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Werder RB, Berthiaume KA, Merritt C, Gallagher M, Villacorta-Martin C, Wang F, Bawa P, Malik V, Lyons SM, Basil MC, Morrisey EE, Kotton DN, Zhou X, Cho MH, Wilson AA. The COPD GWAS gene ADGRG6 instructs function and injury response in human iPSC-derived type II alveolar epithelial cells. Am J Hum Genet 2023; 110:1735-1749. [PMID: 37734371 PMCID: PMC10577075 DOI: 10.1016/j.ajhg.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
Emphysema and chronic obstructive pulmonary disease (COPD) most commonly result from the effects of environmental exposures in genetically susceptible individuals. Genome-wide association studies have implicated ADGRG6 in COPD and reduced lung function, and a limited number of studies have examined the role of ADGRG6 in cells representative of the airway. However, the ADGRG6 locus is also associated with DLCO/VA, an indicator of gas exchange efficiency and alveolar function. Here, we sought to evaluate the mechanistic contributions of ADGRG6 to homeostatic function and disease in type 2 alveolar epithelial cells. We applied an inducible CRISPR interference (CRISPRi) human induced pluripotent stem cell (iPSC) platform to explore ADGRG6 function in iPSC-derived AT2s (iAT2s). We demonstrate that ADGRG6 exerts pleiotropic effects on iAT2s including regulation of focal adhesions, cytoskeleton, tight junctions, and proliferation. Moreover, we find that ADGRG6 knockdown in cigarette smoke-exposed iAT2s alters cellular responses to injury, downregulating apical complexes in favor of proliferation. Our work functionally characterizes the COPD GWAS gene ADGRG6 in human alveolar epithelium.
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Affiliation(s)
- Rhiannon B Werder
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; Murdoch Children's Research Institute, Melbourne, VIC 3052, Australia
| | - Kayleigh A Berthiaume
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA
| | - Carly Merritt
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Marissa Gallagher
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA
| | - Carlos Villacorta-Martin
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA
| | - Feiya Wang
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA
| | - Pushpinder Bawa
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA
| | - Vidhi Malik
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Shawn M Lyons
- Biochemistry Department, Boston University School of Medicine, Boston, MA 02118, USA
| | - Maria C Basil
- School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Edward E Morrisey
- School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Darrell N Kotton
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Xiaobo Zhou
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Andrew A Wilson
- Center for Regenerative Medicine of Boston University and Boston Medical Center, Boston, MA 02118, USA; The Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
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Griese M, Schwerk N, Carlens J, Wetzke M, Emiralioğlu N, Kiper N, Lange J, Krenke K, Seidl E. Minimal important difference in childhood interstitial lung diseases. Thorax 2022; 78:476-483. [PMID: 36572533 PMCID: PMC10176404 DOI: 10.1136/thorax-2022-219206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/25/2022] [Indexed: 12/27/2022]
Abstract
BackgroundMonitoring disease progression in childhood interstitial lung diseases (chILD) is essential. No information for the minimal important difference (MID), which is defined as the smallest change in a parameter that is perceived as important prompting a clinician to change the treatment, is available. We calculated MIDs for vital signs (respiratory rate, peripheral oxygen saturation in room air, Fan severity score) and health-related quality of life (HrQoL) scores.MethodsThis study used data from the Kids Lung Register, which is a web-based management platform that collects data of rare paediatric lung disorders with a focus on chILD. Data of vital signs and HrQoL scores (Health Status Questionnaire, chILD-specific questionnaire and PedsQL V.4.0) were collected. MIDs were calculated according to distribution-based (one-third SD) and anchor-based methods (using forced expiratory volume in 1 s and forced vital capacity) as anchors.ResultsBaseline data of 774 children were used to calculate the following MIDs: respiratory rate 1.3 (z-score), O2saturation in room air 3.0%, Fan severity score 0.2–0.4, Health Status Questionnaire 0.4–0.8, chILD-specific questionnaire 4.4%–8.2%, physical health summary score 7.8%–8.9%, psychosocial health summary score 3.4%–6.9% and total score 5.1%–7.4%. Results of the responsiveness analysis generally agreed with the MIDs calculated.ConclusionsFor the first time, we provide estimates of MIDs for vital signs and HrQoL scores in a large cohort of chILD using different methods.
