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Fırat M, Mutlu Ş, Yoleri B, Boşnak Güçlü M. Comparison of respiratory functions, muscle strength, and physical activity among children with primary ciliary dyskinesia with and without Kartagener's syndrome and healthy controls. Physiother Theory Pract 2023:1-9. [PMID: 38018157 DOI: 10.1080/09593985.2023.2286526] [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: 08/05/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Kartagener's syndrome (KS), consisting of bronchiectasis, situs inversus totalis, and sinusitis, is a subtype of primary ciliary dyskinesia (PCD). The presence of KS may affect respiratory and physical functions. PURPOSE This study aimed to compare respiratory functions, exercise capacity, muscle strength, and physical activity levels among children with PCD with/without KS and healthy peers. METHODS Fifteen patients with KS, 23 with PCD without KS, and 27 controls were compared. Pulmonary function, functional exercise capacity (6-minute walk test - 6MWT), maximal inspiratory, expiratory (MIP, MEP), and skeletal muscle strength, inspiratory muscle endurance (IME), and physical activity level were evaluated. RESULTS The forced expiratory volume in one second (FEV1) % (p = .009), forced expiratory flow from 25%-75% (FEF25-75%) % (p = .001), MIP (p = .034), MEP (p = .003), 6MWT distance (p = .001), and daily steps (p = .034) were significantly different among the groups. Quadriceps femoris (QF) muscle strength and IME were similar in groups (p ˃ .05). FEV1% (p = .002), FEF25-75% % (p = .001), MIP (p = .027), MEP (p = .001), and 6MWT distance (p = .003) in patients with KS; 6MWT distance (p = .003) in patients with PCD without KS was significantly lower than controls. CONCLUSION The presence of KS affects pulmonary function, respiratory muscle strength, and physical activity more. Exercise capacity and physical activity levels are decreased, inspiratory muscle endurance and QF muscle strength are preserved in patients with KS and PCD without KS. Kartagener's syndrome further impairs pulmonary and extrapulmonary outcomes; the reasons should be investigated, and the necessity of rehabilitation approaches that will prevent deterioration come to the fore.
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Affiliation(s)
- Merve Fırat
- Department of Physical Therapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Türkiye
| | - Şeyma Mutlu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Başkent University, Ankara, Türkiye
| | - Betül Yoleri
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Türkiye
| | - Meral Boşnak Güçlü
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Türkiye
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Mori M, Kido T, Sakamoto N, Ozasa M, Kido K, Noguchi Y, Tokito T, Okuno D, Yura H, Hara A, Ishimoto H, Suematsu T, Obase Y, Tanaka Y, Izumikawa K, Takeuchi K, Mukae H. Novel SPEF2 Variant in a Japanese Patient with Primary Ciliary Dyskinesia: A Case Report and Literature Review. J Clin Med 2022; 12:jcm12010317. [PMID: 36615117 PMCID: PMC9821625 DOI: 10.3390/jcm12010317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Primary ciliary dyskinesia (PCD) is a genetic and congenital disease associated with an abnormal ciliary ultrastructure and function and is estimated to affect 1 in 15,000-20,000 individuals. A PCD diagnosis can be achieved by genotyping. Here, we performed whole-exome analysis for the diagnosis of PCD and described the detailed clinical characteristics of the case. A 39-year-old Japanese woman with sinusitis and bronchiectasis without situs inversus had had upper and lower respiratory symptoms since childhood and had received long-term macrolide therapy without an accurate diagnosis. A moderate deterioration of cilia function was observed by high-speed video microscopy analysis; additionally, the number of cells with moving cilia was fewer than that in patients without PCD. Electron microscopy revealed no apparent structural abnormalities. We performed whole-exome analysis and identified novel biallelic variants of SPEF2 in the homozygous state (c.1860_1861insCT). We confirmed the absence of SPEF2 protein expression in the cilia of the nasal mucosa using fluorescent immunostaining. Accordingly, she was diagnosed as having PCD with the SPEF2 variant. The present case suggests that the deterioration of cilia function is moderate, the number of respiratory cells with moving cilia might be reduced, and the respiratory condition could be severe in patients with PCD with the SPEF2 variant.
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Affiliation(s)
- Mayako Mori
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Takashi Kido
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
- Correspondence: ; Tel.: +81-95-819-7273
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Mutsumi Ozasa
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
- Department of Pathology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8520, Japan
| | - Kumiko Kido
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Yasuko Noguchi
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
- J-One, Nagasaki 852-8505, Japan
| | - Takatomo Tokito
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Daisuke Okuno
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Hirokazu Yura
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Atsuko Hara
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Takashi Suematsu
- Central Electron Microscope Laboratory, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan
| | - Yasushi Obase
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
| | - Yoshimasa Tanaka
- Center for Medical Innovation, Nagasaki University, Nagasaki 852-8521, Japan
| | - Koichi Izumikawa
- Department of Infection Control and Education Center, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, Mie University, Tsu 514-8507, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8501, Japan
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Li BB, Lu SL, He X, Lei B, Yao JN, Feng SC, Yu SP. Da Vinci robot-assisted pancreato-duodenectomy in a patient with situs inversus totalis: A case report and review of literature. World J Gastrointest Oncol 2022; 14:1363-1371. [PMID: 36051094 PMCID: PMC9305577 DOI: 10.4251/wjgo.v14.i7.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/30/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Situs inversus totalis (SIT) is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart, liver, spleen, and stomach. Herein, we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.
CASE SUMMARY A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen, accompanied by jaundice and staining of the sclera as chief complaints. Imaging examination detected a mass at the distal end of the common bile duct, with inverted thoracic and abdominal organs. Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma. The patient successfully underwent robotic-assisted pancreaticoduodenectomy; the operation lasted 300 min, the intraoperative blood loss was 500 mL, and there were no intraoperative and postoperative complications.
CONCLUSION SIT is not directly related to the formation of cholangiocarcinoma. Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection. Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe, feasible, minimally invasive, and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.
