadhani R, Jelin AC, Davis JM, Warren DS, Hanley DF, Watkins JA, Samuels J, Sugarman J, Atkinson MA. Neonatal Survival After Serial Amnioinfusions for Bilateral Renal Agenesis: The Renal Anhydramnios Fetal Therapy Trial. JAMA 2023; 330:2096-2105. [PMID: 38051327 PMCID: PMC10698620 DOI: 10.1001/jama.2023.21153] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/28/2023] [Indexed: 12/07/2023]
Abstract
Importance Early anhydramnios during pregnancy, resulting from fetal bilateral renal agenesis, causes lethal pulmonary hypoplasia in neonates. Restoring amniotic fluid via serial amnioinfusions may promote lung development, enabling survival. Objective To assess neonatal outcomes of serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia. Design, Setting, and Participants Prospective, nonrandomized clinical trial conducted at 9 US fetal therapy centers between December 2018 and July 2022. Outcomes are reported for 21 maternal-fetal pairs with confirmed anhydramnios due to isolated fetal bilateral renal agenesis without other identified congenital anomalies. Exposure Enrolled participants initiated ultrasound-guided percutaneous amnioinfusions of isotonic fluid before 26 weeks' gestation, with frequency of infusions individualized to maintain normal amniotic fluid levels for gestational age. Main Outcomes and Measures The primary end point was postnatal infant survival to 14 days of life or longer with dialysis access placement. Results The trial was stopped early based on an interim analysis of 18 maternal-fetal pairs given concern about neonatal morbidity and mortality beyond the primary end point despite demonstration of the efficacy of the intervention. There were 17 live births (94%), with a median gestational age at delivery of 32 weeks, 4 days (IQR, 32-34 weeks). All participants delivered prior to 37 weeks' gestation. The primary outcome was achieved in 14 (82%) of 17 live-born infants (95% CI, 44%-99%). Factors associated with survival to the primary outcome included a higher number of amnioinfusions (P = .01), gestational age greater than 32 weeks (P = .005), and higher birth weight (P = .03). Only 6 (35%) of the 17 neonates born alive survived to hospital discharge while receiving peritoneal dialysis at a median age of 24 weeks of life (range, 12-32 weeks). Conclusions and Relevance Serial amnioinfusions mitigated lethal pulmonary hypoplasia but were associated with preterm delivery. The lower rate of survival to discharge highlights the additional mortality burden independent of lung function. Additional long-term data are needed to fully characterize the outcomes in surviving neonates and assess the morbidity and mortality burden. Trial Registration ClinicalTrials.gov Identifier: NCT03101891.
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Affiliation(s)
- Jena L. Miller
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Ahmet A. Baschat
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Mara Rosner
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Yair J. Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Julie S. Moldenhauer
- Center for Fetal Diagnosis and Treatment, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anthony Johnson
- The Fetal Center, Department of Obstetrics and Gynecology, University of Texas Health Center, Houston
| | - Mauro H. Schenone
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | - Ramen H. Chmait
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Juan M. Gonzalez
- Department of Obstetrics and Gynecology, University of California, San Francisco
| | - Russell S. Miller
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Anita J. Moon-Grady
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco
| | - Ellen Bendel-Stenzel
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amaris M. Keiser
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Radhika Avadhani
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland
| | - Angie C. Jelin
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
| | - Jonathan M. Davis
- Tufts Clinical and Translational Science Institute, Division of Newborn Medicine, Tufts Children’s Hospital, Tufts University, Boston, Massachusetts
| | - Daniel S. Warren
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, Maryland
| | - Joslynn A. Watkins
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Samuels
- Division of Pediatric Nephrology and Hypertension, McGovern School at the University of Texas Health Science Center, Houston
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Meredith A. Atkinson
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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14
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Griffith DE, Aksamit TR. Diagnostic Criteria and the Decision to Treat Nontuberculous Mycobacterial Pulmonary Disease. Clin Chest Med 2023; 44:757-769. [PMID: 37890914 DOI: 10.1016/j.ccm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
The diagnosis of nontuberculous mycobacterial (NTM) pulmonary disease is based on three criteria: patient's symptoms, radiographic findings, and microbiologic results. The microbiologic criterion is the most complicated because it requires more than one positive sputum acid-fast bacilli culture. Clinicians are challenged to apply the diagnostic criteria in the context of variable patient symptoms, NTM pathogenicity, and host susceptibility. The decision to treat NTM pulmonary disease entails assessment of the risks and benefits of therapy and the patient's wishes and ability to receive treatment.
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Affiliation(s)
- David E Griffith
- Department of Medicine, Division of Mycobacterial Disease and Pulmonary Infections, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Timothy R Aksamit
- Pulmonary Disease and Critical Care Medicine, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
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15
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Ye Z, Lin J, Ren Q. Multi-organ support combined with a series of adjuvant therapies: a Chinese case report of pulmonary-renal syndrome due to granulomatosis with polyangiitis. Minerva Med 2023; 114:888-890. [PMID: 37310709 DOI: 10.23736/s0026-4806.23.08691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ziyan Ye
- Intensive Care Unit, Zhejiang Hospital, Hangzhou, China
| | - Juan Lin
- Intensive Care Unit, Zhejiang Hospital, Hangzhou, China -
| | - Qi Ren
- Intensive Care Unit, Zhejiang Hospital, Hangzhou, China
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16
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Daher A, Klose H. [Pathophysiology, diagnosis, prognosis and treatment of pulmonary hypertension associated with chronic lung disease]. Dtsch Med Wochenschr 2023; 148:1507-1513. [PMID: 37949079 DOI: 10.1055/a-2012-0856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
The pathophysiology of pulmonary hypertension associated with chronic lung disease (PH-CLD) is complex, multifactorial, and not consistent among pulmonary diseases. However, pulmonary vasculopathy triggered by various factors, such as chronic alveolar hypoxia or cigarette smoking, seems to play a central role in the pathogenesis of PH-CLD. While the initial workup of PH-CLD is usually complicated by an overlap of symptoms of PH and the underlying lung disease, PH-CLD should be considered when there is a discrepancy between symptoms (especially exertional dyspnea) and pulmonary function tests. Clinical suspicion of PH-CLD can be strengthened by noninvasive diagnostic tools such as transthoracic echocardiography (TTE) or N-terminal pro-B-type natriuretic peptide (NT-pro-BNP). However, a right heart catheterization should only be performed in specialized centers to establish the diagnosis if therapeutic consequences for the patient were expected.The basic treatment of PH-CLD is optimal management of the underlying lung disease. Among the existing interventional and registry-based studies, only a small number of data suggests favorable outcomes when treating PH-CLD patients with PAH-specific medications. Some publications even suggest negative effects. Nevertheless, recent data on inhaled vasoactive therapy in PH-CLD showed positive results for inhaled Treprostinil, although long-term data for this therapeutic approach are still lacking. Treatment of PH-CLD patients with PAH-specific drugs should only be performed in specialized centers and preferably in the context of clinical trials.
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17
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Riehani A, Soubani AO. The spectrum of pulmonary amyloidosis. Respir Med 2023; 218:107407. [PMID: 37696313 DOI: 10.1016/j.rmed.2023.107407] [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: 05/07/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
Amyloidosis is a disease caused by misfolded proteins that deposit in the extracellular matrix as fibrils, resulting in the dysfunction of the involved organ. The lung is a common target of Amyloidosis, but pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis, however in cases of localized pulmonary disease, surgical or transbronchial tissue biopsy might be indicated. Pulmonary amyloidosis can be present in a variety of discrete entities. Diffuse Alveolar septal amyloidosis is the most common type and is usually associated with systemic AL amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. Localized pulmonary Amyloidosis can present as Nodular, Cystic or Tracheobronchial Amyloidosis which may cause symptoms of airway obstruction and large airway stenosis. Pleural effusions, mediastinal lymphadenopathy and pulmonary hypertension has also been reported. Treatment of all types of pulmonary amyloidosis depends on the type of precursor protein, organ involvement and distribution of the disease. Most of the cases are asymptomatic and require only close monitoring. Diffuse alveolar septal amyloidosis treatment follows the treatment of underlying systemic amyloidosis. Tracheobronchial amyloidosis is usually treated with bronchoscopic interventions including debulking and stenting or with external beam radiation. Long-term prognosis of pulmonary amyloidosis usually depends on the type of lung involvement and other organ function.
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Affiliation(s)
- Anas Riehani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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18
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Balakrishnan B, Callahan SJ, Cherian SV, Subramanian A, Sarkar S, Bhatt N, Scholand MB. Climate Change for the Pulmonologist: A Focused Review. Chest 2023; 164:963-974. [PMID: 37054776 DOI: 10.1016/j.chest.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
Climate change adversely impacts global health. Increasingly, temperature variability, inclement weather, declining air quality, and growing food and clean water supply insecurities threaten human health. Earth's temperature is projected to increase up to 6.4 °C by the end of the 21st century, exacerbating the threat. Public and health care professionals, including pulmonologists, perceive the detrimental effects of climate change and air pollution and support efforts to mitigate its effects. In fact, evidence is strong that premature cardiopulmonary death is associated with air pollution exposure via inhalation through the respiratory system, which functions as a portal of entry. However, little guidance is available for pulmonologists in recognizing the effects of climate change and air pollution on the diverse range of pulmonary disorders. To educate and mitigate risk for patients competently, pulmonologists must be armed with evidence-based findings of the impact of climate change and air pollution on specific pulmonary diseases. Our goal is to provide pulmonologists with the background and tools to improve patients' health and to prevent adverse outcomes despite climate change-imposed threats. In this review, we detail current evidence of climate change and air pollution impact on a diverse range of pulmonary disorders. Knowledge enables a proactive and individualized approach toward prevention strategies for patients, rather than merely treating ailments reactively.