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Affiliation(s)
- Matthias Griese
- Munich University Hospital, Dr von Hauner Children's Hospital, German Center for Lung Research (DZL), Munchen, Germany
| | - Nicolaus Schwerk
- Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Julia Carlens
- Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, German Center for Lung Research (DZL), Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | | | - Nural Kiper
- Pediatric Pulmonology, Hacettepe University, Ankara, Turkey
| | - Joanna Lange
- Department of Pediatric Pneumology and Allergy, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Warszawski Uniwersytet Medyczny, Warszawa, Poland
| | - Elias Seidl
- Munich University Hospital, Dr von Hauner Children's Hospital, German Center for Lung Research (DZL), Munchen, Germany
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Ruud EA, Heck S, Stavem K, Søyseth V, Geitung JT, Ashraf H. Low diffusion capacity of the lung predicts pneumothorax and chest drainage after CT-guided lung biopsy. BMC Res Notes 2022; 15:353. [PMID: 36457053 PMCID: PMC9717539 DOI: 10.1186/s13104-022-06234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/15/2022] [Accepted: 10/07/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Complications after CT-guided lung biopsy is a burden both for the individual patient and for the overall healthcare. Pneumothorax is the most common complication. This study determined the association between lung function tests and pneumothorax and chest drainage following CT-guided lung biopsy in consecutive patients in a large university hospital. RESULTS We prospectively registered 875 biopsy procedures from 786 patients in one institution from January 27th 2012 to March 1st 2017 and recorded complications including pneumothorax with or without chest drainage. Lung function data from 637 patients undergoing 710 of the procedures were available. The association of lung function measures with pneumothorax with or without chest drainage was assessed using multivariable logistic regression analyses. Diffusion capacity for carbon monoxide (DLCO) below 4.70 mmol/min/kPa was associated with increased occurrence of pneumothorax and chest drainage after CT guided lung biopsy. We found no association between FEV1, RV and occurrence of pneumothorax and chest drainage. We found low DLCO to be a risk factor of pneumothorax and chest drainage after CT-guided lung biopsy. This should be taken into account in planning and performing the procedure.
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Affiliation(s)
- Espen Asak Ruud
- grid.5510.10000 0004 1936 8921Department of Imaging, Akershus University Hospital, University of Oslo, Sykehusveien 25, 1478 LØrenskog, Norway ,grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway
| | - Sigurd Heck
- grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway
| | - Knut Stavem
- grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XDepartment of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Vidar Søyseth
- grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XDepartment of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Jon Terje Geitung
- grid.5510.10000 0004 1936 8921Department of Imaging, Akershus University Hospital, University of Oslo, Sykehusveien 25, 1478 LØrenskog, Norway ,grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway
| | - Haseem Ashraf
- grid.5510.10000 0004 1936 8921Department of Imaging, Akershus University Hospital, University of Oslo, Sykehusveien 25, 1478 LØrenskog, Norway ,grid.5510.10000 0004 1936 8921University of Oslo, Oslo, Norway
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Peng J, Wang M, Wu Y, Shen Y, Chen L. Clinical Indicators for Asthma-COPD Overlap: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:2567-2575. [PMID: 36259043 PMCID: PMC9572492 DOI: 10.2147/copd.s374079] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background Some clinical indicators have been reported to be useful in differentiating asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) from pure asthma/COPD, but the results were inconsistent. This study aims to evaluate the diagnostic value of these indicators for ACO. Methods Databases of PubMed, EMBASE, Ovid and Web of Science were retrieved. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated in random-effects models. Results 48 eligible studies were included. The pooled results indicated, compared with pure asthma, ACO patients had lower levels of forced expiratory volume in the first second (FEV1)% predicted (pred) (SMD=−1.09, 95% CI −1.3 to −0.87), diffusion lung capacity for carbon monoxide (DLCO)% pred (SMD=−0.83, 95% CI −1.24 to −0.42), fractional exhaled nitric oxide (FeNO) (SMD=−0.23, 95% CI −0.36 to −0.11), and higher levels of induced sputum neutrophil (SMD = 0.51, 95% CI 0.21 to 0.81), circulating YKL-40 (SMD = 0.96, 95% CI 0.27 to 1.64). However, relative to COPD alone, ACO patients had higher levels of FEV1% pred (SMD = 0.15, 95% CI 0.05 to 0.26), DLCO% pred (SMD = 0.38, 95% CI 0.16 to 0.6), FeNO (SMD = 0.59, 95% CI 0.40 to 0.78), serum total immunoglobulin (Ig)E (SMD = 0.42, 95% CI 0.1 to 0.75), blood eosinophil (SMD = 0.44, 95% CI 0.29 to 0.59), induced sputum eosinophil (SMD = 0.62, 95% CI 0.42 to 0.83), and lower levels of induced sputum neutrophil (SMD=−0.48, 95% CI −0.7 to −0.27), circulating YKL-40 (SMD=−1.09, 95% CI −1.92 to −0.26). Conclusion Compared with pure asthma/COPD, ACO patients have different levels of FEV1% pred, DLCO% pred, FeNO, serum total IgE, blood eosinophil, induced sputum eosinophil/neutrophil, and circulating YKL-40, which could be helpful to establish a clinical diagnosis of ACO.