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Affiliation(s)
- Bai-Bei Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shi-Liu Lu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiang He
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Biao Lei
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jian-Ni Yao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Si-Chen Feng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shui-Ping Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Demir Eksi D, Yilmaz E, Basaran AE, Erduran G, Nur B, Mihci E, Karadag B, Bingol A, Alper OM. Novel Gene Variants Associated with Primary Ciliary Dyskinesia. Indian J Pediatr 2022; 89:682-691. [PMID: 35239159 DOI: 10.1007/s12098-022-04098-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the demographic, clinical, and genetic profile of Turkish Caucasian PCD cases. METHODS Targeted next-generation sequencing (t-NGS) of 46 nuclear genes was performed in 21 unrelated PCD cases. Sanger sequencing confirmed of potentially disease-related variations, and genotype-phenotype correlations were evaluated. RESULTS Disease-related variations were identified in eight different genes (CCDC39, CCDC40, CCDC151, DNAAF2, DNAAF4, DNAH11, HYDIN, RSPH4A) in 52.4% (11/21) of the cases. The frequency of variations for CCDC151, DNAH11, and DNAAF2 genes which were highly mutated genes in the cohort was 18% in 11 patients. Each of the remaining gene variations was detected once (9%) in different patients. The variants, p.R482fs*12 in CCDC151, p.E216* in DNAAF2, p.I317* in DNAAF4, p.L318P and p.R1865* in DNAH11, and p.N1505D and p.L1167P in HYDIN gene were identified as novel variations. Interestingly, varying phenotypic findings were identified even in patients with the same mutation, which once again confirmed that PCD has a high phenotypic heterogeneity and shows individual differences. CONCLUSION This t-NGS panel is potentially helpful for exact and rapid identification of reported/novel PCD-disease-causing variants to establish the molecular diagnosis of ciliary diseases.
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Affiliation(s)
- Durkadin Demir Eksi
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, 07070, Turkey.
- Department of Medical Biology, School of Medicine, Alanya Alaaddin Keykubat University, Antalya, 07425, Turkey.
| | - Elanur Yilmaz
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, 07070, Turkey
- Department of Medical Genetics & Koç University Research Center for Translational Medicine (KUTTAM), School of Medicine, Koç University, Istanbul, Turkey
| | - A Erdem Basaran
- Department of Pediatric Pulmonology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Gizem Erduran
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, 07070, Turkey
| | - Banu Nur
- Department of Pediatric Genetics, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Ercan Mihci
- Department of Pediatric Genetics, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Bulent Karadag
- Department of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Aysen Bingol
- Department of Pediatric Pulmonology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Ozgul M Alper
- Department of Medical Biology and Genetics, School of Medicine, Akdeniz University, Antalya, 07070, Turkey.
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Firat M, Bosnak-Guclu M, Sismanlar-Eyuboglu T, Tana-Aslan A. Respiratory muscle strength, exercise capacity and physical activity in patients with primary ciliary dyskinesia: A cross-sectional study. Respir Med 2021; 191:106719. [PMID: 34952415 DOI: 10.1016/j.rmed.2021.106719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The pathophysiological mechanisms of primary ciliary dyskinesia (PCD) may affect many functions, including respiratory, physical, and health status. This study aimed to compare respiratory muscle strength, inspiratory muscle endurance, muscle strength, exercise capacity, physical activity levels, and quality of life in PCD patients and controls. METHODS Twenty-seven patients and 28 controls were included. Respiratory muscle strength (maximal inspiratory (MIP) and maximal expiratory (MEP) pressures), inspiratory muscle endurance (incremental threshold loading test), muscle strength (quadriceps femoris, shoulder abductor, elbow flexor, handgrip), exercise capacity (6-min walk test (6MWT)), physical activity and quality of life (QOL-PCD) were evaluated. RESULTS MIP, inspiratory muscle endurance, quadriceps femoris, and handgrip muscle strength, 6MWT distance, total energy expenditure; childrens' (6-12 years) and their parents' physical function, upper, lower respiratory, and hearing symptoms and treatment burden QOL-PCD subscales scores were significantly lower in patients compared with controls (p < 0.05). The 66.7% of patients did not meet the optimal number of steps. MEP, shoulder abductor, and elbow flexor muscle strength, active energy expenditure, physical activity duration, average metabolic equivalents, number of steps, lying time, and sleep duration; childrens' and their parents' other subscales and adolescents' all QOL-PCD subscales scores were similar between groups (p > 0.05). CONCLUSION Inspiratory muscle strength and endurance, lower extremity and total muscle strength, exercise capacity, total energy expenditure, and childrens' quality of life are impaired compared to healthy controls. Decreased physical activity level is prevalent in these patients. Effects of pulmonary rehabilitation on these impaired outcomes for PCD patients should be investigated. TRIAL REGISTRATION Clinicaltrials.gov: NCT03370029; December 12, 2017.
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Affiliation(s)
- Merve Firat
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Meral Bosnak-Guclu
- Gazi University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | | | - Ayse Tana-Aslan
- Gazi University, Faculty of Medicine, Department of Pediatric Pulmonology, Ankara, Turkey.
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Asfuroglu P, Ramasli Gursoy T, Sismanlar Eyuboglu T, Aslan AT. Evaluation of age at diagnosis and clinical findings of children with primary ciliary dyskinesia. Pediatr Pulmonol 2021; 56:2717-2723. [PMID: 34133086 DOI: 10.1002/ppul.25533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/20/2021] [Accepted: 06/02/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Patients with primary ciliary dyskinesia (PCD) may present with different clinical findings at different ages, and age at diagnosis may differ. We aimed to review clinical factors that affected age at diagnosis of patients with PCD. STUDY DESIGN All 70 patients with PCD who were followed in our pediatric pulmonology department were included. Demographic features, clinical findings, PrImary CiliAry DyskinesiA Rule (PICADAR) scores and pulmonary function tests of patients were recorded and clinical factors that affected age at diagnosis were evaluated. RESULTS The mean age at diagnosis was 8.3 ± 4.6 years. Most of patients (95.7%) had a persistent wet cough. The mean PICADAR score was 6.5 ± 3.2, and there was a negative correlation between PICADAR and age at diagnosis (r = -0.271, p = .023). The mean ages at diagnosis of patients with situs abnormality and recurrent wheezing were earlier than in patients without situs abnormality and recurrent wheezing (6.7 ± 4.3 and 6.8 ± 4.3, p = .002 vs. 9.8 ± 4.3 and 9.0 ± 4.6 years, p = .040, respectively). The mean age at diagnosis of patients with bronchiectasis was later than in patients without bronchiectasis (10.8 ± 3.9 and 6.9 ± 4.4 years, p = .001). Other clinical features were not statistically significant according to age at diagnosis (p > .05). There was no statistically significant relation between age at diagnosis and sex, sibling or relative with PCD and parental consanguinity (p > .05). CONCLUSION Although most patients diagnosed with PCD had symptoms, the diagnosis may be delayed. High PICADAR score is a useful guide to evaluate PCD. Situs abnormality and recurrent wheezing could be clues for early diagnosis of PCD. Early diagnosis of PCD may prevent bronchiectasis.
