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Murakami Y, Sakamoto K, Okumura Y, Suzuki A, Mii S, Sato M, Yokoi T, Hashimoto N, Hasegawa Y. Acute Exacerbation of Pleuroparenchymal Fibroelastosis Secondary to Allogenic Hematopoietic Stem Cell Transplantation. Intern Med 2020; 59:2737-2743. [PMID: 32669500 PMCID: PMC7691016 DOI: 10.2169/internalmedicine.4995-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In this article, we report a case with pleuroparenchymal fibroelastosis (PPFE) following hematopoietic stem cell transplantation (HSCT) that developed acute respiratory failure with new bilateral ground glass opacity, which could not be explained by either a pulmonary infection, drug toxicity or extraparenchymal causes. Although combination therapy with multiple immunosuppressants was transiently effective, the patient died from a recurrent exacerbation. Autopsied lungs demonstrated diffuse alveolar damage superimposed on PPFE. There was no evidence of any coexisting interstitial pneumonia with the usual interstitial pneumonia (UIP) pattern. Our case suggests that acute exacerbation can occur in patients with post-HSCT PPFE, even when a coexisting UIP pattern is absent.
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Affiliation(s)
- Yasushi Murakami
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Yuki Okumura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Japan
| | - Atsushi Suzuki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Shinji Mii
- Department of Pathology, Nagoya University Graduate School of Medicine, Japan
| | - Mitsuo Sato
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
- Department of Pathophysiological Laboratory Sciences, Nagoya University Graduate School of Medicine, Japan
| | | | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan
- Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Japan
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Roumy A, Liaudet L, Rusca M, Marcucci C, Kirsch M. Pulmonary complications associated with veno-arterial extra-corporeal membrane oxygenation: a comprehensive review. Crit Care 2020; 24:212. [PMID: 32393326 PMCID: PMC7216520 DOI: 10.1186/s13054-020-02937-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 12/14/2019] [Accepted: 04/30/2020] [Indexed: 01/07/2023] Open
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-saving technology that provides transient respiratory and circulatory support for patients with profound cardiogenic shock or refractory cardiac arrest. Among its potential complications, VA-ECMO may adversely affect lung function through various pathophysiological mechanisms. The interaction of blood components with the biomaterials of the extracorporeal membrane elicits a systemic inflammatory response which may increase pulmonary vascular permeability and promote the sequestration of polymorphonuclear neutrophils within the lung parenchyma. Also, VA-ECMO increases the afterload of the left ventricle (LV) through reverse flow within the thoracic aorta, resulting in increased LV filling pressure and pulmonary congestion. Furthermore, VA-ECMO may result in long-standing pulmonary hypoxia, due to partial shunting of the pulmonary circulation and to reduced pulsatile blood flow within the bronchial circulation. Ultimately, these different abnormalities may result in a state of persisting lung inflammation and fibrotic changes with concomitant functional impairment, which may compromise weaning from VA-ECMO and could possibly result in long-term lung dysfunction. This review presents the mechanisms of lung damage and dysfunction under VA-ECMO and discusses potential strategies to prevent and treat such alterations.
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Affiliation(s)
- Aurélien Roumy
- Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland.
