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Mordant P, Dauriat G, Brugière O, Borie R, Crestani B, Reynaud-Gaubert M. [Lung transplantation for fibrotic interstitial lung diseases]. Rev Mal Respir 2023; 40 Suppl 1:e42-e51. [PMID: 36610850 DOI: 10.1016/j.rmr.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- P Mordant
- Service de chirurgie vasculaire, thoracique, et transplantation pulmonaire, hôpital Bichat, Assistance publique-Hôpitaux de Paris, université de Paris, Paris, France.
| | - G Dauriat
- Service de pneumologie, hôpital Marie-Lannelongue, groupe hospitalier Paris-Saint Joseph, Le Plessis-Robinson, France
| | - O Brugière
- Service de pneumologie, hôpital Foch, Suresnes, France
| | - R Borie
- Service de pneumologie A, hôpital Bichat, Assistance publique-Hôpitaux de Paris, université de Paris, Paris, France
| | - B Crestani
- Service de pneumologie A, hôpital Bichat, Assistance publique-Hôpitaux de Paris, université de Paris, Paris, France
| | - M Reynaud-Gaubert
- Service de pneumologie, équipe de transplantation pulmonaire, centre hospitalo-universitaire Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
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Kabbani D, Kozlowski HN, Cervera C, Chaparro C, Singer L, Rotstein C, Keshavjee S, Husain S. Granuloma in the explanted lungs: Infectious causes and impact on post-lung transplant mycobacterial infection. Transpl Infect Dis 2020; 22:e13262. [PMID: 32043708 DOI: 10.1111/tid.13262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/11/2020] [Accepted: 01/26/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The significance of granuloma in explanted lungs of lung transplant recipients (LTR) on the development of post-transplant mycobacterial infection is unclear. METHODS A retrospective review comparing LTRs and heart-lung transplant (H-LTR) recipients with granuloma in the explanted lungs between 2000 and 2012 (excluding those LTRs with granuloma due to sarcoidosis) and LTRs or H-LTRs without granuloma. Patients were followed for 2 years post-transplant. RESULTS A total of 144 LTRs and 4 H-LTRs with granulomas (75 necrotizing and 73 non-necrotizing) and a comparator cohort of 144 LTRs and 4 H-LTRs without granuloma were analyzed. In LTRs with granulomas, identification of infectious organisms was more common by histopathology (35 AFB and 22 fungal) compared to cultures (six NTM and seven fungal) taken around time of the transplant. LTRs with granulomas were more likely to have pre-transplant non-tuberculous mycobacteria (NTM) infection compared to LTRs without granuloma; P < .01. In the multivariate analysis, having granuloma or positive mycobacterial cultures at time of transplant were associated with increased risk of post-transplant mycobacterial infection (HR = 1.8 95% CI [1.024-3.154]; P = .041 and HR = 2.083 95% CI [1.011-4.292]; P = .047). Although there was a trend toward increase mycobacterial disease in those with granulomas P = .056, there was no difference in survival post-transplantation between those with or without granuloma in the explanted lung; P = .886. CONCLUSION The presence of granuloma in the explanted lungs of LTRs or positive mycobacterial cultures at time of transplant is associated with an increased risk of mycobacterial infection post-transplant.