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Affiliation(s)
- Pelin Asfuroglu
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Tugba Ramasli Gursoy
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Ayse Tana Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
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Han SM, Hwang CS, Jeon HJ, Lee HY, Cho HJ, Park DJ. Three Cases of Primary Ciliary Dyskinesia Combined With Reduced Exhaled Nitric Oxide. Ann Otol Rhinol Laryngol 2019; 128:1081-1085. [PMID: 31271036 DOI: 10.1177/0003489419861119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The diagnosis of primary ciliary dyskinesia (PCD) is often delayed in part related to the limitations of the available diagnostic tests. We present 3 cases of PCD diagnosed using an exhaled nitric oxide (eNO) measurement. METHODS Three cases with a clinical phenotype consistent with PCD were evaluated using an eNO assay with additional transmission electron microscopy (TEM) and/or genetic panel testing. RESULTS One male and 2 female patients presented with common symptoms included recurrent respiratory infection from early childhood and a history of neonatal respiratory distress as term newborn. Two of them had situs inversus totalis. Fractional eNO measurement revealed extremely low NO levels, and subsequently, TEM analysis confirmed ciliary ultrastructural defects in all patients. One patient had compound heterozygous mutation of the PCD-causative gene (DNAH5) identified using next generation sequencing. CONCLUSION Our report stresses the reliability of eNO measurement in the diagnosis of PCD, accompanied by clinical phenotypes and additional diagnostic tools, such as TEM analysis and genetic testing.
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Affiliation(s)
- Sung Min Han
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, South Korea
| | - Chi Sang Hwang
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, South Korea
| | - Hyun Jong Jeon
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, South Korea
| | - Ho Young Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Ju Cho
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Joon Park
- Department of Otorhinolaryngology, Yonsei University Wonju College of Medicine, South Korea
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Qiu Q, Peng Y, Zhu Z, Chen Z, Zhang C, Ong HH, Tan KS, Hong H, Yan Y, Huang H, Liu J, Li X, Nam HN, Dung NTN, Shi L, Yang Q, Bingle CD, Wang DY. Absence or mislocalization of DNAH5 is a characteristic marker for motile ciliary abnormality in nasal polyps. Laryngoscope 2017; 128:E97-E104. [PMID: 29148098 DOI: 10.1002/lary.26983] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Motile cilia impairment is a common condition in patients with chronically inflamed airways, such as is seen in nasal polyps (NPs). The mechanism underlying this pathogenic condition is complex and not fully understood. METHODS We investigated the presence and localization of dynein axonemal heavy chain 5 (DNAH5) in motile cilia using immunofluorescence staining in paraffin-embedded nasal biopsies from NPs (n = 120) and inferior turbinate mucosa (n = 35) of healthy controls. We also performed single-cell staining on cytospin samples (NP = 5, control = 5). Three patterns of DNAH5 localization are defined, including pattern A (presence throughout the axoneme), pattern B (undetectable in the distal part of the axoneme), and pattern C (completely missing throughout the entire axoneme). We developed a semiquantitative scoring system for which 0 = (pattern A > 70%); 1 = (patterns A + B > 70%); and 2 = (pattern C ≥ 30%) in each high-power field (5 fields per sample). RESULTS Based on our DNAH5 scoring system, the median (1st and 3rd quartile) score was 0.3 (0.2 and 0.4) for samples from controls, and 1.1 (0.6 and 1.6) for samples from NPs in paraffin specimens (P < 0.001). The DNAH5 score had a significant positive relationship with the Lund-Mackay computed tomography score (r = 0.329, P = 0.005) and was higher in patients with eosinophilic NPs (P = 0.006). For cytospin samples, the mean percentage of patterns A, B, and C were 74%, 14%, and 12% in controls, and 48%, 20%, and 32% in NPs, respectively. CONCLUSION Our results suggest that the absence or mislocalization of DNAH5 from motile cilia is a common and potentially important pathological phenomenon in chronically inflamed airway epithelium. LEVEL OF EVIDENCE NA. Laryngoscope, 128:E97-E104, 2018.
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Affiliation(s)
- Qianhui Qiu
- Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Yang Peng
- Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,Department of Otolaryngology Head and Neck Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China.,Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Zhenchao Zhu
- Department of Otolaryngology Head and Neck Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Zhuo Chen
- Department of Otolaryngology Head and Neck Surgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Chi Zhang
- Department of Otolaryngology Head and Neck Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China
| | - Hsiao Hui Ong
- Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kai Sen Tan
- Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Haiyu Hong
- Department of Otolaryngology-Head and Neck Surgery, the 5th Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
| | - Yan Yan
- Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Haoqi Huang
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jing Liu
- Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
| | - Xianqing Li
- Department of Otolaryngology Head and Neck Surgery, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - H N Nam
- Department of Otolaryngology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - N T N Dung
- Department of Otolaryngology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Li Shi
- Department of Otolaryngology, The Second Hospital of Shandong University, Jinan, People's Republic of, China
| | - Qintai Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
| | - Colin D Bingle
- Academic Unit of Respiratory Medicine, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - De-Yun Wang
- Department of Otolaryngology, National University of Singapore, National University Health System, Singapore, Singapore
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Prevalence of primary ciliary dyskinesia in consecutive referrals of suspect cases and the transmission electron microscopy detection rate: a systematic review and meta-analysis. Pediatr Res 2017; 81:398-405. [PMID: 27935903 DOI: 10.1038/pr.2016.263] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/09/2016] [Indexed: 11/08/2022]
Abstract
Diagnostic testing for primary ciliary dyskinesia (PCD) usually includes transmission electron microscopy (TEM), nasal nitric oxide, high-speed video microscopy, and genetics. Diagnostic performance of each test should be assessed toward the development of PCD diagnostic algorithms. We systematically reviewed the literature and quantified PCD prevalence among referrals and TEM detection rate in confirmed PCD patients. Major electronic databases were searched until December 2015 using appropriate terms. Included studies described cohorts of consecutive PCD referrals in which PCD was confirmed by at least TEM and one additional test, in order to compare the index test performance with other test(s). Meta-analyses of pooled PCD prevalence and TEM detection rate across studies were performed. PCD prevalence among referrals was 32% (95% CI: 25-39%, I2 = 92%). TEM detection rate among PCD patients was 83% (95% CI: 75-90%, I2 = 90%). Exclusion of studies reporting isolated inner dynein arm defects as PCD, reduced TEM detection rate and explained an important fraction of observed heterogeneity (74%, 95% CI: 66-83%, I2 = 66%). Approximately, one third of referrals, are diagnosed with PCD. Among PCD patients, a significant percentage, at least as high as 26%, is missed by TEM, a limitation that should be accounted toward the development of an efficacious PCD diagnostic algorithm.
