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Sakamoto S, Kawakita N, Takeuchi T, Sumitomo H, Miyamoto N, Toba H, Kondo K, Takizawa H. Impact of interstitial lung disease gender-age-physiology index in surgically treated lung cancer. Int J Clin Oncol 2024:10.1007/s10147-024-02600-5. [PMID: 39180709 DOI: 10.1007/s10147-024-02600-5] [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: 01/09/2024] [Accepted: 07/31/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND The postoperative prognosis of patients with interstitial lung disease (ILD) and lung cancer is poor. Recently, the ILD-gender-age-physiology (GAP) index was identified as a clinical prognostic factor for patients with ILD. This study investigated the ILD-GAP index and oncological factors regarding postoperative outcomes. METHODS We retrospectively reviewed 87 lung cancer patients with comorbid ILD who underwent curative resection at our institution between April 2005 and December 2019. Short-term postoperative outcomes and overall survival (OS) based on the ILD-GAP index were examined. OS rates after surgery were calculated using the Kaplan-Meier method, and group differences were analyzed using the Log-Rank test. Univariate and multivariate analyses for OS were performed using the Cox regression model. RESULTS Multivariate analyses revealed ILD-GAP index ≥ 4 [Hazard ratio, 3.349; 95% confidence interval 1.375-8.155; P = 0.008] as a factor associated with OS. In the ILD-GAP index ≥ 4 group, no deaths occurred from primary lung cancer, with respiratory-related deaths being the most common, and exacerbation of ILD was more frequent (P = 0.007). Regarding perioperative results, a significant difference was observed in 90-day mortality (2.7% vs. 23.0% [P = 0.022]), and more patients required home oxygen therapy (14.9% vs. 69.2% [P < 0.001]) in the ILD-GAP index ≥ 4 group. CONCLUSIONS An ILD-GAP index ≥ 4 indicated a poor prognostic factor for patients with surgically treated lung cancer. Careful consideration of surgical indications is essential for patients with an ILD-GAP index ≥ 4.
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Affiliation(s)
- Shinichi Sakamoto
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Naoya Kawakita
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Taihei Takeuchi
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hiroyuki Sumitomo
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Naoki Miyamoto
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hiroaki Toba
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kazuya Kondo
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan
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Zhang J, He L, Han T, Tong J, Ren J, Pu J, Zhang M, Guo Y, Jin C. HRCT findings predict 1-year mortality in patients with acute exacerbation of idiopathic inflammatory myopathies-associated interstitial lung disease. Heliyon 2024; 10:e31510. [PMID: 38841458 PMCID: PMC11152933 DOI: 10.1016/j.heliyon.2024.e31510] [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: 01/15/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/07/2024] Open
Abstract
Background Acute exacerbation of idiopathic inflammatory myopathies-associated interstitial lung disease (AE-IIM-ILD) is a significant event associated with increased morbidity and mortality. However, few studies investigated the potential prognostic factors contributing to mortality in patients who experience AE-IIM-ILD. Objectives The purpose of our study was to comprehensively investigate whether high-resolution computed tomography (HRCT) findings predict the 1-year mortality in patients who experience AE-IIM-ILD. Methods A cohort of 69 patients with AE-IIM-ILD was retrospectively created. The cohort was 79.7 % female, with a mean age of 50.7. Several HRCT features, including total interstitial lung disease extent (TIDE), distribution patterns, and radiologic ILD patterns, were assessed. A directed acyclic graph (DAG) was used to evaluate the statistical relationship between variables. The Cox regression method was performed to identify potential prognostic factors associated with mortality. Results The HRCT findings significantly associated with AE-IIM-ILD mortality include TIDE (HR per 10%-increase, 1.64; 95%CI, 1.29-2.1, p < 0.001; model 1: C-index, 0.785), diffuse distribution pattern (HR, 3.75, 95%CI, 1.5-9.38, p = 0.005; model 2: C-index, 0.737), and radiologic diffuse alveolar damage (DAD) pattern (HR, 6.37, 95 % CI, 0.81-50.21, p = 0.079; model 3: C-index, 0.735). TIDE greater than 58.33 %, diffuse distribution pattern, and radiologic DAD pattern correlate with poor prognosis. The 90-day, 180-day, and 1-year survival rates of patients who experience AE-IIM-ILD were 75.3 %, 66.3 %, and 63.3 %, respectively. Conclusion HRCT findings, including TIDE, distribution pattern, and radiological pattern, are predictive of 1-year mortality in patients who experience AE-IIM-ILD.