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Affiliation(s)
- Junjie Peng
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Min Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Yanqiu Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Yongchun Shen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China,Correspondence: Lei Chen; Yongchun Shen, Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China, Email ;
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Diagnostic differentiation between asthma and COPD in primary care using lung function testing. NPJ Prim Care Respir Med 2022; 32:32. [PMID: 36064807 PMCID: PMC9445018 DOI: 10.1038/s41533-022-00298-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 08/16/2022] [Indexed: 12/02/2022] Open
Abstract
Asthma and COPD are defined as different disease entities, but in practice patients often show features of both diseases making it challenging for primary care clinicians to establish a correct diagnosis. We aimed to establish the added value of spirometry and more advanced lung function measurements to differentiate between asthma and COPD. A cross-sectional study in 10 Dutch general practices was performed. 532 subjects were extensively screened on respiratory symptoms and lung function. Two chest physicians assessed if asthma or COPD was present. Using multivariable logistic regression analysis we assessed the ability of three scenarios (i.e. only patient history; diagnostics available to primary care; diagnostics available only to secondary care) to differentiate between the two conditions. Receiver operator characteristics (ROC) curves and area under the curve (AUC) were calculated for each scenario, with the chest physicians’ assessment as golden standard. Results showed that 84 subjects were diagnosed with asthma, 138 with COPD, and 310 with no chronic respiratory disease. In the scenario including only patient history items, ROC characteristics of the model showed an AUC of 0.84 (95% CI 0.78–0.89) for differentiation between asthma and COPD. When adding diagnostics available to primary care (i.e., pre- and postbronchodilator spirometry) AUC increased to 0.89 (95% CI 0.84–0.93; p = 0.020). When adding more advanced secondary care diagnostic tests AUC remained 0.89 (95% CI 0.85–0.94; p = 0.967). We conclude that primary care clinicians’ ability to differentiate between asthma and COPD is enhanced by spirometry testing. More advanced diagnostic tests used in hospital care settings do not seem to provide a better overall diagnostic differentiation between asthma and COPD in primary care patients.
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Schultz CUB, Tupper OD, Ulrik CS. Static lung volumes and diffusion capacity in adults 30 years after being diagnosed with asthma. Asthma Res Pract 2022; 8:4. [PMID: 35922867 PMCID: PMC9351093 DOI: 10.1186/s40733-022-00086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background Long-term follow-up studies of adults with well-characterized asthma are sparse. We aimed to explore static lung volumes and diffusion capacity after 30 + years with asthma. Methods A total of 125 adults with an objectively verified diagnosis of asthma between 1974–1990 at a Danish respiratory outpatient clinic completed a follow-up visit 2017–19. All participants (age range 44–88 years) completed a comprehensive workup and were, based on these assessments, classified as having either active asthma or being in complete remission. The examination program included measurements of static lung volumes and diffusion capacity. Results Participants with active asthma were hyperinflated (residual volume/total lung capacity ratio 0.43, 95% CI 0.41—0.45) (RV/TLC ratio) compared with those in remission (RV/TLC ratio 0.38, 95% CI 0.36—0.41) (p < 0.03). A tendency towards higher diffusion capacity per liter lung volume was seen in participants with active asthma (KCO 100% predicted, 95% CI 97—104) compared with those in remission (KCO 94% pred., 95% CI 89—99) (P = 0.10). Longer asthma duration was associated with a higher KCO 0.47% pred./year (95% CI 0.14—0.80), adjusted for age and smoking. Patients on GINA step 4 and 5 treatment were more hyperinflated (\documentclass[12pt]{minimal}
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\begin{document}$$\Delta$$\end{document}Δ RV 14% pred., 95% CI 3—27) and had higher airway resistance (mean 53% pred., 95% CI 9—97) than participants on lower GINA steps. Patients with uncontrolled disease had substantially higher airway resistance (72% pred. 95% CI 20—124) than well-controlled patients. Conclusion Thirty years after a confirmed diagnosis of asthma, those continuing to have active asthma and those having severe asthma, have higher diffusion capacity and more hyperinflation than patients in remission.
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Affiliation(s)
| | - Oliver Djurhuus Tupper
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Choi JW, Jeong H, Ahn HJ, Yang M, Kim JA, Kim DK, Lee SH, Kim K, Choi J. The impact of pulmonary function tests on early postoperative complications in open lung resection surgery: an observational cohort study. Sci Rep 2022; 12:1277. [PMID: 35075198 PMCID: PMC8786949 DOI: 10.1038/s41598-022-05279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/10/2022] [Indexed: 11/09/2022] Open
Abstract
We investigated whether pulmonary function tests (PFTs) can predict pulmonary complications and if they are, to find new cutoff values in current open lung resection surgery. In this observational study, patients underwent open lung resection surgery at a tertiary hospital were analyzed (n = 1544). Various PFTs were tested by area under the receiver-operating characteristic curve (AUCROC) to predict pulmonary complications until 30 days postoperatively. In results, PFTs were generally not effective to predict pulmonary complications (AUCROC: 0.58-0.66). Therefore, we could not determine new cutoff values, and used previously reported cutoffs for post-hoc analysis [predicted postoperative forced expiratory volume in one second (ppoFEV1) < 40%, predicted postoperative diffusing capacity for carbon monoxide (ppoDLCO) < 40%]. In multivariable analysis, old age, male sex, current smoker, intraoperative transfusion and use of inotropes were independent risk factors for pulmonary complications (model 1: AUCROC 0.737). Addition of ppoFEV1 or ppoDLCO < 40% to model 1 did not significantly increase predictive capability (model 2: AUCROC 0.751, P = 0.065). In propensity score-matched subgroups, patients with ppoFEV1 or ppoDLCO < 40% showed higher rates of pulmonary complications [13% (21/160) vs. 24% (38/160), P = 0.014], but no difference in in-hospital mortality [3% (8/241) vs. 6% (14/241), P = 0.210] or mean survival duration [61 (95% CI 57-66) vs. 65 (95% CI 60-70) months, P = 0.830] compared to patients with both > 40%. In conclusion, PFTs themselves were not effective predictors of pulmonary complications. Decision to proceed with surgical resection of lung cancer should be made on an individual basis considering other risk factors and the patient's goals.