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Kang SH, Kim JH, Kim H, Kim TH. A Case of Primary Ciliary Dyskinesia. JOURNAL OF RHINOLOGY 2017. [DOI: 10.18787/jr.2017.24.2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sung Hoon Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jae Hyung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyunjung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
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Kamel TB, Abd Elmonaem MT, Khalil LH, Goda MH, Sanyelbhaa H, Ramzy MA. Children with chronic lung diseases have cognitive dysfunction as assessed by event-related potential (auditory P300) and Stanford-Binet IQ (SB-IV) test. Eur Arch Otorhinolaryngol 2016; 273:3413-20. [PMID: 27075686 DOI: 10.1007/s00405-016-4044-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/07/2016] [Indexed: 12/15/2022]
Abstract
Chronic lung disease (CLD) in children represents a heterogeneous group of many clinico-pathological entities with risk of adverse impact of chronic or intermittent hypoxia. So far, few researchers have investigated the cognitive function in these children, and the role of auditory P300 in the assessment of their cognitive function has not been investigated yet. This study was designed to assess the cognitive functions among schoolchildren with different chronic pulmonary diseases using both auditory P300 and Stanford-Binet test. This cross-sectional study included 40 school-aged children who were suffering from chronic chest troubles other than asthma and 30 healthy children of similar age, gender and socioeconomic state as a control group. All subjects were evaluated through clinical examination, radiological evaluation and spirometry. Audiological evaluation included (basic otological examination, pure-tone, speech audiometry and immittancemetry). Cognitive function was assessed by auditory P300 and psychological evaluation using Stanford-Binet test (4th edition). Children with chronic lung diseases had significantly lower anthropometric measures compared to healthy controls. They had statistically significant lower IQ scores and delayed P300 latencies denoting lower cognitive abilities. Cognitive dysfunction correlated to severity of disease. P300 latencies were prolonged among hypoxic patients. Cognitive deficits in children with different chronic lung diseases were best detected using both Stanford-Binet test and auditory P300. P300 is an easy objective tool. P300 is affected early with hypoxia and could alarm subtle cognitive dysfunction.
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Affiliation(s)
- Terez Boshra Kamel
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Lobna Hamed Khalil
- Audiology Unit, Department of Otolaryngology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mona Hamdy Goda
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam Sanyelbhaa
- Audiology Unit, Department of Otolaryngology, Menoufia University, Menoufia, Egypt
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Olm MAK, Caldini EG, Mauad T. Diagnosis of primary ciliary dyskinesia. J Bras Pneumol 2016; 41:251-63. [PMID: 26176524 PMCID: PMC4541762 DOI: 10.1590/s1806-37132015000004447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/22/2015] [Indexed: 11/22/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) is a genetic disorder of ciliary structure or function. It results in mucus accumulation and bacterial colonization of the respiratory tract which leads to chronic upper and lower airway infections, organ laterality defects, and fertility problems. We review the respiratory signs and symptoms of PCD, as well as the screening tests for and diagnostic investigation of the disease, together with details related to ciliary function, ciliary ultrastructure, and genetic studies. In addition, we describe the difficulties in diagnosing PCD by means of transmission electron microscopy, as well as describing patient follow-up procedures.
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Affiliation(s)
- Mary Anne Kowal Olm
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elia Garcia Caldini
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
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13
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Establishing normative nasal nitric oxide values in infants. Respir Med 2015; 109:1126-30. [PMID: 26233707 DOI: 10.1016/j.rmed.2015.07.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/02/2015] [Accepted: 07/13/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD), a disease of impaired respiratory cilia motility, is often difficult to diagnose. Recent studies show low nasal nitric oxide (nNO) is closely linked to PCD, allowing the use of nNO measurement for PCD assessments. Nasal NO cutoff values for PCD are stratified by age, given nNO levels normally increase with age. However, normative values for nNO have not been established for infants less than 1 year old. In this study, we aim to establish normative values for nNO in infants and determine their utility in guiding infant PCD assessment. METHODS AND RESULTS We obtained 42 nNO values from infants less than 1 year old without a history of PCD or recurrent sinopulmonary disease. Using regression analysis, we estimated the mean age-adjusted nNO values and established a 95% prediction interval (PI) for normal nNO. Using these findings, we were able to show 14 of 15 infant PCD patients had abnormally low nNO with values below the 95% PI. CONCLUSIONS In this study we determined a regression model that best fits normative nNO values for infants less than 1 year old. This model identified the majority of PCD infants as having abnormally low nNO. These findings suggest nNO measurement can help guide PCD assessment in infants, and perhaps other pulmonary diseases with a link to low nNO. With early assessments, earlier clinical intervention may be possible to slow disease progression and help reduce pulmonary morbidity.