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Affiliation(s)
- Bathmapriya Balakrishnan
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL.
| | - Sean J Callahan
- Division of Pulmonary Medicine, University of Utah Health, Salt Lake City, UT; Division of Pulmonary Medicine, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
| | - Sujith V Cherian
- Division of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
| | - Abirami Subramanian
- Department of Pulmonary and Critical Care Medicine, Baylor Scott and White Health, Dallas, TX; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
| | - Sauradeep Sarkar
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV
| | - Nitin Bhatt
- Division of Pulmonary, Critical Care and Sleep Medicine, Ohio State University, Columbus, OH; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
| | - Mary-Beth Scholand
- Division of Pulmonary Medicine, University of Utah Health, Salt Lake City, UT; Occupational and Environmental Health Section, Diffuse Lung Disease and Lung Transplant Network, CHEST, Glenview, IL
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19
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Barber AT, Liptzin DR, Gower WA, Hinds DM. Pediatric Pulmonology 2022 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2023; 58:2719-2724. [PMID: 37493100 DOI: 10.1002/ppul.26603] [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: 05/29/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
The field of rare and diffuse pediatric lung disease continues to evolve and expand rapidly as clinicians and researchers make advancements in the diagnosis and treatment of children's interstitial and diffuse lung disease, non-cystic fibrosis bronchiectasis, and primary ciliary dyskinesia. Papers published on these topics in Pediatric Pulmonology and other journals in 2022 describe newly recognized disorders, elucidate disease mechanisms and courses, explore potential biomarkers, and assess novel treatments. In this review, we will discuss these important advancements and place them in the context of existing literature.
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Affiliation(s)
- Andrew T Barber
- Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Deborah R Liptzin
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Daniel M Hinds
- Department of Pediatrics, University of Iowa School of Medicine, Iowa City, Iowa, USA
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20
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Singhal KK, Singh R. Chronic Suppurative Lung Disease in Children: A Case Based Approach. Indian J Pediatr 2023; 90:920-926. [PMID: 37389774 DOI: 10.1007/s12098-023-04665-y] [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: 03/17/2023] [Accepted: 05/04/2023] [Indexed: 07/01/2023]
Abstract
Bronchiectasis is a pathologic state of conducting airways manifested radiographically by evidence of bronchial dilation and clinically by chronic productive cough. Considered an "orphan disease" for long, it remains a major contributor to morbidity and mortality in both developed and underdeveloped countries. With the advances in the medical field accompanied by widespread access to vaccines and antibiotics, improved health services and better access to nutrition, the incidences of bronchiectasis have markedly decreased, particularly in developed countries. This review summarizes the current knowledge pertaining to the clinical definition, etiology, clinical approach and management related to pediatric bronchiectasis.
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Affiliation(s)
- Kamal Kumar Singhal
- Division of Pediatric Pulmonology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, India.
| | - Robin Singh
- Division of Pediatric Pulmonology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, Shaheed Bhagat Singh Marg, New Delhi, India
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21
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Ito Y. Who should be treated for nontuberculous mycobacterial pulmonary disease? Respir Investig 2023; 61:387-388. [PMID: 37079944 DOI: 10.1016/j.resinv.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/12/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan.
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22
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Hamed KA, Tillotson G. A narrative review of nontuberculous mycobacterial pulmonary disease: microbiology, epidemiology, diagnosis, and management challenges. Expert Rev Respir Med 2023; 17:973-988. [PMID: 37962332 DOI: 10.1080/17476348.2023.2283135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Nontuberculous mycobacteria (NTM) are a diverse group of mycobacterial species that are ubiquitous in the environment. They are opportunistic pathogens that can cause a range of diseases, especially in individuals with underlying structural lung disease or compromised immune systems. AREAS COVERED This paper provides an in-depth analysis of NTM infections, including microbiology, environmental sources and transmission pathways, risk factors for disease, epidemiology, clinical manifestations and diagnostic approaches, guideline-based treatment recommendations, drugs under development, and management challenges. EXPERT OPINION Future approaches to the management of NTM pulmonary disease will require therapies that are well tolerated, can be taken for a shorter time period and perhaps less frequently, have few drug-drug interactions, and are active against the various strains of pathogens. As the numbers of infections increase, such therapies will be welcomed by clinicians and patients.
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23
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Liu Z, Lami B, Ikonomou L, Gu M. Unlocking the potential of induced pluripotent stem cells for neonatal disease modeling and drug development. Semin Perinatol 2023; 47:151729. [PMID: 37012138 PMCID: PMC10133195 DOI: 10.1016/j.semperi.2023.151729] [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] [Indexed: 04/05/2023]
Abstract
Neonatal lung and heart diseases, albeit rare, can result in poor quality of life, often require long-term management and/or organ transplantation. For example, Congenital Heart Disease (CHD) is one of the most common type of congenital disabilities, affecting nearly 1% of the newborns, and has complex and multifactorial causes, including genetic predisposition and environmental influences. To develop new strategies for heart and lung regeneration in CHD and neonatal lung disease, human induced pluripotent stem cells (hiPSCs) provide a unique and personalized platform for future cell replacement therapy and high-throughput drug screening. Additionally, given the differentiation potential of iPSCs, cardiac cell types such as cardiomyocytes, endothelial cells, and fibroblasts and lung cell types such Type II alveolar epithelial cells can be derived in a dish to study the fundamental pathology during disease progression. In this review, we discuss the applications of hiPSCs in understanding the molecular mechanisms and cellular phenotypes of CHD (e.g., structural heart defect, congenital valve disease, and congenital channelopathies) and congenital lung diseases, such as surfactant deficiencies and Brain-Lung-Thyroid syndrome. We also provide future directions for generating mature cell types from iPSCs, and more complex hiPSC-based systems using three-dimensional (3D) organoids and tissue-engineering. With these potential advancements, the promise that hiPSCs will deliver new CHD and neonatal lung disease treatments may soon be fulfilled.
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Affiliation(s)
- Ziyi Liu
- Perinatal Institute, Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Center for Stem Cell and Organoid Medicine, CuSTOM, Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Bonny Lami
- Perinatal Institute, Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Center for Stem Cell and Organoid Medicine, CuSTOM, Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, United States
| | - Laertis Ikonomou
- Department of Oral Biology, University at Buffalo, The State University of New York, Buffalo, NY, United States; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University at Buffalo, The State University of New York, Buffalo, NY, United States; Cell, Gene and Tissue Engineering Center, University at Buffalo, The State University of New York, Buffalo, NY, United States.
| | - Mingxia Gu
- Perinatal Institute, Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Center for Stem Cell and Organoid Medicine, CuSTOM, Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, United States.
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24
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Jain S, Witt LJ, Ferrante LE. Clin-STAR corner: Recent practice-changing studies at the interface of pulmonary and critical care medicine and geriatrics. J Am Geriatr Soc 2023; 71:705-710. [PMID: 36536494 PMCID: PMC10023292 DOI: 10.1111/jgs.18196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
Older adults suffering from chronic pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung disease, and critical illnesses, such as sepsis and acute respiratory failure, are more vulnerable to adverse outcomes like disability and greater side effects from treatments. In this update, we discuss recent practice-changing clinical trials and observational studies in Pulmonary & Critical Care Medicine that have advanced our understanding of the diagnosis or management of older adults with chronic lung diseases or critical illnesses.