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Affiliation(s)
- Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Heejoon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Keoungah Kim
- Department of Anesthesiology, School of Dentistry, Dankook University, Cheonan, South Korea
| | - Jisun Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
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A five-year clinical audit of concussive injuries in South African collegiate male rugby players—a South African experience. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Terzikhan N, Xu H, Edris A, Bracke KR, Verhamme FM, Stricker BH, Dupuis J, Lahousse L, O'Connor GT, Brusselle GG. Epigenome-wide association study on diffusing capacity of the lung. ERJ Open Res 2021; 7:00567-2020. [PMID: 33748261 PMCID: PMC7957297 DOI: 10.1183/23120541.00567-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Epigenetics may play an important role in the pathogenesis of lung diseases. However, little is known about the epigenetic factors that influence impaired gas exchange at the lung. AIM To identify the epigenetic signatures of the diffusing capacity of the lung measured by carbon monoxide uptake (the diffusing capacity of the lung for carbon monoxide (D LCO)). METHODS An epigenome-wide association study (EWAS) was performed on diffusing capacity, measured by carbon monoxide uptake (D LCO) and per alveolar volume (V A) (as D LCO/V A), using the single-breath technique in 2674 individuals from two population-based cohort studies. These were the Rotterdam Study (RS, the "discovery panel") and the Framingham Heart Study (FHS, the "replication panel"). We assessed the clinical relevance of our findings by investigating the identified sites in whole blood and by lung tissue specific gene expression. RESULTS We identified and replicated two CpG sites (cg05575921 and cg05951221) that were significantly associated with D LCO/V A and one (cg05575921) suggestively associated with D LCO. Furthermore, we found a positive association between aryl hydrocarbon receptor repressor (AHRR) gene (cg05575921) hypomethylation and gene expression of exocyst complex component 3 (EXOC3) in whole blood. We confirmed that the expression of EXOC3 in lung tissue is positively associated with D LCO/V A and D LCO. CONCLUSIONS We report on epigenome-wide associations with diffusing capacity in the general population. Our results suggest EXOC3 to be an excellent candidate, through which smoking-induced hypomethylation of AHRR might affect pulmonary gas exchange.
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Affiliation(s)
- Natalie Terzikhan
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
- These authors contributed equally
| | - Hanfei Xu
- Dept of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- These authors contributed equally
| | - Ahmed Edris
- Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Ken R. Bracke
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Fien M. Verhamme
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Bruno H.C. Stricker
- Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Josée Dupuis
- Dept of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- These authors contributed equally
| | - Lies Lahousse
- Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- These authors contributed equally
| | - George T. O'Connor
- Pulmonary Center, Boston University Schools of Medicine and Public Health, Boston, MA, USA
- These authors contributed equally
| | - Guy G. Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Dept of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Respiratory Medicine, Erasmus MC – University Medical Center Rotterdam, Rotterdam, The Netherlands
- These authors contributed equally
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García I, Drobnic F, Arrillaga B, Pons V, Viscor G. Lung capacity and alveolar gas diffusion in aquatic athletes: Implications for performance and health. APUNTS SPORTS MEDICINE 2021. [DOI: 10.1016/j.apunsm.2020.100339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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García I, Drobnic F, Pons V, Viscor G. Swimming exercise transiently decrease lung diffusing capacity in elite swimmers. J Sports Med Phys Fitness 2020; 61:666-672. [PMID: 33146491 DOI: 10.23736/s0022-4707.20.11302-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Swimmers have larger lungs and a higher diffusion capacity than other athletes, but it remains unknown whether swimming exercise changes lung diffusing properties. This study aimed to evaluate modifications in pulmonary alveolar-capillary diffusion after swimming exercise. METHODS The participants were 21 elite level swimmers, including 7 females and 14 males, with a training volume of 45-70 kilometers of swimming per week. The single-breath method was used to measure the lung diffusing capacity for carbon monoxide (DLCO and the transfer coefficient of the lungs for carbon monoxide (K<inf>CO</inf>) before and after 10 training sessions over 4 weeks along 207 pre- to postevaluations. RESULTS Swimming training consistently decreased lung diffusion capacity during the follow-up period, both DL<inf>CO</inf> (44.4±8.1 to 43.3±8.9 mL·min-1·mmHg-1, P=0.047, ŋ2<inf>p</inf>=0.55) and K<inf>CO</inf> (5.92±0.79 to 5.70±0.81 mL·min-1·mmHg-1·L-1, P=0.003, ŋ2<inf>p</inf>=0.75). CONCLUSIONS Elite swimmers experience a subclinical impairment in lung diffusing capacity after swimming exercise, but the stress caused by swimming on the lungs and the acute reduction in DL<inf>CO</inf> does not lead to physiological dysfunction.