| | - Lucas Liaudet
- Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland
| | - Marco Rusca
- Department of Intensive Care Medicine, University Hospital, Lausanne, Switzerland
| | - Carlo Marcucci
- Department of Anesthesiology, University Hospital, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
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Di N, Zhou X, Chen Y, Zhao X, Li L, Jiang L, Luo B, Chen X, Yang D. Could semiquantitative analysis of real-time ultrasound elastography distinguish more liver parenchyma alterations of nonalcoholic fatty liver disease in patients with polycystic ovary syndrome? Arch Endocrinol Metab 2019; 63:128-136. [PMID: 30916169 PMCID: PMC10522130 DOI: 10.20945/2359-3997000000119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Nonalcoholic fatty liver disease is the commonest diffuse liver disease, of which women with polycystic ovary syndrome are at an increased risk. The aim of the present study was to assess the diagnostic value of the semiquantitative strain parameters of real-time ultrasound elastography for nonalcoholic fatty liver disease in patients with polycystic ovary syndrome. SUBJECTS AND METHODS Thirty-five polycystic ovary syndrome patients with nonalcoholic fatty liver disease, 70 polycystic ovary syndrome patients without nonalcoholic fatty liver disease, and 70 healthy female controls of reproductive age were included. All participants underwent ultrasonic examination and semiquantitative analysis of real-time ultrasound elastography of the liver. RESULTS Main semi quantitative strain parameters, such as average strain value, differed significantly among groups polycystic ovary syndrome with nonalcoholic fatty liver disease, polycystic ovary syndrome without nonalcoholic fatty liver disease, and control (87.02 ± 10.16 vs. 96.31 ± 11.44 vs. 104.49 ± 7.28, p < 0.001). Clinical and laboratory parameters differed significantly between the two subgroups with low or high average strain value. For diagnostic value of average strain value for elevated aminotransferase, the area under the curve was 0.808 (range 0.721-0.895). In multiple linear regression analysis, polycystic ovary syndrome, waist circumference, and metabolic syndrome were stand-alone independent factors associated with average strain value among subjects without nonalcoholic fatty liver disease. CONCLUSION Semiquantitative real-time ultrasound elastography analysis could distinguish liver parenchyma alterations in patients with polycystic ovary syndrome more sensitively. The diagnostic value of the proposed method for nonalcoholic fatty liver disease need further research.
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Affiliation(s)
- Na Di
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of UltrasoundGuangzhouChinaDepartment of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of Obstetrics and GynecologyGuangzhouChinaDepartment of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinchuan Zhou
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of UltrasoundGuangzhouChinaDepartment of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaxiao Chen
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of Obstetrics and GynecologyGuangzhouChinaDepartment of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaomiao Zhao
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of Obstetrics and GynecologyGuangzhouChinaDepartment of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lin Li
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of Obstetrics and GynecologyGuangzhouChinaDepartment of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Linlin Jiang
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of Obstetrics and GynecologyGuangzhouChinaDepartment of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of UltrasoundGuangzhouChinaDepartment of Ultrasound, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoli Chen
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of Obstetrics and GynecologyGuangzhouChinaDepartment of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dongzi Yang
- Sun Yat-sen UniversitySun Yat-sen UniversitySun Yat-sen Memorial HospitalDepartment of Obstetrics and GynecologyGuangzhouChinaDepartment of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Muttray J, Mehrabi A, Hafezi M, Saffari A, Bui-Ta TTT, Meyburg J, Wühl E, Schenk JP. ARFI shear-wave elastography with simulation of acute urinary tract obstruction in an ex vivo porcine kidney model. Diagn Interv Radiol 2018; 24:308-315. [PMID: 30211684 PMCID: PMC6135057 DOI: 10.5152/dir.2018.17353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 04/08/2018] [Accepted: 04/17/2018] [Indexed: 01/29/2023]
Abstract
METHODS A total of 20 heparinized pig kidneys were investigated at 10 intrapelvic hydrostatic pressure steps (0-90 mmHg). SWE (ARFI; Virtual TouchTM IQ, Siemens) measurements were taken at three different measuring regions and in two measuring sequences using a linear ultrasonography probe (9L4, Siemens). Median values of 10 shear-wave speed (SWS) measurements were calculated for each pressure step. Logarithmic transformed median SWS values were analyzed in a linear mixed model. RESULTS SWS increased significantly with increasing intrapelvic pressure. Median SWS for all kidneys in both measuring sequences and all measuring regions was 1.47 m/s (interquartile range [IQR], 0.38 m/s) at 0 mmHg, 1.94 m/s (IQR, 0.42 m/s) at 30 mmHg, 2.07 m/s (IQR, 0.43 m/s) at 60 mmHg, 2.24 m/s (IQR, 0.49 m/s) at 90 mmHg. The correlation between pelvic pressure increase and median SWS values for the central parenchyma was significantly higher compared with the peripheral parenchyma. CONCLUSION Acutely increased renal pelvic pressure correlates with increasing SWS values in ARFI elastography in an ex vivo porcine kidney model.