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Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Leah J. Witt
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, CA
| | - Lauren E. Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
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25
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le Poole K, Vrielink H. The role of plasmapheresis in the pulmonary-renal syndrome. Transfus Apher Sci 2023; 62:103681. [PMID: 36872122 DOI: 10.1016/j.transci.2023.103681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Kaatje le Poole
- Sanquin Blood Supply, Department of Transfusion Medicine, Plesmanlaan 125, 1066 CX Amsterdam, the Netherlands.
| | - Hans Vrielink
- Sanquin Blood Supply, Department of Transfusion Medicine, Plesmanlaan 125, 1066 CX Amsterdam, the Netherlands
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26
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Remcho TP, Kolls JK. Gene Therapy for Occupational Lung Disease: Steering Macrophages in the Right Direction? Am J Respir Cell Mol Biol 2023; 68:129-130. [PMID: 36315436 PMCID: PMC9986556 DOI: 10.1165/rcmb.2022-0408ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- T Parks Remcho
- Center for Translational Research in Infection and Inflammation Tulane University School of Medicine New Orleans, Louisiana
| | - Jay K Kolls
- Center for Translational Research in Infection and Inflammation Tulane University School of Medicine New Orleans, Louisiana
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27
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Saha BK, Aiman A, Chong WH, Saha S, Song J, Bonnier A. Updates in idiopathic pulmonary hemosiderosis in 2022: A state of the art review. Pediatr Pulmonol 2023; 58:382-391. [PMID: 36324124 DOI: 10.1002/ppul.26230] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
This manuscript reports the recent advances in idiopathic pulmonary hemosiderosis (IPH), a rare cause of diffuse alveolar hemorrhage in children and adults. This narrative review of the literature summarizes different aspects of IPH, including proposed pathogenesis, patient demographics, clinical and radiological characteristics, treatment, and prognosis. Additionally, the association between Celiac Disease (CD) and IPH is carefully evaluated. IPH is a frequently misdiagnosed disease. The delay in the diagnosis of IPH is often significant but fortunately, appears to have decreased in recent years. IPH in adults and children have distinct demographic preferences. The autoantibodies are common in IPH but with a definite difference between the adult and pediatric populations. The definitive diagnosis of IPH requires lung biopsy and careful exclusion of all competing diagnoses, even with lung biopsy showing bland pulmonary hemorrhage. The presence of nonspecific inflammatory cells or lymphoid aggregates may suggest a secondary immunologic phenomenon and needs careful evaluation and follow-up. A substantial number of patients suffer from coexisting CD, also known as Lane-Hamilton syndrome (LHS), and all patients with IPH need to be evaluated for LHS by serology. Although strict gluten free diet can manage the majority of patients with LHS, other patients generally require immunosuppressive therapy. The corticosteroids are the backbone of IPH therapy. Recently utilized experimental treatment options include mesenchymal stem cell transplant, liposteroid and bronchial artery embolization. The immunosuppression should be adjusted to achieve optimal disease control. Patients may progress to end-stage lung disease despite all measures, and lung transplantation may be the only viable option.
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Affiliation(s)
- Biplab K Saha
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida, USA
| | - Alexis Aiman
- New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Arkansas, USA
| | - Woon Hean Chong
- Department of Intensive Care Medicine, Ng Teng Fong General Hospital, National University Health System, Singapore City, Singapore
| | - Santu Saha
- Department of Internal Medicine, Saha Clinic, Narail, Bangladesh
| | - Jini Song
- New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Arkansas, USA
| | - Alyssa Bonnier
- Department of Critical Care Nursing, Goldfarb School of Nursing, Barnes Jewish College, St. Louis, Missouri, USA
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28
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Schoettler ML, Saldana BD, Berkenkamp L, Chonat S, Watkins B, Rotz SJ, Simons D, Graf E, Rossi C, Cheng J, Hammers YA, Rytting H, Williams KM. Pulmonary Manifestations and Vascular Changes in Pediatric Transplantation-Associated Thrombotic Microangiopathy. Transplant Cell Ther 2023; 29:45.e1-45.e8. [PMID: 36202334 PMCID: PMC11003462 DOI: 10.1016/j.jtct.2022.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/08/2022]
Abstract
Although transplant-associated thrombotic microangiopathy (TA-TMA) commonly complicates pediatric hematopoietic cellular therapy (HCT), pulmonary manifestations and histology of TA-TMA (pTA-TMA) are rarely reported, with scant data available on timing, risk factors, pathogenesis, and outcomes. Pulmonary hypertension (PH) and diffuse alveolar hemorrhage (DAH) are recognized manifestations of pTA-TMA. The objective of this study was to characterize the pathologic findings, outcomes, and coincident diagnoses preceding biopsy-proven pTA-TMA. In Institutional Review Board- approved retrospective studies, available lung tissue was reviewed at 2 institutions between January 2016 and August 2021 to include those with pulmonary vascular pathology. Histologic features of pTA-TMA were present in 10 children with prior respiratory decline after an allogeneic HCT (allo-HCT; n = 9) or autologous HCT (n = 1). Pathologic lesions included muscular medialization, microthrombi, and red cell fragments, in addition to perivasculitis and intimal arteritis. Parenchymal findings included diffuse alveolar damage, organizing pneumonia, and plasmocytic infiltrates. Six children were clinically diagnosed with TA-TMA, and all were treated with eculizumab, at a median of 2.5 days after clinical diagnosis (range, 0 to 11 days). Four were identified postmortem. Coincident pulmonary infection was confirmed in 8 of the 10 patients. Five allo-HCT recipients (56%) experienced graft-versus-host disease (GVHD; 4 acute, 1 chronic) prior to the onset of respiratory symptoms. Two patients (20%) had clinically recognized DAH, although 9 (90%) had evidence of DAH on histology. Although all 10 patients underwent echocardiography at the time of symptom onset and 9 had serial echocardiograms, only 2 patients had PH detected. Treatments varied and included sildenafil (n = 3), steroids (n = 1), and eculizumab (n = 6). One patient was alive at the time of this report; the remaining 9 died, at a median of 52 days after onset of respiratory symptoms (range 4 to 440 days) and a median of 126 days post-HCT (range, 13 to 947 days). pTA-TMA is a heterogeneous histologic disease characterized by arteriolar inflammation, microthrombi, and often DAH. pTA-TMA presented with respiratory decline with systemic TA-TMA in all patients. Clinicians should maintain a high degree of suspicion for DAH in patients with TA-TMA and pulmonary symptoms. Coincident rates of GVHD and pulmonary infections were high, whereas the rate of PH identified by echocardiography was 20%. Outcomes were poor despite early use of eculizumab and other therapies. Our data merit consideration of pTA-TMA in patients with acute respiratory decline in the setting of systemic TA-TMA, GVHD, and infection. Investigation of additional therapies for pTA-TMA is needed as well. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Michelle L Schoettler
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, Georgia.
| | - Blachy D Saldana
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC
| | - Lisa Berkenkamp
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, Georgia
| | - Satheesh Chonat
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, Georgia
| | - Benjamin Watkins
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, Georgia
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology and Blood and Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Dawn Simons
- Children's Healthcare of Atlanta, Emory University, Pediatric Pulmonology, Atlanta, Georgia
| | - Emily Graf
- Division of Blood and Marrow Transplantation, Children's National Hospital, Washington, DC
| | | | - Jinjun Cheng
- Division of Pathology, Children's National Hospital, Washington, DC
| | - Yuki A Hammers
- Children's Healthcare of Atlanta, Department of Pathology, Atlanta, Georgia
| | - Heather Rytting
- Children's Healthcare of Atlanta, Department of Pathology, Atlanta, Georgia
| | - Kirsten M Williams
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta and Emory University Department of Pediatrics, Atlanta, Georgia
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29
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Prieto Fernandez A, Palomo Antequera B, Del Castillo Arango K, Blanco Guindel M, Nava Tomas ME, Mesa Alvarez AM. Inhalational lung diseases. Radiologia (Engl Ed) 2022; 64 Suppl 3:290-300. [PMID: 36737167 DOI: 10.1016/j.rxeng.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/03/2022] [Indexed: 02/05/2023]
Abstract
The term inhalational lung disease comprises a group of entities that develop secondary to the active aspiration of particles. Most are occupational lung diseases. Inhalational lung diseases are classified as occupational diseases (pneumoconiosis, chemical pneumonitis), hypersensitivity pneumonitis, and electronic-cigarette-associated lung diseases. The radiologic findings often consist of nonspecific interstitial patterns that can be difficult to interpret. Therefore, radiologists' experience and multidisciplinary teamwork are key to ensure correct evaluation. The role of the radiologist is fundamental in preventive measures as well as in diagnosis and management, having an important impact on patients' overall health. It is crucial to take into account patients' possible exposure to particles both at work and at home.
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Affiliation(s)
- A Prieto Fernandez
- Sección de Radiología Torácica, Hospital Universitario Central de Asturias, Instituto Nacional de Silicosis, Oviedo, Asturias, Spain.
| | - B Palomo Antequera
- Sección de Radiología Torácica, Hospital Universitario Central de Asturias, Instituto Nacional de Silicosis, Oviedo, Asturias, Spain
| | - K Del Castillo Arango
- Sección de Radiología Torácica, Hospital Universitario Central de Asturias, Instituto Nacional de Silicosis, Oviedo, Asturias, Spain
| | - M Blanco Guindel
- Sección de Radiología Torácica, Hospital Universitario Central de Asturias, Instituto Nacional de Silicosis, Oviedo, Asturias, Spain
| | - M E Nava Tomas
- Sección de Radiología Torácica, Hospital Universitario Central de Asturias, Instituto Nacional de Silicosis, Oviedo, Asturias, Spain
| | - A M Mesa Alvarez
- Sección de Radiología Torácica, Hospital Universitario Central de Asturias, Instituto Nacional de Silicosis, Oviedo, Asturias, Spain
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30
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Ohta S, Matsuyoshi T, Kaneko H, Kosen D, Suzuki H, Hamaguchi J, Sato Y, Shimizu K. Venovenous Extracorporeal Membrane Oxygenation in Diffuse Alveolar Hemorrhage Secondary to Anti-neutrophil Cytoplasmic Autoantibody-associated Vasculitis: Starting without Systemic Anticoagulation. Intern Med 2022; 61:3569-3573. [PMID: 35569985 PMCID: PMC9790777 DOI: 10.2169/internalmedicine.9472-22] [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: 01/07/2023] Open
Abstract
Regarding extracorporeal membrane oxygenation (ECMO) support against hemorrhagic conditions, there seems to be a dilemma when deciding between maintaining the circuit patency by systemic anticoagulation and increasing the risk of bleeding. We herein report two cases of diffuse alveolar hemorrhage (DAH) caused by myeloperoxidase (MPO) anti-neutrophil cytoplasmic autoantibody-associated vasculitis (AAV) successfully treated with venovenous (VV)-ECMO support, both initially started without systemic anticoagulation. Under anticoagulation-free ECMO management, we should consider the shortcomings of frequent circuit exchange and hemorrhagic diathesis related to circuit-induced disseminated intravascular coagulation (DIC).