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Affiliation(s)
- Iker García
- Section of Physiology, Department of Cellular Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, Barcelona, Spain - .,Department pf Physiology and Nutrition, Centre d'Alt Rendiment (CAR), Barcelona, Spain -
| | | | - Victoria Pons
- Department pf Physiology and Nutrition, Centre d'Alt Rendiment (CAR), Barcelona, Spain
| | - Ginés Viscor
- Section of Physiology, Department of Cellular Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, Barcelona, Spain
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12
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García I, Drobnic F, Pons V, Viscor G. Changes in Lung Diffusing Capacity of Elite Artistic Swimmers During Training. Int J Sports Med 2020; 42:227-233. [PMID: 32851635 DOI: 10.1055/a-1212-1020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Artistic swimmers (AS) are exposed to repeated apnoeas in the aquatic environment during high intensity exercise provoking specific physiological responses to training, apnoea, and immersion. This study aimed to evaluate the changes in lung diffusing capacity in AS pre-, mid- and post-training in a combined session of apnoeic swimming, figures and choreography. Eleven elite female AS from the Spanish national team were the study's participants. The single-breath method was used to measure lung diffusing capacity for carbon monoxide (DLCO) and one-way repeated measures ANOVA was utilized to evaluate the statistical analysis. Basal values of DLCO were higher than normal for their age and height (33.6±4.9 mL·min-1·mmHg-1; 139±19%) and there were a significant interaction between DLCO and AS training (ŋ2 p=0.547). After the apnoeic swimming (mid-training) there was an increase in DLCO from basal to 36.7±7.3 mL·min-1·mmHg-1 (p=0.021), and after the figures and choreography (post-training) there was a decrease compared to mid-training (32.3±4.6 mL·min-1·mmHg-1, p=0.013). Lung diffusing capacity changes occur during AS training, including a large increase after apnoeic swimming. There were no differences in lung diffusing capacity from pre- to post-training, although large inter-individual variability was observed.
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Affiliation(s)
- Iker García
- Secció de Fisiologia, Departament de Biologia Cel lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain.,Departament de Fisiologia i Nutricio, Centre d'Alt Rendiment, Sant Cugat Del Valles, Spain
| | | | - Victoria Pons
- Departament de Fisiologia i Nutricio, Centre d'Alt Rendiment, Sant Cugat Del Valles, Spain
| | - Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
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13
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Lung Diffusion in a 14-Day Swimming Altitude Training Camp at 1850 Meters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103501. [PMID: 32429560 PMCID: PMC7277217 DOI: 10.3390/ijerph17103501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022]
Abstract
Swimming exercise at sea level causes a transient decrease in lung diffusing capacity for carbon monoxide (DLCO). The exposure to hypobaric hypoxia can affect lung gas exchange, and hypoxic pulmonary vasoconstriction may elicit pulmonary oedema. The purpose of this study is to evaluate whether there are changes in DLCO during a 14-day altitude training camp (1850 m) in elite swimmers and the acute effects of a combined training session of swimming in moderate hypoxia and 44-min cycling in acute normobaric severe hypoxia (3000 m). Participants were eight international level swimmers (5 females and 3 males; 17–24 years old; 173.5 ± 5.5 cm; 64.4 ± 5.3 kg) with a training volume of 80 km per week. The single-breath method was used to measure the changes in DLCO and functional gas exchange parameters. No changes in DLCO after a 14-day altitude training camp at 1850 m were detected but a decrease in alveolar volume (VA; 7.13 ± 1.61 vs. 6.50 ± 1.59 L; p = 0.005; d = 0.396) and an increase in the transfer coefficient of the lung for carbon monoxide (KCO; 6.23 ± 1.03 vs. 6.83 ± 1.31 mL·min−1·mmHg−1·L−1; p = 0.038; d = 0.509) after the altitude camp were observed. During the acute hypoxia combined session, there were no changes in DLCO after swimming training at 1850 m, but there was a decrease in DLCO after cycling at a simulated altitude of 3000 m (40.6 ± 10.8 vs. 36.8 ± 11.2 mL·min−1·mmHg−1; p = 0.044; d = 0.341). A training camp at moderate altitude did not alter pulmonary diffusing capacity in elite swimmers, although a cycling session at a higher simulated altitude caused a certain degree of impairment of the alveolar–capillary gas exchange.
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14
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Ergözen S, Demir A, Acar E. A carbon monoxide poisoning case due to lung diffusion test. Am J Emerg Med 2020; 38:1047.e1-1047.e2. [DOI: 10.1016/j.ajem.2019.12.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022] Open
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15
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Terzikhan N, Sun F, Verhamme FM, Adams HHH, Loth D, Bracke KR, Stricker BHC, Lahousse L, Dupuis J, Brusselle GG, O'Connor GT. Heritability and genome-wide association study of diffusing capacity of the lung. Eur Respir J 2018; 52:13993003.00647-2018. [PMID: 30049742 DOI: 10.1183/13993003.00647-2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/22/2018] [Indexed: 12/31/2022]
Abstract
Although several genome-wide association studies (GWAS) have investigated the genetics of pulmonary ventilatory function, little is known about the genetic factors that influence gas exchange. The aim of the study was to investigate the heritability of, and genetic variants associated with the diffusing capacity of the lung.GWAS was performed on diffusing capacity of the lung measured by carbon monoxide uptake (DLCO) and per alveolar volume (VA) using the single-breath technique, in 8372 individuals from two population-based cohort studies, the Rotterdam Study and the Framingham Heart Study. Heritability was estimated in related (n=6246) and unrelated (n=3286) individuals.Heritability of DLCO and DLCO/VA ranged between 23% and 28% in unrelated individuals and between 45% and 49% in related individuals. Meta-analysis identified a genetic variant in ADGRG6 that is significantly associated with DLCO/VA Gene expression analysis of ADGRG6 in human lung tissue revealed a decreased expression in patients with chronic obstructive pulmonary disease (COPD) and subjects with decreased DLCO/VADLCO and DLCO/VA are heritable traits, with a considerable proportion of variance explained by genetics. A functional variant in ADGRG6 gene region was significantly associated with DLCO/VA Pulmonary ADGRG6 expression was decreased in patients with COPD.