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Affiliation(s)
- Jingping Zhang
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
| | - Liyu He
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
| | - Tingting Han
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
| | - Jiayin Tong
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
| | - Jialiang Ren
- GE Healthcare China, Daxing District, Tongji South Road No.1, Beijing, 100176, PR China
| | - Jiantao Pu
- Department of Radiology and Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Ming Zhang
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
- Shaanxi Engineering Research Center of Computational Imaging and Medical Intelligence, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
| | - Youmin Guo
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
- Shaanxi Engineering Research Center of Computational Imaging and Medical Intelligence, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
| | - Chenwang Jin
- Department of Radiology, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
- Shaanxi Engineering Research Center of Computational Imaging and Medical Intelligence, 277 Yanta West Road, Xi'an, Shaanxi, 710061, PR China
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Ghanbar MI, Danoff SK. Review of Pulmonary Manifestations in Antisynthetase Syndrome. Semin Respir Crit Care Med 2024; 45:365-385. [PMID: 38710221 DOI: 10.1055/s-0044-1785536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Antisynthetase syndrome (ASyS) is now a widely recognized entity within the spectrum of idiopathic inflammatory myopathies. Initially described in patients with a triad of myositis, arthritis, and interstitial lung disease (ILD), its presentation can be diverse. Additional common symptoms experienced by patients with ASyS include Raynaud's phenomenon, mechanic's hand, and fever. Although there is a significant overlap with polymyositis and dermatomyositis, the key distinction lies in the presence of antisynthetase antibodies (ASAs). Up to 10 ASAs have been identified to correlate with a presentation of ASyS, each having manifestations that may slightly differ from others. Despite the proposal of three classification criteria to aid diagnosis, the heterogeneous nature of patient presentations poses challenges. ILD confers a significant burden in patients with ASyS, sometimes manifesting in isolation. Notably, ILD is also often the initial presentation of ASyS, requiring pulmonologists to remain vigilant for an accurate diagnosis. This article will comprehensively review the various aspects of ASyS, including disease presentation, diagnosis, management, and clinical course, with a primary focus on its pulmonary manifestations.
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Affiliation(s)
- Mohammad I Ghanbar
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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Qin S, Jiao B, Kang B, Li H, Liu H, Ji C, Yang S, Yuan H, Wang X. Non-contrast computed tomography-based radiomics for staging of connective tissue disease-associated interstitial lung disease. Front Immunol 2023; 14:1213008. [PMID: 37868980 PMCID: PMC10587549 DOI: 10.3389/fimmu.2023.1213008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/15/2023] [Indexed: 10/24/2023] Open
Abstract
Rationale and introduction It is of significance to assess the severity and predict the mortality of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). In this double-center retrospective study, we developed and validated a radiomics nomogram for clinical management by using the ILD-GAP (gender, age, and pulmonary physiology) index system. Materials and methods Patients with CTD-ILD were staged using the ILD-GAP index system. A clinical factor model was built by demographics and CT features, and a radiomics signature was developed using radiomics features extracted from CT images. Combined with the radiomics signature and independent clinical factors, a radiomics nomogram was constructed and evaluated by the area under the curve (AUC) from receiver operating characteristic (ROC) analyses. The models were externally validated in dataset 2 to evaluate the model generalization ability using ROC analysis. Results A total of 245 patients from two clinical centers (dataset 1, n = 202; dataset 2, n = 43) were screened. Pack-years of smoking, traction bronchiectasis, and nine radiomics features were used to build the radiomics nomogram, which showed favorable calibration and discrimination in the training cohort {AUC, 0.887 [95% confidence interval (CI): 0.827-0.940]}, the internal validation cohort [AUC, 0.885 (95% CI: 0.816-0.922)], and the external validation cohort [AUC, 0.85 (95% CI: 0.720-0.919)]. Decision curve analysis demonstrated that the nomogram outperformed the clinical factor model and radiomics signature in terms of clinical usefulness. Conclusion The CT-based radiomics nomogram showed favorable efficacy in predicting individual ILD-GAP stages.