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Affiliation(s)
- Soichi Ohta
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan
| | - Takeo Matsuyoshi
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan
| | - Hitoshi Kaneko
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan
| | - Daiyu Kosen
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan
| | - Hiroaki Suzuki
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan
| | - Jun Hamaguchi
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan
| | - Yuichi Sato
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan
| | - Keiki Shimizu
- Emergency and Critical Care Center, Tokyo Metropolitan Tama Medical Center, Japan
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Bernadette Sreter K, Pavlović D, Tomić M, Šenjug P, Galešić Ljubanović D. PULMONARY HEMORRHAGE AND CRESCENTIC GLOMERULONEPHRITIS IN A PATIENT WITH SEROPOSITIVE ANTI-GLOMERULAR BASEMENT MEMBRANE DISEASE AND ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODIES. Acta Clin Croat 2022; 61:528-533. [PMID: 37492353 PMCID: PMC10364110 DOI: 10.20471/acc.2022.61.03.19] [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] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/29/2017] [Indexed: 07/27/2023] Open
Abstract
Anti-glomerular basement membrane (anti-GBM) disease is an acute and life-threatening systemic autoimmune disorder. The coexistence of circulating anti-neutrophil cytoplasmic antibodies (ANCA) and anti-GBM disease, the so-called double-positive disease (DPD), is exceptionally rare. We report a unique case of DPD manifesting as pulmonary-renal syndrome (PRS) in a 46-year-old woman who first presented with clinical and radiological suspicion of pneumonia. Chest computed tomography scan later revealed bilateral alveolar hemorrhage. Kidney biopsy showed necrotizing crescentic (100% glomeruli) glomerulonephritis. On immunofluorescence microscopy, glomeruli were global linear positive for IgG, confirming anti-GBM disease. Double positivity was detected for circulating anti-myeloperoxidase ANCA (p-ANCA) and anti-GBM antibodies. Acute renal failure evolved rapidly. Therapeutic plasma exchange (TPE) and hemodialysis (HD) were initiated early in combination with intravenous pulse corticosteroid therapy followed by oral methylprednisolone and cyclophosphamide. Pulmonary hemorrhage resolved, but renal function could not be preserved. The patient remains HD dependent. This case report highlights that pulmonary symptomatology may be the leading clinical presentation of PRS, with initially normal renal function at DPD onset. Early recognition and diagnosis are therefore crucial to timely clinical intervention. The role of prompt kidney biopsy and initiation of TPE and HD in PRS must not be underestimated.
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Affiliation(s)
- Katherina Bernadette Sreter
- Department of Clinical Immunology, Pulmonology and Rheumatology, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - Draško Pavlović
- Department of Nephrology and Dialysis, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia, and University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Monika Tomić
- Department of Internal Medicine, University Hospital Mostar, Mostar, Bosnia and Herzegovina, and University of Mostar, School of Medicine, Mostar, Bosnia and Herzegovina
| | - Petar Šenjug
- Department of Pathology, University Hospital Dubrava, Zagreb, Croatia
| | - Danica Galešić Ljubanović
- Department of Pathology, University Hospital Dubrava, Zagreb, Croatia
- Department of Pathology, University of Zagreb, School of Medicine, Zagreb, Croatia
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Hynds RE. Exploiting the potential of lung stem cells to develop pro-regenerative therapies. Biol Open 2022; 11:bio059423. [PMID: 36239242 PMCID: PMC9581519 DOI: 10.1242/bio.059423] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Acute and chronic lung diseases are a leading cause of morbidity and mortality globally. Unfortunately, these diseases are increasing in frequency and we have limited treatment options for severe lung diseases. New therapies are needed that not only treat symptoms or slow disease progression, but also enable the regeneration of functional lung tissue. Both airways and alveoli contain populations of epithelial stem cells with the potential to self-renew and produce differentiated progeny. Understanding the mechanisms that determine the behaviour of these cells, and their interactions with their niches, will allow future generations of respiratory therapies that protect the lungs from disease onset, promote regeneration from endogenous stem cells or enable regeneration through the delivery of exogenous cells. This review summarises progress towards each of these goals, highlighting the challenges and opportunities of developing pro-regenerative (bio)pharmaceutical, gene and cell therapies for respiratory diseases.
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Affiliation(s)
- Robert E. Hynds
- Epithelial Cell Biology in ENT Research (EpiCENTR) Group, Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1DZ, UK
- UCL Cancer Institute, University College London, London, WC1E 6DD, UK
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Brenna CTA, Khan S, Djaiani G, Buckey Jr. JC, Katznelson R. The role of routine pulmonary imaging before hyperbaric oxygen treatment. Diving Hyperb Med 2022; 52:197-207. [PMID: 36100931 PMCID: PMC9731143 DOI: 10.28920/dhm52.3.197-207] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/05/2022] [Indexed: 11/05/2022]
Abstract
Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with potentially severe sequelae such as pneumothoraces. Pulmonary blebs, bullae, and other emphysematous airspace abnormalities increase the risk of respiratory complications and are prevalent in otherwise healthy adults. HBOT providers may elect to use chest X-ray routinely as a pre-treatment screening tool to identify these anomalies, particularly if a history of preceding pulmonary disease is identified, but this approach has a low sensitivity and frequently provides false negative results. Computed tomography scans offer greater sensitivity for airspace lesions, but given the high prevalence of incidental and insignificant pulmonary findings among healthy individuals, would lead to a high false positive rate because most lesions are unlikely to pose a hazard during HBOT. Post-mortem and imaging studies of airspace lesion prevalence show that a significant proportion of patients who undergo HBOT likely have pulmonary abnormalities such as blebs and bullae. Nevertheless, pulmonary barotrauma is rare, and occurs mainly in those with known underlying lung pathology. Consequently, routinely using chest X-ray or computed tomography scans as screening tools prior to HBOT for low-risk patients without a pertinent medical history or lack of clinical symptoms of cardiorespiratory disease is of low value. This review outlines published cases of patients experiencing pulmonary barotrauma while undergoing pressurised treatment/testing in a hyperbaric chamber and analyses the relationship between barotrauma and pulmonary findings on imaging prior to or following exposure. A checklist and clinical decision-making tool based on suggested low-risk and high-risk features are offered to guide the use of targeted baseline thoracic imaging prior to HBOT.
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Affiliation(s)
- Connor TA Brenna
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - George Djaiani
- Department of Anesthesia, University Health Network, Toronto, ON, Canada
| | - Jay C Buckey Jr.
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Rita Katznelson
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, University Health Network, Toronto, ON, Canada
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Niranjan V, Tarantino G, Kumar J, Stokes D, O’Connor R, O’Regan A. The Impact of Dance Interventions on Patients with Noninfectious Pulmonary Diseases: A Systematic Review. Int J Environ Res Public Health 2022; 19:11115. [PMID: 36078841 PMCID: PMC9518039 DOI: 10.3390/ijerph191711115] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
Dance has been highlighted as one of the most enjoyable, safe, and feasible forms of physical activity, improving physical health, mental health, and general well-being, among various patients. Little is known about the effect and impact of dance interventions to improve health among patients with pulmonary diseases, and research lacks a robust synthesis of evidence. Therefore, this systematic review aimed to investigate the impact of dance intervention on patients with noninfectious pulmonary diseases. Following the PRISMA guidelines, six electronic databases were searched in May 2022. Of the 1308 unique records identified, seven studies (five quantitative, two qualitative) across four countries were included in this systematic review. Six studies investigated adult populations, and one study explored the effect of dance on children. The dance interventions lasted between 1 and 10 weeks. Overall, dance was perceived to have a broad range of physical/mental/social benefits, including quality of life, social cohesion, dyspnoea levels, balance, exercise tolerance, general well-being, and adherence to nutrition regimens. Furthermore, the dance session was the most enjoyable activity among children and adolescents with asthma. With available evidence, dance interventions are promising and may effectively improve health and well-being among patients with noninfectious pulmonary diseases. More organised and continuous long-term dance interventions in future may reveal a detailed impact on health outcomes.