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Affiliation(s)
- Natalie Terzikhan
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Dept of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,These authors contributed equally
| | - Fangui Sun
- Dept of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,These authors contributed equally
| | - Fien M Verhamme
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,These authors contributed equally
| | - Hieab H H Adams
- Dept of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Daan Loth
- Dept of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ken R Bracke
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Bruno H C Stricker
- Dept of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lies Lahousse
- Dept of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,These authors contributed equally
| | - Josée Dupuis
- Dept of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,These authors contributed equally
| | - Guy G Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Dept of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Respiratory Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands.,These authors contributed equally
| | - George T O'Connor
- Pulmonary Center, Boston University Schools of Medicine and Public Health, Boston, MA, USA.,These authors contributed equally
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16
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Janssen DJA, Wouters EFM, Parra YL, Stakenborg K, Franssen FME. Prevalence of thoracic pain in patients with chronic obstructive pulmonary disease and relationship with patient characteristics: a cross-sectional observational study. BMC Pulm Med 2016; 16:47. [PMID: 27052199 PMCID: PMC4823883 DOI: 10.1186/s12890-016-0210-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/23/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Objectives of this study were to evaluate the prevalence of thoracic pain in patients with chronic obstructive pulmonary disease (COPD) and its relationship with Forced Expiratory Volume in the first second (FEV1), static hyperinflation, dyspnoea, functional exercise capacity, disease-specific health status, anxiety, and depression. METHODS This cross-sectional observational study included patients with COPD entering pulmonary rehabilitation. Participants underwent spirometry, plethysmography, and measurement of single breath diffusion capacity. Pain was assessed using a multidimensional, structured pain interview. In addition, dyspnoea severity (Modified Medical Research Council Dyspnoea Scale (mMRC)), functional exercise capacity (six-minute walking distance (6MWD)), disease-specific health status (COPD Assessment Test (CAT)), and symptoms of anxiety and depression (Hospital Anxiety Depression Scale (HADS)) were recorded. RESULTS 55 of the included 67 participants reported chronic pain (82.1%). 53.7% had thoracic pain. After considering multiple comparisons, only younger age and worse CAT scores were related with the presence of thoracic pain (p = 0.01). There were no relationships between thoracic pain and FEV1, static lung hyperinflation, diffusion capacity, mMRC score, 6MWD, anxiety or depression. CONCLUSION Thoracic pain is highly prevalent in COPD patients and is related to impaired disease-specific health status, but there is no relationship with FEV1, static hyperinflation, dyspnoea severity or functional exercise capacity.
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Affiliation(s)
- D J A Janssen
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, PO Box 4009, 6080 AA HAELEN, Hornerheide 1, 6085, Horn, NM, The Netherlands. .,Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
| | - E F M Wouters
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, PO Box 4009, 6080 AA HAELEN, Hornerheide 1, 6085, Horn, NM, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Y Lozano Parra
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, PO Box 4009, 6080 AA HAELEN, Hornerheide 1, 6085, Horn, NM, The Netherlands
| | - K Stakenborg
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, PO Box 4009, 6080 AA HAELEN, Hornerheide 1, 6085, Horn, NM, The Netherlands
| | - F M E Franssen
- Department of Research & Education, CIRO, Centre of expertise for chronic organ failure, PO Box 4009, 6080 AA HAELEN, Hornerheide 1, 6085, Horn, NM, The Netherlands.,Centre of Expertise for Palliative Care, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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17
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Cleveland ZI, Virgincar RS, Qi Y, Robertson SH, Degan S, Driehuys B. 3D MRI of impaired hyperpolarized 129Xe uptake in a rat model of pulmonary fibrosis. NMR IN BIOMEDICINE 2014; 27:1502-14. [PMID: 24816478 PMCID: PMC4229493 DOI: 10.1002/nbm.3127] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/17/2014] [Accepted: 03/31/2014] [Indexed: 05/24/2023]
Abstract
A variety of pulmonary pathologies, in particular interstitial lung diseases, are characterized by thickening of the pulmonary blood-gas barrier, and this thickening results in reduced gas exchange. Such diffusive impairment is challenging to quantify spatially, because the distributions of the metabolically relevant gases (CO2 and O2) cannot be detected directly within the lungs. Hyperpolarized (HP) (129)Xe is a promising surrogate for these metabolic gases, because MR spectroscopy and imaging allow gaseous alveolar (129)Xe to be detected separately from (129)Xe dissolved in the red blood cells (RBCs) and the adjacent tissues, which comprise blood plasma and lung interstitium. Because (129)Xe reaches the RBCs by diffusing across the same barrier tissues (blood plasma and interstitium) as O2, barrier thickening will delay (129)Xe transit and, thus, reduce RBC-specific (129)Xe MR signal. Here we have exploited these properties to generate 3D, MR images of (129)Xe uptake by the RBCs in two groups of rats. In the experimental group, unilateral fibrotic injury was generated prior to imaging by instilling bleomycin into one lung. In the control group, a unilateral sham instillation of saline was performed. Uptake of (129)Xe by the RBCs, quantified as the fraction of RBC signal relative to total dissolved (129)Xe signal, was significantly reduced (P = 0.03) in the injured lungs of bleomycin-treated animals. In contrast, no significant difference (P = 0.56) was observed between the saline-treated and untreated lungs of control animals. Together, these results indicate that 3D MRI of HP (129)Xe dissolved in the pulmonary tissues can provide useful biomarkers of impaired diffusive gas exchange resulting from fibrotic thickening.