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Hosie PH, Fitzgerald DA, Jaffe A, Birman CS, Rutland J, Morgan LC. Presentation of primary ciliary dyskinesia in children: 30 years' experience. J Paediatr Child Health 2015; 51:722-6. [PMID: 25510893 DOI: 10.1111/jpc.12791] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 12/24/2022]
Abstract
AIM Primary ciliary dyskinesia (PCD) is a rare (1:15,000) condition resulting in recurrent suppurative respiratory tract infections, progressive lung damage and hearing impairment. As the diagnosis is often delayed for years, the purpose of this study was to review the presenting features of children with PCD attending Australia's initial diagnostic PCD service over a 30-year period. METHOD A retrospective review of the symptoms of children diagnosed with PCD at Concord Hospital between 1982 and 2012 was undertaken. RESULTS One thousand thirty-seven paediatric patients were referred for assessment and underwent nasal ciliary brushing. Eighty-four (8.1%) had PCD based on microscopic analysis of nasal cilia. This included 81 with ciliary ultrastructural abnormalities demonstrated on electron microscopy and 3 with a suggestive phenotype, reduced ciliary beat frequency and a family history of PCD. The median age at diagnosis was 6.4 years (range 0.1 to 18.2 years). Forty-six per cent had situs abnormalities and 31% had a family member with PCD. Recurrent cough (81%), rhinosinusitis (71%), recurrent otitis media (49%) and neonatal respiratory distress (57%) were reported. Bronchiectasis at presentation was documented in 32%. Situs abnormalities and neonatal respiratory distress were present together in 26%. CONCLUSION PCD remains under-recognised by health-care workers. The combination of neonatal respiratory distress, chronic suppurative cough and rhinosinusitis was the most common documented symptom cluster at presentation in cases of PCD. A heightened awareness of the clinical features of the disease may help to lower the age at diagnosis, facilitate appropriate treatment and improve long-term outcomes.
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Affiliation(s)
- Patrick H Hosie
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Catherine S Birman
- Department of ENT Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Jonathan Rutland
- Discipline of Adult Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Lucy C Morgan
- Discipline of Adult Medicine, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
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Minov J, Karadzinska-Bislimovska J, Vasilevska K, Stoleski S, Mijakoski D. Assessment of the Non-Cystic Fibrosis Bronchiectasis Severity: The FACED Score vs the Bronchiectasis Severity Index. Open Respir Med J 2015; 9:46-51. [PMID: 25893025 PMCID: PMC4397824 DOI: 10.2174/1874306401509010046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/17/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-cystic fibrosis bronchiectasis (NCFB) is a multidimensional disease, and no single isolated parameter is proved to have sufficient power for any overall determination of its severity and prognosis. OBJECTIVE To compare the results of the assessment of the NCFB severity with respect to its prognosis in the same patients by two different validated scores, i.e. the FACED score and the Bronchiectasis Severity Index (BSI). METHODS An observational study including 37 patients with NCFB (16 males and 21 female aged 46 to 76 years) was performed. All patients underwent evaluation of the variables incorporated in the FACED score (FEV1 % predicted, age, chronic colonization by Pseudomaonas aeruginosa, radiological extent of the disease, and dyspnea) and in the BSI (age, body mass index, FEV1 % predicted, hospitalization and exacerbations in previous year, dyspnea, chronic colonization by Pseudomaonas aeruginosa and other microrganisms, and radiological extent of the disease). RESULTS According to the value of the derived overall FACED score we found 17 patients (45.9%) with mild bronchiectasis, 14 patients (37.8%) with moderate bronchiectasis and 6 patients (16.2%) with severe bronchiectasis. The mean derived FACED score was 3.4 ± 1.3. In addition, according to the value of the derived overall BSI score, the frequency of patients with low, intermediate and high BSI score was 16 patients (43,2%), 14 patients (37.8%) and 7 patients (18.9%), respectively. The mean derived BSI score was 6.4 ± 2.5. CONCLUSION We found similar results by the assessment of the NCFB severity in regard to its prognosis by both the FACED score and the BSI. Further studies determining how these scores may impact clinical practice are needed.
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Affiliation(s)
- J Minov
- Institute for Occupational Health of R. Macedonia – WHO Collaborating Center and GA2LEN Collaborating Center, Skopje, R. Macedonia
| | - J Karadzinska-Bislimovska
- Institute for Occupational Health of R. Macedonia – WHO Collaborating Center and GA2LEN Collaborating Center, Skopje, R. Macedonia
| | - K Vasilevska
- Institute for Epidemiology and Biostatistics, Skopje, R. Macedonia
| | - S Stoleski
- Institute for Occupational Health of R. Macedonia – WHO Collaborating Center and GA2LEN Collaborating Center, Skopje, R. Macedonia
| | - D Mijakoski
- Institute for Occupational Health of R. Macedonia – WHO Collaborating Center and GA2LEN Collaborating Center, Skopje, R. Macedonia
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Sui W, Hou X, Che W, Ou M, Sun G, Huang S, Liu F, Chen P, Wei X, Dai Y. CCDC40 mutation as a cause of primary ciliary dyskinesia: a case report and review of literature. CLINICAL RESPIRATORY JOURNAL 2015; 10:614-21. [PMID: 25619595 DOI: 10.1111/crj.12268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 01/02/2015] [Accepted: 01/20/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Weiguo Sui
- Guangxi Key Laboratory of Metabolic Diseases Research; Guilin Guangxi China
| | - Xianliang Hou
- Guangxi Key Laboratory of Metabolic Diseases Research; Guilin Guangxi China
- College of Life Science; Guangxi Normal University; Guilin Guangxi China
| | - Wenti Che
- Guangxi Key Laboratory of Metabolic Diseases Research; Guilin Guangxi China
| | - Minglin Ou
- Guangxi Key Laboratory of Metabolic Diseases Research; Guilin Guangxi China
| | - Guoping Sun
- Lab. Center; Shenzhen Pingshan People's Hospital; Shenzhen Guangdong China
| | - Shengxing Huang
- Clinical Medical Research Center; the Second Clinical Medical College of Jinan University (Shenzhen People's Hospital); Shenzhen Guangdong China
| | - Fuhua Liu
- Guangxi Key Laboratory of Metabolic Diseases Research; Guilin Guangxi China
| | - Peng Chen
- Guangxi Key Laboratory of Metabolic Diseases Research; Guilin Guangxi China
| | - Xiaolian Wei
- Guangxi Key Laboratory of Metabolic Diseases Research; Guilin Guangxi China
| | - Yong Dai
- Guangxi Key Laboratory of Metabolic Diseases Research; Guilin Guangxi China
- Clinical Medical Research Center; the Second Clinical Medical College of Jinan University (Shenzhen People's Hospital); Shenzhen Guangdong China
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Hosie P, Fitzgerald DA, Jaffe A, Birman CS, Morgan L. Primary ciliary dyskinesia: overlooked and undertreated in children. J Paediatr Child Health 2014; 50:952-8. [PMID: 24943508 DOI: 10.1111/jpc.12628] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/29/2022]
Abstract
Primary ciliary dyskinesia (PCD) is a multi-organ disorder associated with chronic oto-sino-pulmonary disease, neonatal respiratory distress, situs abnormalities and reduced fertility. Repeated respiratory tract infections leads to the almost universal development of bronchiectasis. These clinical manifestations are a consequence of poorly functioning motile cilia. However, confirming the diagnosis is quite difficult and is often delayed, so the true incidence of PCD may be significantly higher than current estimates. Nasal nitric oxide has been earmarked as a useful screening tool for identifying patients, but its use is limited in pre-school-aged children. Due to the rarity of PCD, the evidence base for management is somewhat limited, and treatment regimens are extrapolated from other suppurative lung disorders, like cystic fibrosis.