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Affiliation(s)
- Vikram Niranjan
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Giampiero Tarantino
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Jaspal Kumar
- NUS Centre for Cancer Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 169857, Singapore
| | - Diarmuid Stokes
- UCD Library, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Ray O’Connor
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Andrew O’Regan
- School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
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Mornex JF, Balduyck M, Bouchecareilh M, Cuvelier A, Epaud R, Kerjouan M, Le Rouzic O, Pison C, Plantier L, Pujazon MC, Reynaud-Gaubert M, Toutain A, Trumbic B, Willemin MC, Zysman M, Brun O, Campana M, Chabot F, Chamouard V, Dechomet M, Fauve J, Girerd B, Gnakamene C, Lefrançois S, Lombard JN, Maitre B, Maynié-François C, Moerman A, Payancé A, Reix P, Revel D, Revel MP, Schuers M, Terrioux P, Theron D, Willersinn F, Cottin V, Mal H. [French clinical practice guidelines for the diagnosis and management of lung disease with alpha 1-antitrypsin deficiency]. Rev Mal Respir 2022; 39:633-656. [PMID: 35906149 DOI: 10.1016/j.rmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Affiliation(s)
- J-F Mornex
- Université de Lyon, université Lyon 1, INRAE, EPHE, UMR754, IVPC, 69007 Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares, hospices civils de Lyon, hôpital Louis-Pradel, service de pneumologie, 69500 Bron, France.
| | - M Balduyck
- CHU de Lille, centre de biologie pathologie, laboratoire de biochimie et biologie moléculaire HMNO, faculté de pharmacie, EA 7364 RADEME, université de Lille, service de biochimie et biologie moléculaire, Lille, France
| | - M Bouchecareilh
- Université de Bordeaux, CNRS, Inserm U1053 BaRITon, Bordeaux, France
| | - A Cuvelier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, Rouen, France; Groupe de recherche sur le handicap ventilatoire et neurologique (GRHVN), université Normandie Rouen, Rouen, France
| | - R Epaud
- Centre de références des maladies respiratoires rares, site de Créteil, Créteil, France
| | - M Kerjouan
- Service de pneumologie, CHU Pontchaillou, Rennes, France
| | - O Le Rouzic
- CHU Lille, service de pneumologie et immuno-allergologie, Lille, France; Université de Lille, CNRS, Inserm, institut Pasteur de Lille, U1019, UMR 9017, CIIL, OpInfIELD team, Lille, France
| | - C Pison
- Service de pneumologie physiologie, pôle thorax et vaisseaux, CHU de Grenoble, Grenoble, France; Université Grenoble Alpes, Saint-Martin-d'Hères, France
| | - L Plantier
- Service de pneumologie et explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Université de Tours, CEPR, Inserm UMR1100, Tours, France
| | - M-C Pujazon
- Service de pneumologie et allergologie, pôle clinique des voies respiratoires, hôpital Larrey, Toulouse, France
| | - M Reynaud-Gaubert
- Service de pneumologie, centre de compétence pour les maladies pulmonaires rares, AP-HM, CHU Nord, Marseille, France; Aix-Marseille université, IHU-Méditerranée infection, Marseille, France
| | - A Toutain
- Service de génétique, CHU de Tours, Tours, France; UMR 1253, iBrain, université de Tours, Inserm, Tours, France
| | | | - M-C Willemin
- Service de pneumologie et oncologie thoracique, CHU d'Angers, hôpital Larrey, Angers, France
| | - M Zysman
- Service de pneumologie, CHU Haut-Lévèque, Bordeaux, France; Université de Bordeaux, centre de recherche cardiothoracique, Inserm U1045, CIC 1401, Pessac, France
| | - O Brun
- Centre de pneumologie et d'allergologie respiratoire, Perpignan, France
| | - M Campana
- Service de pneumologie, CHR d'Orléans, Orléans, France
| | - F Chabot
- Département de pneumologie, CHRU de Nancy, Vandœuvre-lès-Nancy, France; Inserm U1116, université de Lorraine, Vandœuvre-lès-Nancy, France
| | - V Chamouard
- Service pharmaceutique, hôpital cardiologique, GHE, HCL, Bron, France
| | - M Dechomet
- Service d'immunologie biologique, centre de biologie sud, centre hospitalier Lyon Sud, HCL, Pierre-Bénite, France
| | - J Fauve
- Cabinet médical, Bollène, France
| | - B Girerd
- Université Paris-Saclay, faculté de médecine, Le Kremlin-Bicêtre, France; AP-HP, centre de référence de l'hypertension pulmonaire, service de pneumologie et soins intensifs respiratoires, hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm UMR_S 999, hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - C Gnakamene
- Service de pneumologie, CH de Montélimar, GH Portes de Provence, Montélimar, France
| | | | | | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal, Créteil, France; Inserm U952, UFR de santé, université Paris-Est Créteil, Créteil, France
| | - C Maynié-François
- Université de Lyon, collège universitaire de médecine générale, Lyon, France; Université Claude-Bernard Lyon 1, laboratoire de biométrie et biologie évolutive, UMR5558, Villeurbanne, France
| | - A Moerman
- CHRU de Lille, hôpital Jeanne-de-Flandre, Lille, France; Cabinet de médecine générale, Lille, France
| | - A Payancé
- Service d'hépatologie, CHU Beaujon, AP-HP, Clichy, France; Filière de santé maladies rares du foie de l'adulte et de l'enfant (FilFoie), CHU Saint-Antoine, Paris, France
| | - P Reix
- Service de pneumologie pédiatrique, allergologie, mucoviscidose, hôpital Femme-Mère-Enfant, HCL, Bron, France; UMR 5558 CNRS équipe EMET, université Claude-Bernard Lyon 1, Villeurbanne, France
| | - D Revel
- Université Claude-Bernard Lyon 1, Lyon, France; Hospices civils de Lyon, Lyon, France
| | - M-P Revel
- Université Paris Descartes, Paris, France; Service de radiologie, hôpital Cochin, AP-HP, Paris, France
| | - M Schuers
- Université de Rouen Normandie, département de médecine générale, Rouen, France; Sorbonne université, LIMICS U1142, Paris, France
| | | | - D Theron
- Asten santé, Isneauville, France
| | | | - V Cottin
- Université de Lyon, université Lyon 1, INRAE, EPHE, UMR754, IVPC, 69007 Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares, hospices civils de Lyon, hôpital Louis-Pradel, service de pneumologie, 69500 Bron, France
| | - H Mal
- Service de pneumologie B, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France; Inserm U1152, université Paris Diderot, site Xavier Bichat, Paris, France
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Wang Y, Ma Q, Zhu F, Xia Z. [Research progress of mesenchymal stem cells and their derivatives nebulization in the treatment of pulmonary diseases]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2022; 34:881-885. [PMID: 36177936 DOI: 10.3760/cma.j.cn121430-20220706-00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In acute or chronic lung diseases, inappropriate immune response and abnormal repair process can lead to irreversible damage to lung tissue, which in turn leads to decreased lung function and even respiratory failure or death. Mesenchymal stem cells (MSCs) and their derivatives have shown wide application prospects in cell therapy and acellular therapy of lung diseases and are entering the clinical transformation stage because of their unique physiological functions and characteristics, but the safety and efficacy of MSCs and their derivatives are still controversial. Nebulization therapy provides new opportunities and challenges for the innovative treatment of MSCs and their derivatives in lung diseases. In a number of preclinical studies and clinical trials, there have been evidence that atomization therapy of MSCs and their derivatives is safe and effective. This method could be an optimal solution for the treatment of various complex lung diseases. However, extensive research should be carried out on various strategies and their compatibility with different nebulizers before this method can be used in clinical setting. In this paper, we review the research progress of MSCs and their derivatives by nebulization in the treatment of pulmonary diseases.
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Affiliation(s)
- Yusong Wang
- Department of Burns, the First Affiliated Hospital, Naval Medical University, Shanghai 200433, China. Corresponding author: Xia Zhaofan,
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Ono Y, Niimi K, Horio Y, Takihara T, Takahashi G, Harada K, Takiguchi H, Tomomatsu K, Hayama N, Oguma T, Aoki T, Urano T, Sekiguchi T, Koizumi J, Asano K. Trans-arterial Embolization in a Patient with Unilateral Absence of Pulmonary Artery: Treatment Success and the Four-year Prognosis. Intern Med 2022; 61:2343-2346. [PMID: 35022349 PMCID: PMC9424082 DOI: 10.2169/internalmedicine.8667-21] [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: 11/22/2022] Open
Abstract
Unilateral absence of the pulmonary artery (UAPA) with or without other anomalies in the heart is a rare congenital malformation. A 55-year-old Filipino woman without a remarkable medical history was admitted to our hospital for hemoptysis. Contrast-enhanced chest computed tomography revealed the absence of the left pulmonary artery. Echocardiography and right heart catheterization showed no cardiac malformations or pulmonary hypertension. We diagnosed her with isolated left-sided UAPA and performed transarterial embolization of the left inferior phrenic artery. This resolved the hemoptysis, and there was no recurrence during the four-year follow-up period.