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Affiliation(s)
- Zackary I. Cleveland
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC
| | - Rohan, S. Virgincar
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC
- Department of Biomedical Engineering, Duke University, Durham, NC
| | - Yi Qi
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC
| | - Scott H. Robertson
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC
- Graduate Program in Medical Physics; Duke University Medical Center, Durham, NC
| | - Simone Degan
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC
- Center for Molecular and Biomolecular Imaging, Duke University, Durham, NC
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Department of Radiology, Duke University Medical Center, Durham, NC
- Department of Biomedical Engineering, Duke University, Durham, NC
- Graduate Program in Medical Physics; Duke University Medical Center, Durham, NC
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18
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Fitzgerald NM, Kennedy B, Fitzgerald DA, Selvadurai H. Diffusion capacity of carbon monoxide (DLCO) pre- and post-exercise in children in health and disease. Pediatr Pulmonol 2014; 49:782-9. [PMID: 24395764 DOI: 10.1002/ppul.22925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 07/30/2013] [Indexed: 11/10/2022]
Abstract
RATIONALE A decrease in diffusion capacity for carbon monoxide (DLCO) after exercise has been reported in healthy adults. There is limited information for post-exercise DLCO available in children either in health or in disease. OBJECTIVES To evaluate (1) reproducibility of DLCO measures in children, (2) differences in DLCO between elite athletic swimmers (AS), stable cystic fibrosis patients (CF), and healthy controls (Con) at rest; and (3) after a maximal treadmill exercise test. METHODS Participants performed spirometry and DLCO at baseline, a maximal treadmill exercise test and repeated DLCO measures for 2 hr after cessation of exercise. RESULTS The mean (SD) co-efficient of variation between baseline DLCO tests was 2.49% (1.86%). In girls, the mean baseline DLCO (ml/min/mmHg) was 18.61 (4.15) in CF, 22.32 (4.79) in controls and 27.18 (5.33) in AS. In boys: 23.68 (5.31) in CF, 28.09 (9.95) in controls and 37.75 (9.46) in AS. Baseline DLCO was significantly higher in AS than in CF patients (P < 0.01). In girls post-exercise, the greatest mean decrease in DLCO from baseline was -7.50% to -12.83% and in boys -6.92% to -17.71%. The decline in DLCO was less important in the athletes than the other groups (P < 0.05). CONCLUSIONS DLCO is highly repeatable in children. AS have an increased DLCO at rest compared to both children with CF and controls. There is a decline from baseline to post-exercise DLCO and while there are disease-specific differences, the general pattern of change in DLCO measures after exercise is similar in children to adults.
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Affiliation(s)
- Nicholas M Fitzgerald
- University of New South Wales, Sydney, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia
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19
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In vitro and in vivo studies of a rapid and selective breath test for tuberculosis based upon mycobacterial CO dehydrogenase. mBio 2014; 5:e00990. [PMID: 24736224 PMCID: PMC3993857 DOI: 10.1128/mbio.00990-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
One of the major hurdles in treating tuberculosis (TB) is the time-consuming and difficult methodology for diagnosis. Stable-isotope breath tests hold great potential for rapidly diagnosing an infectious disease, monitoring therapy, and determining a bacterial phenotype in a rapid, point-of-care manner that does not require invasive sampling. Here we describe the preclinical development of a potentially highly selective TB diagnostic breath test based upon the organism’s CO dehydrogenase activity. After development of the test in vitro, we were able to use the breath test to discriminate between infected and control rabbits, demonstrating that a diagnosis can potentially be made and also that a complex bacterial phenotype can be noninvasively and rapidly studied in the host. Tuberculosis (TB) remains a major infectious cause of disease and death worldwide, and effective diagnosis and then treatment are the tools with which we fight TB. The more quickly and more specific the diagnosis can be made, the better, and this is also true of diagnosis being as close to the patient (point of care) as possible. Here we report our preclinical development of breath tests based upon specific mycobacterial metabolism that could, with development, allow rapid point-of-care diagnosis through measuring the mycobacterial conversion of labeled CO to labeled CO2.