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Affiliation(s)
- Patrick Hosie
- Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, New South Wales, Australia; Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney Medical School, Sydney, New South Wales, Australia
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18
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Schofield LM, Horobin HE. Growing up with Primary Ciliary Dyskinesia in Bradford, UK: exploring patients experiences as a physiotherapist. Physiother Theory Pract 2013; 30:157-64. [PMID: 24156703 DOI: 10.3109/09593985.2013.845863] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary Ciliary Dyskinesia (PCD) is a condition which causes impaired mucociliary clearance, resulting in sputum retention and recurrent respiratory tract infections. Physiotherapy, in the form of airway clearance techniques and exercise is recommended to patients with PCD to facilitate sputum clearance. As children diagnosed with PCD develop into adults, understanding their experiences of growing up with this long-term condition and undertaking physiotherapy may help to provide insight to clinicians. No previous research has been published which explores the lived experiences of children and young people with PCD. The prevalence of PCD in Bradford in the North of the UK is unusually high, signifying the importance of understanding the experiences of this patient population. This qualitative study used Interpretive Phenomenological Analysis to allow the researcher, as a physiotherapist, to investigate the lived experiences of five paediatric patients with PCD. While patients' experiences are all unique, three themes emerged across the analysis of the interviews: (1) the experiences of day to day life with the symptoms and treatment burden of PCD; (2) participants' awareness of their own symptoms and knowledge of PCD; and (3) the development of mastery skills and devolution of management from the family to the growing child. The results from this study suggested that facilitation of disease acceptance, strategies to increase patient empowerment, the use of patient-centred communication and understanding the contextualisation of patients' experiences may all help to guide clinical practice.
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Affiliation(s)
- Lynne M Schofield
- Department of Physiotherapy, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary , Duckworth Lane, Bradford , UK
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20
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Marthin JK, Nielsen KG. Hand-held tidal breathing nasal nitric oxide measurement--a promising targeted case-finding tool for the diagnosis of primary ciliary dyskinesia. PLoS One 2013; 8:e57262. [PMID: 23437356 PMCID: PMC3577728 DOI: 10.1371/journal.pone.0057262] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/21/2013] [Indexed: 11/18/2022] Open
Abstract
Background Nasal nitric oxide (nNO) measurement is an established first line test in the work-up for primary ciliary dyskinesia (PCD). Tidal breathing nNO (TB-nNO) measurements require minimal cooperation and are potentially useful even in young children. Hand-held NO devices are becoming increasingly widespread for asthma management. Therefore, we chose to assess whether hand-held TB-nNO measurements reliably discriminate between PCD, and Healthy Subjects (HS) and included Cystic Fibrosis (CF) patients as a disease control group known to have intermediate nNO levels. Methods In this cross sectional, single centre, single occasion, proof-of-concept study in children and adults with PCD and CF, and in HS we compared feasibility, success rates, discriminatory capacity, repeatability and agreement between a hand-held electrochemical device equipped with a nNO software application sampling at flow rates 2 ml/s or 5 ml/s, and two stationary chemiluminescence devices, applying both tidal breathing and velum closure techniques. Results Measurements were done in 16 PCD patients, 21 patients with CF and 20 HS aged between 3.8 and 60.9 years. Hand-held TB-nNO showed high success rate (96.5–100%) vs. velum closure nNO techniques (70.2–89.5%). Hand-held TB-nNO sampling at flow rate 5 ml/s showed equally high discriminative power (PCD vs. HS [p<0.0001] and PCD vs. CF [p<0.0001]) and reaching close to 100% sensitivity and specificity, superior repeatability (CV% = 10%) and equal limits of agreement compared to TB-nNO by stationary devices and even compared to velum closure sampling. Conclusion Hand-held TB-nNO discriminates significantly between PCD, CF and HS and shows promising potential as a widespread targeted case-finding tool for PCD, although further studies are warranted before implementation.
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Affiliation(s)
- June Kehlet Marthin
- Pediatric Pulmonary Service, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Kim KC, Park JH, Ban GY, Yoo HS, Shin YS, Park HS, Ye YM. Kartagener's syndrome with immunoglobulin G subclass deficiency. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.3.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ki-Chan Kim
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Joo-Han Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ga-Young Ban
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hye-Soo Yoo
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo-Seob Shin
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Svobodová T, Djakow J, Zemková D, Cipra A, Pohunek P, Lebl J. Impaired Growth during Childhood in Patients with Primary Ciliary Dyskinesia. Int J Endocrinol 2013; 2013:731423. [PMID: 24454367 PMCID: PMC3876717 DOI: 10.1155/2013/731423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/19/2013] [Indexed: 11/23/2022] Open
Abstract
Primary ciliary dyskinesia (PCD) leads to recurrent/chronic respiratory infections, resulting in chronic inflammation and potentially in chronic pulmonary disease with bronchiectasis. We analyzed longitudinal data on body length/height and body mass index (BMI) for 29 children and young adults with PCD aging 1.5-24 years (median, 14.5) who had been diagnosed at the age of 0.5-17 years (median, 8). Of these, 10 carried pathogenic mutations in either DNAH5 or DNAI1. In children with PCD, body length/height progressively decreased from +0.40 ± 0.24 SDS (the 1st birthday), +0.16 ± 0.23 SDS (3 years old), and -0.13 ± 0.21 SDS (5 years old) to -0.54 ± 0.19 SDS (7 years old; P = 0.01 versus 0), -0.67 ± 0.21 SDS (9 years old; P = 0.005 versus 0), -0.52 ± 0.24 SDS (11 years old; P = 0.04 versus 0), and -0.53 ± 0.23 SDS (13 years old; P = 0.03 versus 0). These results reflect low growth rates during the childhood growth period. Thereafter, heights stabilized up to the age of 17 years. The growth deterioration was not dependent on sex or disease severity but was more pronounced in DNAH5 or DNAI1 mutation carriers. BMI did not differ from population standards, which suggests that nutritional deficits are not the cause of growth delay. We conclude that PCD leads to chronic deprivation with significant growth deterioration during childhood.