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Affiliation(s)
- Yoshitaka Ono
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Kyoko Niimi
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Yukihiro Horio
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | | | - Genki Takahashi
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Kazuki Harada
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | | | | | - Naoki Hayama
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Takuya Aoki
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Tetsuya Urano
- Division of Pulmonary Medicine, Department of Medicine, Japan
| | - Tatsuya Sekiguchi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Japan
| | - Jun Koizumi
- Department of Diagnostic Radiology, Tokai University School of Medicine, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Japan
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Ting AE, Baker EK, Champagne J, Desai TJ, Dos Santos CC, Heijink IH, Itescu S, Le Blanc K, Matthay MA, McAuley DF, McIntyre L, Mei SHJ, Parekkadan B, Rocco PRM, Sheridan J, Thébaud B, Weiss DJ. Proceedings of the ISCT scientific signature series symposium, "Advances in cell and gene therapies for lung diseases and critical illnesses": International Society for Cell & Gene Therapy, Burlington VT, US, July 16, 2021. Cytotherapy 2022; 24:774-788. [PMID: 35613962 DOI: 10.1016/j.jcyt.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/20/2022]
Abstract
The ISCT Scientific Signature Series Symposium "Advances in Cell and Gene Therapies for Lung Diseases and Critical Illnesses" was held as an independent symposium in conjunction with the biennial meeting, "Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Diseases," which took place July 12-15, 2021, at the University of Vermont. This is the third Respiratory System-based Signature Series event; the first 2, "Tracheal Bioengineering, the Next Steps" and "Cellular Therapies for Pulmonary Diseases and Critical Illnesses: State of the Art of European Science," took place in 2014 and 2015, respectively. Cell- and gene-based therapies for respiratory diseases and critical illnesses continue to be a source of great promise and opportunity. This reflects ongoing advancements in understanding of the mechanisms by which cell-based therapies, particularly those using mesenchymal stromal cells (MSCs), can mitigate different lung injuries and the increasing sophistication with which preclinical data is translated into clinical investigations. This also reflects continuing evolution in gene transfer vectors, including those designed for in situ gene editing in parallel with those targeting gene or cell replacement. Therefore, this symposium convened global thought leaders in a forum designed to catalyze communication and collaboration to bring the greatest possible innovation and value of cell- and gene-based therapies for patients with respiratory diseases and critical illnesses.
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Affiliation(s)
| | - Elizabeth K Baker
- Newborn Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia
| | | | - Tushar J Desai
- Stanford University School of Medicine, Stanford, California, USA
| | - Claudia C Dos Santos
- Interdepartmental Division of Critical Care, Department of Medicine and the Keenan Center for Biomedical Research, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Irene H Heijink
- Medical Center Groningen, Department of Pathology and Medical Biology, University of Groningen, Groningen, the Netherlands
| | | | - Katarina Le Blanc
- Department of Laboratory Medicine, Karolinska Institutet, Sweden; Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Michael A Matthay
- University of San Francisco, San Francisco, California, United States
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, NI, UK
| | | | - Shirley H J Mei
- Sinclair Centre for Regenerative Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Biju Parekkadan
- Sentien Biotechnologies, Lexington, Massachusetts, USA; Rutgers University, Piscataway, New Jersey, USA
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Daniel J Weiss
- University of Vermont College of Medicine, Burlington, Vermont, USA.
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Azhdari MH, Goodarzi N, Doroudian M, MacLoughlin R. Molecular Insight into the Therapeutic Effects of Stem Cell-Derived Exosomes in Respiratory Diseases and the Potential for Pulmonary Delivery. Int J Mol Sci 2022; 23:ijms23116273. [PMID: 35682948 PMCID: PMC9181737 DOI: 10.3390/ijms23116273] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023] Open
Abstract
Respiratory diseases are the cause of millions of deaths annually around the world. Despite the recent growth of our understanding of underlying mechanisms contributing to the pathogenesis of lung diseases, most therapeutic approaches are still limited to symptomatic treatments and therapies that only delay disease progression. Several clinical and preclinical studies have suggested stem cell (SC) therapy as a promising approach for treating various lung diseases. However, challenges such as the potential tumorigenicity, the low survival rate of the SCs in the recipient body, and difficulties in cell culturing and storage have limited the applicability of SC therapy. SC-derived extracellular vesicles (SC-EVs), particularly SC-derived exosomes (SC-Exos), exhibit most therapeutic properties of stem cells without their potential drawbacks. Similar to SCs, SC-Exos exhibit immunomodulatory, anti-inflammatory, and antifibrotic properties with the potential to be employed in the treatment of various inflammatory and chronic respiratory diseases. Furthermore, recent studies have demonstrated that the microRNA (miRNA) content of SC-Exos may play a crucial role in the therapeutic potential of these exosomes. Several studies have investigated the administration of SC-Exos via the pulmonary route, and techniques for SCs and SC-Exos delivery to the lungs by intratracheal instillation or inhalation have been developed. Here, we review the literature discussing the therapeutic effects of SC-Exos against respiratory diseases and advances in the pulmonary route of delivery of these exosomes to the damaged tissues.
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Affiliation(s)
- Mohammad H. Azhdari
- Department of Cell and Molecular Sciences, Faculty of Biological Sciences, Kharazmi University, Tehran 15719-14911, Iran; (M.H.A.); (N.G.)
| | - Nima Goodarzi
- Department of Cell and Molecular Sciences, Faculty of Biological Sciences, Kharazmi University, Tehran 15719-14911, Iran; (M.H.A.); (N.G.)
| | - Mohammad Doroudian
- Department of Cell and Molecular Sciences, Faculty of Biological Sciences, Kharazmi University, Tehran 15719-14911, Iran; (M.H.A.); (N.G.)
- Correspondence: author: (M.D.); (R.M.)
| | - Ronan MacLoughlin
- Research and Development, Science and Emerging Technologies, Aerogen Limited, IDA Business Park, H91 HE94 Galway, Ireland
- School of Pharmacy, Royal College of Surgeons, D02 YN77 Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Correspondence: author: (M.D.); (R.M.)
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Stankovic M, Veljovic K, Popovic N, Kojic S, Dunjic Manevski S, Radojkovic D, Golic N. Lactobacillus brevis BGZLS10-17 and Lb. plantarum BGPKM22 Exhibit Anti-Inflammatory Effect by Attenuation of NF-κB and MAPK Signaling in Human Bronchial Epithelial Cells. Int J Mol Sci 2022; 23:ijms23105547. [PMID: 35628361 PMCID: PMC9146699 DOI: 10.3390/ijms23105547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 12/28/2022] Open
Abstract
Bronchial epithelial cells are exposed to environmental influences, microbiota, and pathogens and also serve as a powerful effector that initiate and propagate inflammation by the release of pro-inflammatory mediators. Recent studies suggested that lung microbiota differ between inflammatory lung diseases and healthy lungs implicating their contribution in the modulation of lung immunity. Lactic acid bacteria (LAB) are natural inhabitants of healthy human lungs and also possess immunomodulatory effects, but so far, there are no studies investigating their anti-inflammatory potential in respiratory cells. In this study, we investigated immunomodulatory features of 21 natural LAB strains in lipopolysaccharide (LPS)-stimulated human bronchial epithelial cells (BEAS-2B). Our results show that several LAB strains reduced the expression of pro-inflammatory cytokine and chemokine genes. We also demonstrated that two LAB strains, Lactobacillus brevis BGZLS10-17 and Lb. plantarum BGPKM22, effectively attenuated LPS-induced nuclear factor-κB (NF-κB) nuclear translocation. Moreover, BGZLS10-17 and BGPKM22 reduced the activation of p38, extracellular signal-related kinase (ERK), and c-Jun amino-terminal kinase (JNK) signaling cascade resulting in a reduction of pro-inflammatory mediator expressions in BEAS-2B cells. Collectively, the LAB strains BGZLS10-17 and BGPKM22 exhibited anti-inflammatory effects in BEAS-2B cells and could be employed to balance immune response in lungs and replenish diminished lung microbiota in chronic lung diseases.
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Affiliation(s)
- Marija Stankovic
- Laboratory for Molecular Biology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (S.K.); (S.D.M.); (D.R.)
- Correspondence:
| | - Katarina Veljovic
- Laboratory for Molecular Microbiology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (K.V.); (N.P.); (N.G.)
| | - Nikola Popovic
- Laboratory for Molecular Microbiology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (K.V.); (N.P.); (N.G.)
| | - Snezana Kojic
- Laboratory for Molecular Biology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (S.K.); (S.D.M.); (D.R.)
| | - Sofija Dunjic Manevski
- Laboratory for Molecular Biology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (S.K.); (S.D.M.); (D.R.)
| | - Dragica Radojkovic
- Laboratory for Molecular Biology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (S.K.); (S.D.M.); (D.R.)
| | - Natasa Golic
- Laboratory for Molecular Microbiology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, 11042 Belgrade, Serbia; (K.V.); (N.P.); (N.G.)
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Abstract
Noninvasive ventilation (NIV) provides respiratory support without the use of invasive ventilation with techniques that do not bypass the upper airway. NIV is particularly attractive given its associated reduced risk of complications associated with intubation. Available NIV modes include nasal cannula, simple mask, nonrebreather, high flow nasal cannula, continuous positive airway pressure (CPAP), and bilevel positive airway pressure. Acute exacerbation of COPD, cardiogenic pulmonary edema, and COVID-19 are conditions for which NIV has shown to be beneficial, whereas there is no consensus among the use of NIV in trauma patients and ARDS.