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20
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Abstract
There is comparatively little data on diffusion capacity in children during exercise. With the advent of improved technology, there is an increasing interest in exercise testing of children in order to predict the evolution of lung disease. In addition to the standard measure of exercise capacity, the VO(2max), interest is evolving in the consequences of alterations in diffusion capacity which may be unmasked with exercise. This review will consider what is known about diffusion capacity with exercise in children with well documented lung disease in the form of cystic fibrosis, healthy controls and swimmers as elite athletes with the largest lung volumes.
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21
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Odo NU, Mandel JH, Perlman DM, Alexander BH, Scanlon PD. Estimates of restrictive ventilatory defect in the mining industry. Considerations for epidemiological investigations: a cross-sectional study. BMJ Open 2013; 3:bmjopen-2013-002561. [PMID: 23869101 PMCID: PMC3717471 DOI: 10.1136/bmjopen-2013-002561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES (1) To assess the impact of American Thoracic Society and European Respiratory Society (ATS/ERS) 'acceptability' and 'usability' criteria for spirometry on the estimates of restrictive ventilatory defect in a population of taconite miners. (2) To compare estimates of restrictive ventilatory defect with three different pulmonary function tests (spirometry, alveolar volume (VA) and diffusing capacity (DL,CO)). (3) To assess the role of population characteristics on these estimates. DESIGN Cross-sectional study. SETTING Current and former workers in six current taconite mining operations of northeastern Minnesota were surveyed. PARTICIPANTS We attempted to enrol 3313 participants. Of these, 1353 responded while 1188 current and former workers fully participated in the survey and 1084 performed complete pulmonary function testing and were assessed. PRIMARY AND SECONDARY OUTCOME MEASURES We applied ATS/ERS acceptability criteria for all tests and categorised participants into groups according to whether they fully met, partially met or did not meet acceptability criteria for spirometry. Obstruction and restriction were defined utilising the lower limit of normal for all tests. When using VA, restriction was identified after excluding obstruction. RESULTS Only 519 (47.9%) tests fully met ATS/ERS spirometry acceptability criteria. Within this group, 5% had obstruction and 6%, restriction on spirometry. In contrast, among all participants (N=1084), 16.8% had obstruction, while 4.5% had restriction. VA showed similar results in all groups after obstruction was excluded. Impaired gas transfer (reduced DL,CO) was identified in less than 50% of restriction identified by either spirometry or VA. Body mass index (BMI) was significantly related to spirometric restriction in all groups. CONCLUSIONS Population estimates of restriction using spirometry or VA varied by spirometric acceptability criteria. Other factors identified as important considerations in the estimation of restrictive ventilatory defect included increased BMI and gas transfer impairment in a relatively smaller proportion of those with spirometric restriction. These insights are important when interpreting population-based physiological data in occupational settings.
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Affiliation(s)
- Nnaemeka U Odo
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Jeffrey H Mandel
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - David M Perlman
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Bruce H Alexander
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Paul D Scanlon
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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22
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Cleveland ZI, Cofer GP, Metz G, Beaver D, Nouls J, Kaushik SS, Kraft M, Wolber J, Kelly KT, McAdams HP, Driehuys B. Hyperpolarized Xe MR imaging of alveolar gas uptake in humans. PLoS One 2010; 5:e12192. [PMID: 20808950 PMCID: PMC2922382 DOI: 10.1371/journal.pone.0012192] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 07/20/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One of the central physiological functions of the lungs is to transfer inhaled gases from the alveoli to pulmonary capillary blood. However, current measures of alveolar gas uptake provide only global information and thus lack the sensitivity and specificity needed to account for regional variations in gas exchange. METHODS AND PRINCIPAL FINDINGS Here we exploit the solubility, high magnetic resonance (MR) signal intensity, and large chemical shift of hyperpolarized (HP) (129)Xe to probe the regional uptake of alveolar gases by directly imaging HP (129)Xe dissolved in the gas exchange tissues and pulmonary capillary blood of human subjects. The resulting single breath-hold, three-dimensional MR images are optimized using millisecond repetition times and high flip angle radio-frequency pulses, because the dissolved HP (129)Xe magnetization is rapidly replenished by diffusive exchange with alveolar (129)Xe. The dissolved HP (129)Xe MR images display significant, directional heterogeneity, with increased signal intensity observed from the gravity-dependent portions of the lungs. CONCLUSIONS The features observed in dissolved-phase (129)Xe MR images are consistent with gravity-dependent lung deformation, which produces increased ventilation, reduced alveolar size (i.e., higher surface-to-volume ratios), higher tissue densities, and increased perfusion in the dependent portions of the lungs. Thus, these results suggest that dissolved HP (129)Xe imaging reports on pulmonary function at a fundamental level.
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Affiliation(s)
- Zackary I. Cleveland
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gary P. Cofer
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Gregory Metz
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Denise Beaver
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - John Nouls
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - S. Sivaram Kaushik
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Monica Kraft
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Kevin T. Kelly
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - H. Page McAdams
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, United States of America
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