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Affiliation(s)
- Tamara Svobodová
- Department of Pediatrics, 2nd Faculty of Medicine, University Hospital Motol, Charles University, 150 06 Prague, Czech Republic
| | - Jana Djakow
- Department of Pediatrics, 2nd Faculty of Medicine, University Hospital Motol, Charles University, 150 06 Prague, Czech Republic
| | - Daniela Zemková
- Department of Pediatrics, 2nd Faculty of Medicine, University Hospital Motol, Charles University, 150 06 Prague, Czech Republic
| | - Adam Cipra
- Department of Pediatrics, Masaryk's Hospital, 400 11 Usti nad Labem, Czech Republic
| | - Petr Pohunek
- Department of Pediatrics, 2nd Faculty of Medicine, University Hospital Motol, Charles University, 150 06 Prague, Czech Republic
| | - Jan Lebl
- Department of Pediatrics, 2nd Faculty of Medicine, University Hospital Motol, Charles University, 150 06 Prague, Czech Republic
- *Jan Lebl:
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Primary ciliary dyskinesia: clinical criteria indicating ultrastructural studies. Arch Bronconeumol 2012; 49:99-104. [PMID: 23265970 DOI: 10.1016/j.arbres.2012.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/15/2012] [Accepted: 10/30/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) is a congenital disease characterized by impaired ciliary function, which involves a wide range of symptoms that are mainly respiratory. Recent articles that base diagnosis on ciliary ultrastructural studies have estimated its prevalence to be 1/10,000 newborns, which is higher than previously thought. Our objective is to define criteria for clinical suspicion of DCP that would indicate ultrastructural studies, while optimizing these and providing early diagnoses. METHODS Ours is a descriptive, retrospective review of patients diagnosed with DCP in the Pediatric Pulmonology Unit at our hospital, from 1994 to 2010. The inclusion of cases was based on clinical suspicion criteria. Diagnosis was confirmed by characteristic ultrastructural changes observed in the electron microscopic study of the cilia. RESULTS Sixty-three samples were analyzed, and 34 cases of DCP and one case of acilia were confirmed. Mean age at diagnosis was 3.6 (range: 1 month to 19 years of age). The most frequent initial symptom was prolonged neonatal tachypnea in the newborns (20%) and lower respiratory tract episodes in the school-aged patients: recurrent pneumonia (46%), difficult-to-control asthma (26%), bronchiectasis (8.6%) and massive atelectasis (2.9%). Associated symptoms were present in 46% of the cases. CONCLUSION Our publication proposes the implementation of several clinical criteria depending on the age of presentation that would indicate the active search for alterations in the ciliary epithelium at reference centers.
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McEvoy MJ. Cyanotic episodes in an infant with known situs inversus: indications for an apparent life-threatening event evaluation. J Pediatr Health Care 2012; 26:364-9. [PMID: 22410196 DOI: 10.1016/j.pedhc.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 01/11/2012] [Accepted: 02/02/2012] [Indexed: 11/17/2022]
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Djakow J, Svobodová T, Hrach K, Uhlík J, Cinek O, Pohunek P. Effectiveness of sequencing selected exons of DNAH5 and DNAI1 in diagnosis of primary ciliary dyskinesia. Pediatr Pulmonol 2012; 47:864-75. [PMID: 22416021 DOI: 10.1002/ppul.22520] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 11/28/2011] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Primary ciliary dyskinesia (PCD) is a rare genetically heterogenous condition. Mutations in DNAH5 or DNAI1 genes can be found in about a third of the patients with PCD. Increased occurrence of mutations was described in several exons of these long genes. The objective of the study was to test the sensitivity of sequencing of selected 13 exons (as compared to costly sequencing of all 100 exons of the two genes), and to determine the prevalence of the DNAH5 or DNAI1 mutations in the Czech PCD database. METHODS The Czech national PCD database has identified 31 pediatric patients, diagnosed based on clinical findings and tests on the ciliated epithelium. Twenty-seven patients from 24 families agreed on genetic testing. In the first step, direct sequencing of selected 13 exons (9 of DNAH5 and 4 of DNAI1) was performed, and then we compared its effectiveness in detecting at least one mutation with results of sequencing all 100 exons of the two genes. RESULTS The sequencing of all exons identified compound heterozygosity for PCD mutations in nine patients from eight families (DNAH5 in eight and DNAI1 in one patient), and heterozygozity for a DNAH5 mutation of uncertain functional significance in one additional patient. The first step of selected exon sequencing detected a mutation in five out of these eight families, its actual sensitivity being 62.5%, with a high predictive value. The phenotypic and clinical characteristics of all the paediatric patients with PCD are shown. CONCLUSIONS Selected exon sequencing detects at least one mutated allele in over a half of our patients who have PCD due to DNAH5 or DNAI1 mutations. To lower the costs of the genetic testing, targeted step-wise genetic testing may be a reasonable approach to detect mutations in PCD patients, especially if their phenotype is taken into account.
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Affiliation(s)
- Jana Djakow
- 2nd Faculty of Medicine, Department of Pediatrics, Charles University in Prague and University Hospital Motol, Prague, Czech Republic.