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Affiliation(s)
- Dima Kabbani
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada.,Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, TO, Ontario, Canada
| | - Hannah N Kozlowski
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, TO, Ontario, Canada
| | - Carlos Cervera
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Cecilia Chaparro
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lianne Singer
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Coleman Rotstein
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, TO, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shahid Husain
- Division of Infectious Diseases, Department of Medicine, Multi-Organ Transplant Program, University of Toronto, TO, Ontario, Canada
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Fattori A, Ohana M, Hirschi S, Kessler R, Santelmo N, Nathan N, Chenard MP, Raymond S, Legendre M, Calabrese F. A Nonsmoker Man in His 40s With a Diagnosis of Genetic-Related Idiopathic Pulmonary Fibrosis (Surfactant-Protein C Gene Mutation). Chest 2019; 155:e91-e96. [PMID: 30955586 DOI: 10.1016/j.chest.2018.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/05/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022] Open
Abstract
A nonsmoker man in his 40s underwent bilateral lung transplantation with a referral diagnosis of genetic-related idiopathic pulmonary fibrosis (IPF). The patient had no medical history in childhood and early adulthood, nor was there a family history of IPF. His nonsmoker father presented with lung cancer at 59 years of age. The patient was a professional brass instrument player; he had started playing at 9 years of age, and he was recently playing 3 to 4 h per day. He had a 7-year clinical history of chronic cough and shortness of breath. Bilateral fine crackles were present at clinical examination. There was no digital clubbing. Data had been collected since 2015: no clinical or immunologic signs of connective tissue disease were evident, including autoantibodies for myositis or anti-synthetase syndrome. Chest radiograph showed diffuse interstitial lung disease. Results of pulmonary function tests yielded a restrictive pattern with decreased FVC and decreased total lung capacity (69% and 47% of predicted, respectively). The FEV1/FVC ratio was 86%, and carbon monoxide transfer coefficient was 36% of predicted. BAL cellular analysis consisted of macrophages (66%), lymphocytes (19%; CD4+/CD8+ ratio, 0.16), neutrophils (10%), and eosinophils (5%).
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Affiliation(s)
- Antonin Fattori
- Department of Pathology, University of Strasbourg, Strasbourg, France
| | - Mickael Ohana
- Department of Radiology, University of Strasbourg, Strasbourg, France
| | - Sandrine Hirschi
- Department of Pneumology, University of Strasbourg, Strasbourg, France
| | - Romain Kessler
- Department of Pneumology, University of Strasbourg, Strasbourg, France
| | - Nicola Santelmo
- Department of Thoracic Surgery, University of Strasbourg, Strasbourg, France
| | - Nadia Nathan
- Department of Pediatric Pulmonology, Inserm UMR_S933, Armand-Trousseau Hospital, Paris, France
| | | | | | - Marie Legendre
- Sorbonne Université, Inserm and AP-HP, Inserm UMR_S933 and Genetics Department, Armand-Trousseau Hospital, Paris, France
| | - Fiorella Calabrese
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
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Panchabhai TS, Arrossi AV, Highland KB, Bandyopadhyay D, Culver DA, Budev MM, Farver CF. A single-institution study of concordance of pathological diagnoses for interstitial lung diseases between pre-transplantation surgical lung biopsies and lung explants. BMC Pulm Med 2019; 19:20. [PMID: 30665375 PMCID: PMC6341514 DOI: 10.1186/s12890-019-0778-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 01/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By comparing diagnoses made by pre-transplant surgical lung biopsy (SLB) and the final pathologic diagnosis of the explanted pathology (EP), we aimed to study the factors that could impact pathologic diagnoses in patients with interstitial lung disease (ILD). METHODS We retrospectively reviewed the lung transplant database at Cleveland Clinic [01/01/2006-12/31/2013] to include all lung transplant recipients with a prior diagnosis of ILD. Two pulmonary pathologists independently reviewed each SLB and lung explant. The diagnoses were labeled as concordant (same diagnosis on SLB and explant) or discordant (diagnosis on SLB and explant were different) by consensus. RESULTS Of 389 patients transplanted for ILD, 217 had an SLB before transplant. Pathological diagnoses were concordant in 190 patients (87.6%) [165 UIP (86.8%), 13 NSIP (6.8%), 8 CHP (4.2%) and 4 other diagnoses (2.1%). In 27 cases (12.4%), the diagnosis on SLB differed from EP. 8/27 were diagnosed with UIP on SLB and of these, 5 were re-classified as NSIP. 14/19 (73.7%) patients with a SLB diagnosis "other than UIP" were re-categorized as UIP based on explant. Discordant cases had a greater time between SLB and EP than concordant cases (1553 days vs 1248 days). CONCLUSIONS The pathologic diagnosis of ILD by SLB prior to lung transplant is accurate in most patients, but may be misleading in a small subset of patients. The majority of discordant cases that were reclassified as UIP could be due to a sampling error, or perhaps, an increased time from the date of the SLB to transplant. Future studies examining how multidisciplinary consensus diagnosis affects this discordance are necessary.