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Affiliation(s)
- Jens Muttray
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Arianeb Mehrabi
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Mohammadreza Hafezi
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Arash Saffari
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Thi Thanh Tam Bui-Ta
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
| | - Jochen Meyburg
- From the Division of Pediatric Radiology, Clinic of Diagnostic and Interventional Radiology (J.M., T.T.T.B.-T., J.P.S. ), Department of Visceral and Transplantation Surgery (A.M., M.H., A.S.), Clinic I, Center for Pediatrics and Adolescent Medicine (J.M.), Division of Pediatric Nephrology, Clinic I, Center for Pediatrics and Adolescent Medicine (E.W.), University of Heidelberg School of Medicine, Heidelberg, Germany
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Magee N, Zou A, Zhang Y. Pathogenesis of Nonalcoholic Steatohepatitis: Interactions between Liver Parenchymal and Nonparenchymal Cells. Biomed Res Int 2016; 2016:5170402. [PMID: 27822476 PMCID: PMC5086374 DOI: 10.1155/2016/5170402] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/22/2016] [Indexed: 12/14/2022]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease in the Western countries, affecting up to 25% of the general population and becoming a major health concern in both adults and children. NAFLD encompasses the entire spectrum of fatty liver disease in individuals without significant alcohol consumption, ranging from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) and cirrhosis. NASH is a manifestation of the metabolic syndrome and hepatic disorders with the presence of steatosis, hepatocyte injury (ballooning), inflammation, and, in some patients, progressive fibrosis leading to cirrhosis. The pathogenesis of NASH is a complex process and implicates cell interactions between liver parenchymal and nonparenchymal cells as well as crosstalk between various immune cell populations in liver. Lipotoxicity appears to be the central driver of hepatic cellular injury via oxidative stress and endoplasmic reticulum (ER) stress. This review focuses on the contributions of hepatocytes and nonparenchymal cells to NASH, assessing their potential applications to the development of novel therapeutic agents. Currently, there are limited pharmacological treatments for NASH; therefore, an increased understanding of NASH pathogenesis is pertinent to improve disease interventions in the future.
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Affiliation(s)
- Nancy Magee
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - An Zou
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Yuxia Zhang
- Department of Pharmacology, Toxicology & Therapeutics, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Abudeev SA, Popugaev KA, Kruglyakov NM, Belousova KA, Terekhov DA, Leushin KY, Aronov MS, Karpova OV, Zelenkov AV, Kiselev KV, Fedin AB, Zabelin MV, Samoylov AS. [HYPOTHERMIA INFLUENCES ON OXYGEN TENSION IN THE BRAIN PARENCHYMA IN PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE]. Anesteziol Reanimatol 2016; 61:155-158. [PMID: 27468510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Aneurysmal subarachnoid hemorrhage is a serious medical and social problem. The main physiological mechanisms that determine secondary brain damage in this patients are intracranial hypertension, cerebral vasospasm, dysfunction of autoregulation mechanisms, violation of liquorodynamics and delayed cerebral ischemia. The multimodal neuromonitoring for prevention and timely correction ofsecondary brain injury factors has become routine practice in neuroICU. Measurement of oxygen tension in the brain parenchyma is one of neuromonitoring options. During the years of intensive use of this method in clinical practice the reasons for reducing the oxygen tension in the brain parenchyma were revealed, as well as developed and clinically validated algorithms for correction of such conditions. However, there are clinical situations that are difficult to interpret and even more difficult to make the right tactical and therapeutic solutions. We present the clinical observation of the patient with aneurysmal subarachnoid hemorrhage, who had dramatically reduced brain intraparenchymal oxygen pressure although prolonged hypothermia were used. Despite this, the outcome was favorable. The analysis allowed to assume that the reason for this decrease in oxygen tension in the brain parenchyma could be hypothermia itself
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