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Affiliation(s)
- Songnan Qin
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Bingxuan Jiao
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Bing Kang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Haiou Li
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hongwu Liu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Congshan Ji
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shifeng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hongtao Yuan
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Qin S, Kang B, Liu H, Ji C, Li H, Zhang J, Wang X. A computed tomography-based radiomics nomogram for predicting overall survival in patients with connective tissue disease-associated interstitial lung disease. Eur J Radiol 2023; 165:110963. [PMID: 37437436 DOI: 10.1016/j.ejrad.2023.110963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Accurate prognostic prediction is beneficial for the management of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). The purpose of the present study was to develop and validate a nomogram using clinical features and computed tomography (CT) based radiomics features to predict overall survival (OS) in patients with CTD-ILD, and to assess the incremental prognostic value the radiomics might add to clinical risk factors. MATERIALS & METHODS Patients from two clinical centers with CTD-ILD were enrolled in the present retrospective study. A radiomics signature, a clinical model and a combined nomogram were developed and assessed in the cohorts. The incremental value of radiomics signature to the clinical independent risk factors in survival prediction was evaluated. The models were externally validated to evaluate the model generalization ability. RESULTS A total of 215 patients (mean age, 53 years ± 14 [standard deviation], 45 men) were evaluated. Patients with higher radiomics scores had higher mortality risk than those with lower radiomics scores (Hazard ratio, 12.396; 95% CI, 3.364-45.680; P < 0.001). The combined nomogram showed better predictive capability than the clinical model did with higher C-indices (0.800, 0.738, 0.742 vs. 0.747, 0.631, 0.587 in the training, internal- and external-validation cohort, respectively), time-AUCs and overall net-benefit. CONCLUSION The radiomics signature is a potential prognostic biomarker of CTD-ILD and add incremental value to the clinical independent risk factors. The combined nomogram can provide a more accurate estimation of OS than the clinical model for CTD-ILD patients. CLINICAL RELEVANCE STATEMENT The developed combined nomogram showed accurate prognostic prediction performance, which is beneficial for the management of CTD-ILD patients. It also proved radiomics could extract prognostic information from CT images.
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Affiliation(s)
- Songnan Qin
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan 250021, Shandong, China
| | - Bing Kang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan 250021, Shandong, China
| | - Hongwu Liu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan 250021, Shandong, China
| | - Congshan Ji
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan 250021, Shandong, China
| | - Haiou Li
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, China
| | - Juntao Zhang
- GE Healthcare, PDx GMS Advanced Analytics, Shanghai, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan 250021, Shandong, China; Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324, Jing 5 Rd, Jinan 250021, Shandong, China.
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Predictors of progression in idiopathic inflammatory myopathies with interstitial lung disease. J Transl Int Med 2022. [PMID: 37533847 PMCID: PMC10393057 DOI: 10.2478/jtim-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The idiopathic inflammatory myopathies (IIMs) are a group of connective tissue diseases that afect multiple organ systems, including the lungs. Interstitial lung disease (ILD) is the most common and heterogeneous complication of IIMs, with its degree ranging from mild to fatal. Thus, it is critical to identify clinical features and validated biomarkers for predicting disease progression and prognosis, which could be beneficial for therapy adjustment. In this review, we discuss predictors for rapid progression of IIM-ILD and propose guidance for disease monitoring and implications of therapy. Systematic screening of myositis-specific antibodies, measuring serum biomarker levels, pulmonary function tests, and chest high-resolution computer tomography will be beneficial for the evaluation of disease progression and prognosis.