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Affiliation(s)
- Tanmay S Panchabhai
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Andrea Valeria Arrossi
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kristin B Highland
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marie M Budev
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carol F Farver
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
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Kim H, Jeon YK, Lee HJ, Kim YT, Chung DH. Clinico-pathological Analysis of the Lungs from Patients with Lung Transplantation in a Single Institute in Korea. J Korean Med Sci 2015; 30:1439-45. [PMID: 26425040 PMCID: PMC4575932 DOI: 10.3346/jkms.2015.30.10.1439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/18/2015] [Indexed: 11/20/2022] Open
Abstract
Recently, the numbers of lung transplantation (LT) has been increased in Korea. However, post-LT outcome has not been successful in all patients, which may be partially affected by the primary lung disease. Therefore comprehensive understanding in original pathological diagnosis of patients with LT would be needed for achieving better clinical outcome. To address this issue, we performed clinico-pathological analysis of the explanted lungs from 29 patients who underwent LT over a 9-yr period in Seoul National University Hospital. Among them, 26 patients received single (1/26) or double (25/26) LT, while heart-lung transplantation was performed in 3 patients. The final clinico-pathological diagnoses were idiopathic pulmonary fibrosis/usual interstitial pneumonia (UIP) (n = 6), acute interstitial pneumonia (AIP)/diffuse alveolar damage (DAD) (n = 4), AIP/non-specific interstitial pneumonia with DAD (n = 1), collagen vascular disease-related interstitial lung disease (CVD-ILD)/DAD (n = 3), CVD-ILD/UIP (n = 1), lymphangioleiomyomatosis (n = 1), bronchiectasis (n = 4), pulmonary arterial hypertension (n = 2), tuberculosis (n = 1), bronchiolitis obliterans (BO) (n = 1), and lung cancer (n = 1). Moreover, 4 patients who had chemotherapy and hematopoietic stem cell transplantation due to hematologic malignancy showed unclassifiable interstitial pneumonia with extensive fibrosis in the lungs. Our study demonstrates that pathology of the explanted lungs from Korean patients with LT is different from that of other countries except for interstitial lung disease and bronchiectasis, which may be helpful for optimization of selecting LT candidates for Korean patients.
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Affiliation(s)
- Hyojin Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Joo Lee
- Department of Thoracic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Xenotransplantation Research Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Transplantation Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Xenotransplantation Research Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Kern RM, Singer JP, Koth L, Mooney J, Golden J, Hays S, Greenland J, Wolters P, Ghio E, Jones KD, Leard L, Kukreja J, Blanc PD. Lung transplantation for hypersensitivity pneumonitis. Chest 2015; 147:1558-1565. [PMID: 25412059 PMCID: PMC4451710 DOI: 10.1378/chest.14-1543] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/10/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is an inhaled antigen-mediated interstitial lung disease (ILD). Advanced disease may necessitate the need for lung transplantation. There are no published studies addressing lung transplant outcomes in HP. We characterized HP outcomes compared with referents undergoing lung transplantation for idiopathic pulmonary fibrosis (IPF). METHODS To identify HP cases, we reviewed records for all ILD lung transplantation cases at our institution from 2000 to 2013. We compared clinical characteristics, survival, and acute and chronic rejection for lung transplant recipients with HP to referents with IPF. We also reviewed diagnoses of HP discovered only by explant pathology and looked for evidence of recurrent HP after transplant. Survival was compared using Kaplan-Meier methods and Cox proportional hazard modeling. RESULTS We analyzed 31 subjects with HP and 91 with IPF among 183 cases undergoing lung transplantation for ILD. Survival at 1, 3, and 5 years after lung transplant in HP compared with IPF was 96%, 89%, and 89% vs 86%, 67%, and 49%, respectively. Subjects with HP manifested a reduced adjusted risk for death compared with subjects with IPF (hazard ratio, 0.25; 95% CI, 0.08-0.74; P = .013). Of the 31 cases, the diagnosis of HP was unexpectedly made at explant in five (16%). Two subjects developed recurrent HP in their allografts. CONCLUSIONS Overall, subjects with HP have excellent medium-term survival after lung transplantation and, relative to IPF, a reduced risk for death. HP may be initially discovered only by review of the explant pathology. Notably, HP may recur in the allograft.