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Affiliation(s)
- Patrycja Popowicz
- Department of General Surgery, East Carolina University- Vidant Medical Center, 2100 Stantonsburg Road, Greenville, NC 27834, USA.
| | - Kenji Leonard
- Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, East Carolina University- Vidant Medical Center, 2100 Stantonsburg Road, Greenville, NC 27834, USA
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Kostelníková P, Skácelová M, Špíšek M, Šimíček M, Horák P. Diffuse alveolar hemorrhage as a life threatening manifestation of newly diagnosed granulomatosis with polyangiitis following COVID-19 infection - a case report. Vnitr Lek 2022; 68:290-294. [PMID: 36283819 DOI: 10.36290/vnl.2022.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A case report of a patient with newly diagnosed granulomatosis with polyangiitis (GPA) after undergoing COVID-19 (Coronavirus Disease 2019) is discussed. GPA is one of the ANCA-associated vasculitis, which is characterized by the presence of autoantibodies against cytoplasmic enzymes neutrophils (Anti Neutrophil Cytoplasmatic Antibodies). It is a vasculitis that mainly affects small blood vessels, leading to damage to the kidneys, lungs, and upper respiratory tract, including the paranasal sinuses and orbits. This disease can result in an acute life-threatening condition. Such complications include diffuse alveolar hemorrhage (DAH), a condition characterized by blood leakage from the pulmonary vessels into the alveoli, often leading to acute vital signs and even respiratory failure. DAH can have many causes - autoimmune diseases including vasculitides as well as non-immunological causes. Early and adequate comprehensive therapy including immunosuppressive treatment (cyclophosphamide/rituximab and glucocorticoids) can be life-saving.
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Abstract
Noninfectious lung diseases contribute to nonrelapse mortality. They constitute a spectrum of diseases that can affect the parenchyma, airways, or vascular pulmonary components and specifically exclude cardiac and renal causes. The differential diagnoses of these entities differ as a function of time after hematopoietic cell transplantation. Specific diagnosis, prognosis, and optimal treatment remain challenging, although progress has been made in recent decades.
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Affiliation(s)
- Kirsten M. Williams
- Correspondence Kirsten M. Williams, Blood and Marrow
Transplant Program, Aflac Cancer and Blood Disorders Center, Emory University
School of Medicine, Children's Healthcare of Atlanta, 1760 Haygood Dr,
3rd floor W362, Atlanta, GA 30322; e-mail:
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Head W, Kumar N, Thomas C, Leon S, Dieffenbaugher S, Eriksson E. Are rib fractures stable? An analysis of progressive rib fracture offset in the acute trauma setting. J Trauma Acute Care Surg 2021; 91:917-922. [PMID: 34407002 DOI: 10.1097/ta.0000000000003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rib fractures serve as both a marker of injury severity and a guide for clinical decision making for trauma patients. Although recent studies have suggested that rib fractures are dynamic, the degree of progressive offset remains unknown. The purpose of this study was to further characterize the change that takes place in the acute trauma setting. METHODS A 4-year (2016-2019) retrospective assessment of adult trauma patients with rib fracture(s) admitted to a level I trauma center was performed. Initial and follow-up computed tomography scans were analyzed to determine the magnitude of offset. Relevant clinical course variables were examined, and location of chest wall instability was examined using the difference of interquartile range of median change. Statistical Product and Services Solutions (Version 25, IBM Corp. Armonk, NY) was then used to generate a neural network-multilayer perceptron that highlighted independent variable importance. RESULTS Fifty-three patients met the inclusion criteria for severe injury. Clinical course variables that either trended or significantly predicted the occurrence of progressive offset were Abbreviated Injury Scale Thoracic Scores (3.1 ± 0.4 no progression vs. 3.4 ± 0.6 yes progression; p = 0.121), flail segment (14% no progression vs. 43% yes progression; p = 0.053), and number of ribs fractured (4 [2-8] no progression vs. 7 [5-9] yes progression; p = 0.023). The location of progressive offset largely corresponded to the posterolateral region as demonstrated by the differences of interquartile range of median change. The neural network demonstrated that ribs 4 to 6 (normalized importance [NI], 100%), the posterolateral region (NI, 87.9%), and multiple fractures per rib (NI, 66.6%) were valuable in predicting whether progressive offset occurred (receiver operating characteristic curve - area under the curve = 0.869). CONCLUSION Rib fractures are not stable, particularly for those patients with multiple fractures in the mid-to-upper ribs localized to the posterolateral region. These findings may identify both trauma patients with worse outcomes and help develop better management strategies for rib fractures. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- William Head
- From the Department of Surgery (W.H., N.K., C.T., S.L., E.E.), Medical University of South Carolina, Charleston, South Carolina; and Department of Surgery (S.D.), Atrium Health Carolinas Medical Center, Charlotte, North Carolina
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Zhao Y, Jiang F, Yu H, Wang Y, Wang Z, Sun P, Ni Z, Wang W, Jiang L, Fan J, Zhang L, Powell CA, Liang Z. Bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB) for intubated patients with severe lung diseases. Crit Care 2021; 25:359. [PMID: 34649600 PMCID: PMC8515780 DOI: 10.1186/s13054-021-03782-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/02/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Examinations based on lung tissue specimen can play a significant role in the diagnosis for critically ill and intubated patients with lung infiltration. However, severe complications including tension pneumothorax and intrabronchial hemorrhage limit the application of needle biopsy. METHODS A refined needle biopsy technique, named bronchus-blocked ultrasound-guided percutaneous transthoracic needle biopsy (BUS-PTNB), was performed on four intubated patients between August 2020 and April 2021. BUS-PTNB was done at bedside, following an EPUBNOW (evaluation, preparation, ultrasound location, bronchus blocking, needle biopsy, observation, and withdrawal of blocker) workflow. Parameters including procedure feasibility, sample acquisition, perioperative conditions, and complications were observed. Tissue specimens were sent to pathological examinations and microbial tests. RESULTS Adequate specimens were successfully obtained from four patients. Diagnosis and treatment were correspondingly refined based on pathological and microbial tests. Intrabronchial hemorrhage occurred in patient 1 but was stopped by endobronchial blocker. Mild pneumothorax happened in patient 4 due to little air leakage, and closed thoracic drainage was placed. During the procedure, peripheral capillary hemoglobin oxygen saturation (SPO2), blood pressure, and heart rate of patient 4 fluctuated but recovered quickly. Vital signs were stable for patient 1-3. CONCLUSIONS BUS-PTNB provides a promising, practical and feasible method in acquiring tissue specimen for critically ill patients under intratracheal intubation. It may facilitate the pathological diagnosis or other tissue-based tests for intubated patients and improve clinical outcomes.
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Affiliation(s)
- Yuean Zhao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Faming Jiang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - He Yu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Ye Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China.
| | - Zhen Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Peng Sun
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Zhong Ni
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Weiya Wang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Lili Jiang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Junping Fan
- Department of Pulmonary Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Lanlan Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China
| | - Charles A Powell
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China.
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Stockley JA, Alhuthail EA, Coney AM, Parekh D, Geberhiwot T, Gautum N, Madathil SC, Cooper BG. Lung function and breathing patterns in hospitalised COVID-19 survivors: a review of post-COVID-19 Clinics. Respir Res 2021; 22:255. [PMID: 34579722 PMCID: PMC8474952 DOI: 10.1186/s12931-021-01834-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/29/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION There is relatively little published on the effects of COVID-19 on respiratory physiology, particularly breathing patterns. We sought to determine if there were lasting detrimental effect following hospital discharge and if these related to the severity of COVID-19. METHODS We reviewed lung function and breathing patterns in COVID-19 survivors > 3 months after discharge, comparing patients who had been admitted to the intensive therapy unit (ITU) (n = 47) to those who just received ward treatments (n = 45). Lung function included spirometry and gas transfer and breathing patterns were measured with structured light plethysmography. Continuous data were compared with an independent t-test or Mann Whitney-U test (depending on distribution) and nominal data were compared using a Fisher's exact test (for 2 categories in 2 groups) or a chi-squared test (for > 2 categories in 2 groups). A p-value of < 0.05 was taken to be statistically significant. RESULTS We found evidence of pulmonary restriction (reduced vital capacity and/or alveolar volume) in 65.4% of all patients. 36.1% of all patients has a reduced transfer factor (TLCO) but the majority of these (78.1%) had a preserved/increased transfer coefficient (KCO), suggesting an extrapulmonary cause. There were no major differences between ITU and ward lung function, although KCO alone was higher in the ITU patients (p = 0.03). This could be explained partly by obesity, respiratory muscle fatigue, localised microvascular changes, or haemosiderosis from lung damage. Abnormal breathing patterns were observed in 18.8% of subjects, although no consistent pattern of breathing pattern abnormalities was evident. CONCLUSIONS An "extrapulmonary restrictive" like pattern appears to be a common phenomenon in previously admitted COVID-19 survivors. Whilst the cause of this is not clear, the effects seem to be similar on patients whether or not they received mechanical ventilation or had ward based respiratory support/supplemental oxygen.