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Acute exacerbation of interstitial lung disease associated with rheumatic disease. Nat Rev Rheumatol 2022; 18:85-96. [PMID: 34876670 DOI: 10.1038/s41584-021-00721-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
Interstitial lung disease (ILD) is a cause of morbidity and mortality in patients with rheumatic diseases, such as connective-tissue diseases, rheumatoid arthritis and systemic vasculitis. Some patients with ILD secondary to rheumatic disease (RD-ILD) experience acute exacerbations, with sudden ILD progression and high mortality during or immediately after the exacerbation, and a very low 1-year survival rate. In the ILD subtype idiopathic pulmonary fibrosis (IPF), an acute exacerbation is defined as acute worsening or development of dyspnoea associated with new bilateral ground-glass opacities and/or consolidations at high-resolution CT, superimposed on a background pattern consistent with fibrosing ILD. However, acute exacerbation in RD-ILD (AE-RD-ILD) currently has no specific definition. The aetiology and pathogenesis of AE-RD-ILD remain unclear, but distinct triggers might include infection, mechanical stress, microaspiration and DMARD treatment. At this time, no effective evidence-based therapeutic strategies for AE-RD-ILD are available. In clinical practice, AE-RD-ILD is often empirically treated with high-dose systemic steroids and antibiotics, with or without immunosuppressive drugs. In this Review, we summarize the clinical features, diagnosis, management and prognosis of AE-RD-ILD, enabling the similarities and differences with acute exacerbation in IPF to be critically assessed.
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Tseng CW, Wang KL, Fu PK, Huang CY, Hsieh TY, Hsieh CW, Lai KL, Hung WT, Lin CT, Tang KT, Chen YM, Huang WN, Chen YH. GAP Score and CA-153 Associated with One-Year Mortality in Anti-MDA-5 Antibody-Positive Patients: A Real-World Experience. J Clin Med 2021; 10:jcm10225241. [PMID: 34830523 PMCID: PMC8618032 DOI: 10.3390/jcm10225241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background. Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody is associated with respiratory failure and death in patients with idiopathic inflammatory myositis (IIM) and interstitial lung disease (ILD). This study aimed to investigate clinical parameters associated with mortality in anti-MDA-5 antibody-positive patients. Methods. We retrospectively reviewed the clinical and laboratory data, and pulmonary function test results in 55 anti-MDA-5 antibody-positive patients. A comparison was made between the survivors and non-survivors at the 12-month follow-up. Results. A total of 13 patients (23.6%) died within 12 months. Non-survivors had higher GAP scores (gender, age, and physiology score for idiopathic pulmonary fibrosis) (1 vs. 6, p < 0.01) and CA-153 (16.4 vs. 72.9, p < 0.01). In addition, rapid progressive ILD, fever, peak ferritin, leukocyte count, lactate dehydrogenase, CT score, intravenous immunoglobulin, mycophenolic acid, CMV infections, pneumocystis pneumonia, and pneumothorax were significantly associated with increased risks of 1-year mortality, while forced vital capacity, forced expiratory volume in one second, and diffusion capacity for carbon monoxide were correlated with decreased risk of 1-year mortality. Conclusions. Our study results suggest that GAP scores and CA-153 could be prognostic factors for 1-year mortality in anti-MDA-5 antibody-positive patients. A prompt pulmonary function test and CA-153 are essential for these patients to guide further management.
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Affiliation(s)
- Chih-Wei Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
| | - Kao-Lun Wang
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-L.W.); (C.-Y.H.)
| | - Pin-Kuei Fu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- College of Human Science and Social Innovation, HungKuang University, Taichung 43302, Taiwan
- Integrated Care Center of Interstitial Lung Disease, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Cheng-Yi Huang
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-L.W.); (C.-Y.H.)
| | - Tsu-Yi Hsieh
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Ph.D. Programme of Business, Feng Chia University, Taichung 40724, Taiwan
| | - Chia-Wei Hsieh
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
- Rong Hsing Research Center for Translational Medicine & Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
| | - Wei-Ting Hung
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
- Department of Medical Education, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Rong Hsing Research Center for Translational Medicine & Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Ching-Tsai Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
| | - Kuo-Tung Tang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
- Rong Hsing Research Center for Translational Medicine & Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
- Rong Hsing Research Center for Translational Medicine & Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Correspondence: ; Tel.: +886-4-2359-2525 (ext. 4400)
| | - Wen-Nan Huang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-W.T.); (T.-Y.H.); (C.-W.H.); (K.-L.L.); (W.-T.H.); (C.-T.L.); (K.-T.T.); (W.-N.H.); (Y.-H.C.)
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
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