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Affiliation(s)
- Ryan M Kern
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco.
| | - Jonathan P Singer
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - Laura Koth
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - Joshua Mooney
- Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, CA
| | - Jeff Golden
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - Steven Hays
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - John Greenland
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - Paul Wolters
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - Emily Ghio
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - Kirk D Jones
- Department of Pathology, Pulmonary Pathology and Cytopathology University of California San Francisco, San Francisco
| | - Lorriana Leard
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco
| | - Jasleen Kukreja
- Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, CA
| | - Paul D Blanc
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco; Division of Occupational and Environmental Medicine, University of California San Francisco; Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, CA
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Watanabe K. Pleuroparenchymal Fibroelastosis: Its Clinical Characteristics. CURRENT RESPIRATORY MEDICINE REVIEWS 2013; 9:299-237. [PMID: 24578677 PMCID: PMC3933942 DOI: 10.2174/1573398x0904140129125307] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 10/09/2013] [Accepted: 10/12/2013] [Indexed: 12/31/2022]
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a rare pulmonary fibrosis that is clinically characterized by upperlobe predominant fibrosis. PPFE is a slowly progressive disorder and its first symptom is dyspnea or dry cough. Chest pain because of pneumothorax may be the first symptom in some patients. Patients with PPFE are slender with a flat rib cage or abnormally narrowed anterior-posterior thoracic dimension. Decreases in forced vital capacity, total lung capacity, and diffusing capacity are respiratory-function characteristics of PPFE, similar to those seen in idiopathic pulmonary fibrosis (IPF). The most remarkable difference in clinical features between PPFE and IPF is imaging findings, with upper-lobe-predominant lesions in PPFE and lower-lobe-predominant lesions in IPF.
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Affiliation(s)
- Kentaro Watanabe
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan
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Serpin B4 isoform overexpression is associated with aberrant epithelial proliferation and lung cancer in idiopathic pulmonary fibrosis. Pathology 2012; 44:192-8. [PMID: 22406480 DOI: 10.1097/pat.0b013e3283511b61] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS The aim of the study was to evaluate the role of Serpin B3/B4 in advanced idiopathic pulmonary fibrosis (IPF) patients, mainly focusing on epithelial proliferation. METHODS Lungs from 48 IPF patients (including cases with cancer or high-grade epithelial dysplasia) were studied and compared with other diffuse parenchymal diseases and normal lungs. Immunohistochemistry for Serpin B3/B4 and Ki-67 was quantified in all cases, distinguishing stained metaplastic cells. In IPF patients correlations between Serpin expression and several clinicopathological data, including fibrotic remodelling [fibrosis extension and transforming growth factor β expression (TGF-β)] were performed. Molecular analysis was used for Serpin isoform characterisation. RESULTS In IPF patients Serpin B3/B4 and Ki-67 were significantly overexpressed in many metaplastic cells (mainly squamous type) compared to control cases. Higher Serpin B3/B4 was found in older patients and cases with more impaired respiratory function. Serpin B3/B4 expression was related to both TGF-β and Ki-67 and was higher in patients with cancer/high-grade dysplasia. Serpin B3 was expressed in all cases, whereas Serpin B4 was expressed only in IPF. CONCLUSIONS Serpin B3/B4, particularly Serpin B4, appears to play an important role in aberrant epithelial proliferation. Evaluation of Serpin B3/B4 could have prognostic value in predicting disease progression, especially in patients with increased susceptibility to lung cancer.
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Lung. PATHOLOGY OF SOLID ORGAN TRANSPLANTATION 2009. [PMCID: PMC7120462 DOI: 10.1007/978-3-540-79343-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Experiments with animals in the 1940 and 1950s demonstrated that lung transplantation was technically possible [33]. In 1963, Dr. James Hardy performed the first human lung transplantation. The recipient survived 18 days, ultimately succumbing to renal failure and malnutrition [58]. From 1963 through 1978, multiple attempts at lung transplantation failed because of rejection and complications at the bronchial anastomosis. In the 1980s, improvements in immunosuppression, especially the introduction of cyclosporin A, and enhanced surgical techniques led to renewed interest in organ transplantation. In 1981, a 45-year-old-woman received the first successful heart–lung transplantation for idiopathic pulmonary arterial hypertension (IPAH) [106]. She survived 5 years after the procedure. Two years later the first successful single lung transplantation for idiopathic pulmonary fibrosis (IPF) [128] was reported, and in 1986 the first double lung transplantation for emphysema [25] was performed.
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