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Affiliation(s)
- James A Stockley
- Lung Function and Sleep, Outpatient Department Area 3, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK.
| | - Eyas A Alhuthail
- School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- College of Sciences and Health Professions, Basic Sciences Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Andrew M Coney
- School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Dhruv Parekh
- Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, UoB, Birmingham, UK
| | - Tarekegn Geberhiwot
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Nandan Gautum
- Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Shyam C Madathil
- Respiratory Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Brendan G Cooper
- Lung Function and Sleep, Outpatient Department Area 3, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
- School of Biomedical Sciences, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Neff S, Drake MG, Slatore CG, Burnham E. Inhaled Marijuana and the Lungs. Am J Respir Crit Care Med 2021; 204:P9-P10. [PMID: 34499025 DOI: 10.1164/rccm.2044p9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Faverio P, Luppi F, Rebora P, Busnelli S, Stainer A, Catalano M, Parachini L, Monzani A, Galimberti S, Bini F, Bodini BD, Betti M, De Giacomi F, Scarpazza P, Oggionni E, Scartabellati A, Bilucaglia L, Ceruti P, Modina D, Harari S, Caminati A, Valsecchi MG, Bellani G, Foti G, Pesci A. Six-Month Pulmonary Impairment after Severe COVID-19: A Prospective, Multicentre Follow-Up Study. Respiration 2021; 100:1078-1087. [PMID: 34515212 PMCID: PMC8450855 DOI: 10.1159/000518141] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/30/2021] [Accepted: 06/18/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Long-term pulmonary sequelae following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia are not yet confirmed; however, preliminary observations suggest a possible relevant clinical, functional, and radiological impairment. OBJECTIVES The aim of this study was to identify and characterize pulmonary sequelae caused by SARS-CoV-2 pneumonia at 6-month follow-up. METHODS In this multicentre, prospective, observational cohort study, patients hospitalized for SARS-CoV-2 pneumonia and without prior diagnosis of structural lung diseases were stratified by maximum ventilatory support ("oxygen only," "continuous positive airway pressure," and "invasive mechanical ventilation") and followed up at 6 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6-min walking test, chest X-ray, physical examination, and modified Medical Research Council (mMRC) dyspnoea score were collected. RESULTS Between March and June 2020, 312 patients were enrolled (83, 27% women; median interquartile range age 61.1 [53.4, 69.3] years). The parameters that showed the highest rate of impairment were DLCO and chest X-ray, in 46% and 25% of patients, respectively. However, only a minority of patients reported dyspnoea (31%), defined as mMRC ≥1, or showed restrictive ventilatory defects (9%). In the logistic regression model, having asthma as a comorbidity was associated with DLCO impairment at follow-up, while prophylactic heparin administration during hospitalization appeared as a protective factor. The need for invasive ventilatory support during hospitalization was associated with chest imaging abnormalities. CONCLUSIONS DLCO and radiological assessment appear to be the most sensitive tools to monitor patients with the coronavirus disease 2019 (COVID-19) during follow-up. Future studies with longer follow-up are warranted to better understand pulmonary sequelae.
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Affiliation(s)
- Paola Faverio
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Fabrizio Luppi
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Paola Rebora
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano Bicocca, Monza, Italy
| | - Sara Busnelli
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Anna Stainer
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Martina Catalano
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Luca Parachini
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Anna Monzani
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano Bicocca, Monza, Italy
| | - Francesco Bini
- Department of Internal Medicine, UOC Pulmonology, Ospedale G. Salvini, ASST-Rhodense, Milan, Italy
| | - Bruno Dino Bodini
- Department of Internal Medicine, UOC Pulmonology, Ospedale G. Salvini, ASST-Rhodense, Milan, Italy
| | - Monia Betti
- Division of Pulmonary Medicine, Cremona Hospital, ASST Cremona, Cremona, Italy
| | - Federica De Giacomi
- Division of Pulmonary Medicine, Cremona Hospital, ASST Cremona, Cremona, Italy
| | - Paolo Scarpazza
- Division of Pulmonary Medicine, Civile Hospital, Vimercate, Italy
| | - Elisa Oggionni
- Division of Pulmonary Medicine, Civile Hospital, Vimercate, Italy
| | | | - Luca Bilucaglia
- Department of Pulmonology and Respiratory High-Dependency Unit, Ospedale Maggiore, Crema, Italy
| | - Paolo Ceruti
- U.O. Pneumologia e Fisiopatologia Respiratoria, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Denise Modina
- U.O. Pneumologia e Fisiopatologia Respiratoria, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sergio Harari
- Department of Medical Sciences, Department of Clinical Sciences and Community Health, San Giuseppe Hospital, MultiMedica IRCCS and Università degli Studi di Milano, Milan, Italy
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano Bicocca, Monza, Italy
| | - Giacomo Bellani
- Department of Anesthesia and Intensive Care Medicine, School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giuseppe Foti
- Department of Anesthesia and Intensive Care Medicine, School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Alberto Pesci
- School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy
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Yang S, Guo JQ, Yan XF, Tang SJ. [Interpretation of clinical practice guideline on the treatment of nontuberculous mycobacterial pulmonary disease: Euro‑American 2020 edition]. Zhonghua Jie He He Hu Xi Za Zhi 2021; 44:699-704. [PMID: 34645135 DOI: 10.3760/cma.j.cn112147-20210222-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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50
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Nayor M, Shen L, Hunninghake GM, Kochunov P, Barr RG, Bluemke DA, Broeckel U, Caravan P, Cheng S, de Vries PS, Hoffmann U, Kolossváry M, Li H, Luo J, McNally EM, Thanassoulis G, Arnett DK, Vasan RS. Progress and Research Priorities in Imaging Genomics for Heart and Lung Disease: Summary of an NHLBI Workshop. Circ Cardiovasc Imaging 2021; 14:e012943. [PMID: 34387095 PMCID: PMC8486340 DOI: 10.1161/circimaging.121.012943] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Imaging genomics is a rapidly evolving field that combines state-of-the-art bioimaging with genomic information to resolve phenotypic heterogeneity associated with genomic variation, improve risk prediction, discover prevention approaches, and enable precision diagnosis and treatment. Contemporary bioimaging methods provide exceptional resolution generating discrete and quantitative high-dimensional phenotypes for genomics investigation. Despite substantial progress in combining high-dimensional bioimaging and genomic data, methods for imaging genomics are evolving. Recognizing the potential impact of imaging genomics on the study of heart and lung disease, the National Heart, Lung, and Blood Institute convened a workshop to review cutting-edge approaches and methodologies in imaging genomics studies, and to establish research priorities for future investigation. This report summarizes the presentations and discussions at the workshop. In particular, we highlight the need for increased availability of imaging genomics data in diverse populations, dedicated focus on less common conditions, and centralization of efforts around specific disease areas.
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Affiliation(s)
- Matthew Nayor
- Cardiology Division, Department of Medicine, Massachusetts
General Hospital, Harvard Medical School, Boston, MA
| | - Li Shen
- Department of Biostatistics, Epidemiology and Informatics,
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gary M. Hunninghake
- Division of Pulmonary and Critical Care Medicine, Harvard
Medical School, Brigham and Women’s Hospital, Boston, MA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of
Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - R. Graham Barr
- Department of Medicine and Department of Epidemiology,
Mailman School of Public Health, Columbia University Irving Medical Center, New
York, NY
| | - David A. Bluemke
- Department of Radiology, University of Wisconsin-Madison
School of Medicine and Public Health, Madison, WI
| | - Ulrich Broeckel
- Section of Genomic Pediatrics, Department of Pediatrics,
Medicine and Physiology, Children’s Research Institute and Genomic Sciences
and Precision Medicine Center, Medical College of Wisconsin, Milwaukee, WI
| | - Peter Caravan
- Institute for Innovation in Imaging, Athinoula A. Martinos
Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical
School, Charlestown, MA
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute,
Cedars-Sinai Medical Center, Los Angeles, CA
| | - Paul S. de Vries
- Human Genetics Center, Department of Epidemiology, Human
Genetics, and Environmental Sciences, School of Public Health, The University of
Texas Health Science Center at Houston, Houston, TX
| | - Udo Hoffmann
- Department of Radiology, Harvard Medical School,
Massachusetts General Hospital, Boston, Massachusetts
| | - Márton Kolossváry
- Department of Radiology, Harvard Medical School,
Massachusetts General Hospital, Boston, Massachusetts
| | - Huiqing Li
- Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, Bethesda, MD
| | - James Luo
- Division of Cardiovascular Sciences, National Heart,
Lung, and Blood Institute, Bethesda, MD
| | - Elizabeth M. McNally
- Center for Genetic Medicine, Northwestern University
Feinberg School of Medicine, Chicago, IL
| | - George Thanassoulis
- Preventive and Genomic Cardiology, McGill University
Health Center and Research Institute, Montreal, Quebec, Canada
| | - Donna K. Arnett
- College of Public Health, University of Kentucky,
Lexington KY
| | - Ramachandran S. Vasan
- Sections of Preventive Medicine and Epidemiology, and
Cardiology, Department of Medicine, Department of Epidemiology, Boston University
Schools of Medicine and Public Health, and Center for Computing and Data Sciences,
Boston University, Boston, MA
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