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Olm MAK, Kögler JE, Macchione M, Shoemark A, Saldiva PHN, Rodrigues JC. Primary ciliary dyskinesia: evaluation using cilia beat frequency assessment via spectral analysis of digital microscopy images. J Appl Physiol (1985) 2011; 111:295-302. [PMID: 21551013 DOI: 10.1152/japplphysiol.00629.2010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Ciliary beat frequency (CBF) measurements provide valuable information for diagnosing of primary ciliary dyskinesia (PCD). We developed a system for measuring CBF, used it in association with electron microscopy to diagnose PCD, and then analyzed characteristics of PCD patients. The CBF measurement system was based on power spectra measured through digital imaging. Twenty-four patients suspected of having PCD (age 1-19 yr) were selected from a group of 75 children and adolescents with pneumopathies of unknown causes. Ten healthy, nonsmoking volunteers (age ≥ 17 yr) served as a control group. Nasal brush samples were collected, and CBF and electron microscopy were performed. PCD was diagnosed in 12 patients: 5 had radial spoke defects, 3 showed absent central microtubule pairs with transposition, 2 had outer dynein arm defects, 1 had a shortened outer dynein arm, and 1 had a normal ultrastructure. Previous studies have reported that the most common cilia defects are in the dynein arm. As expected, the mean CBF was higher in the control group (P < 0.001) and patients with normal ultrastructure (P < 0.002), than in those diagnosed with cilia ultrastructural defects (i.e., PCD patients). An obstructive ventilatory pattern was observed in 70% of the PCD patients who underwent pulmonary function tests. All PCD patients presented bronchial wall thickening on chest computed tomography scans. The protocol and diagnostic techniques employed allowed us to diagnose PCD in 16% of patients in this study.
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Affiliation(s)
- Mary A K Olm
- Pediatric Pneumology Unit, Child Institute, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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27
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Love D, Li FQ, Burke MC, Cyge B, Ohmitsu M, Cabello J, Larson JE, Brody SL, Cohen JC, Takemaru KI. Altered lung morphogenesis, epithelial cell differentiation and mechanics in mice deficient in the Wnt/β-catenin antagonist Chibby. PLoS One 2010; 5:e13600. [PMID: 21049041 PMCID: PMC2963606 DOI: 10.1371/journal.pone.0013600] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 10/01/2010] [Indexed: 12/21/2022] Open
Abstract
The canonical Wnt/β-catenin pathway plays crucial roles in various aspects of lung morphogenesis and regeneration/repair. Here, we examined the lung phenotype and function in mice lacking the Wnt/β-catenin antagonist Chibby (Cby). In support of its inhibitory role in canonical Wnt signaling, expression of β-catenin target genes is elevated in the Cby−/− lung. Notably, Cby protein is prominently associated with the centrosome/basal body microtubule structures in embryonic lung epithelial progenitor cells, and later enriches as discrete foci at the base of motile cilia in airway ciliated cells. At birth, Cby−/− lungs are grossly normal but spontaneously develop alveolar airspace enlargement with reduced proliferation and abnormal differentiation of lung epithelial cells, resulting in altered pulmonary function. Consistent with the Cby expression pattern, airway ciliated cells exhibit a marked paucity of motile cilia with apparent failure of basal body docking. Moreover, we demonstrate that Cby is a direct downstream target for the master ciliogenesis transcription factor Foxj1. Collectively, our results demonstrate that Cby facilitates proper postnatal lung development and function.
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Affiliation(s)
- Damon Love
- Department of Pharmacological Sciences, SUNY at Stony Brook, Stony Brook, New York, United States of America
- Graduate Program in Molecular and Cellular Pharmacology, SUNY at Stony Brook, Stony Brook, New York, United States of America
| | - Feng-Qian Li
- Department of Pharmacological Sciences, SUNY at Stony Brook, Stony Brook, New York, United States of America
- Graduate Program in Molecular and Cellular Pharmacology, SUNY at Stony Brook, Stony Brook, New York, United States of America
| | - Michael C. Burke
- Medical Scientist Program (MSTP), SUNY at Stony Brook, Stony Brook, New York, United States of America
- Graduate Program in Genetics, SUNY at Stony Brook, Stony Brook, New York, United States of America
| | - Benjamin Cyge
- Department of Pharmacological Sciences, SUNY at Stony Brook, Stony Brook, New York, United States of America
- Graduate Program in Molecular and Cellular Pharmacology, SUNY at Stony Brook, Stony Brook, New York, United States of America
| | - Masao Ohmitsu
- Department of Pharmacological Sciences, SUNY at Stony Brook, Stony Brook, New York, United States of America
| | - Jeffrey Cabello
- Department of Pharmacological Sciences, SUNY at Stony Brook, Stony Brook, New York, United States of America
| | - Janet E. Larson
- Section of Neonatology, Department of Pediatrics, SUNY at Stony Brook, Stony Brook, New York, United States of America
| | - Steven L. Brody
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - J. Craig Cohen
- Section of Neonatology, Department of Pediatrics, SUNY at Stony Brook, Stony Brook, New York, United States of America
| | - Ken-Ichi Takemaru
- Department of Pharmacological Sciences, SUNY at Stony Brook, Stony Brook, New York, United States of America
- Graduate Program in Molecular and Cellular Pharmacology, SUNY at Stony Brook, Stony Brook, New York, United States of America
- Graduate Program in Genetics, SUNY at Stony Brook, Stony Brook, New York, United States of America
- * E-mail:
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28
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Fermeiro J, Bandeira T, Lobo L, Pereira L. Discinesia ciliar primária revisitada: A propósito de três casos clínicos. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010; 16:837-47. [DOI: 10.1016/s0873-2159(15)30076-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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29
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Niu ZH, Huang XF, Jia XF, Zheng J, Yuan Y, Shi TY, Diao H, Yu HG, Sun F, Zhang HQ, Shi HJ, Feng Y. A sperm viability test using SYBR-14/propidium iodide flow cytometry as a tool for rapid screening of primary ciliary dyskinesia patients and for choosing sperm sources for intracytoplasmic sperm injection. Fertil Steril 2010; 95:389-92. [PMID: 20797703 DOI: 10.1016/j.fertnstert.2010.07.1045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 06/12/2010] [Accepted: 07/08/2010] [Indexed: 11/29/2022]
Abstract
Spermatozoa viability tests based on dual-color flow cytometry after staining with Sybr-14/propidium iodide were performed on 44 men with complete asthenospermia for primary ciliary dyskinesia (PCD) screening, and seven were identified with PCD by electron microscopy of ultrastructural ciliary defects. Six PCD patients underwent eight intracytoplasmic sperm injection therapy cycles using ejaculated sperm or testicular sperm, obtaining a mean fertilization rate of 46.6%, with three healthy babies born and one in utero at the time of writing.
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Affiliation(s)
- Zhi-hong Niu
- Department of Gynecology and Obstetrics, Medical School of Fudan University, and Reproductive Medical Center, Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, People's Republic of China
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Abstract
Bronchiectasis is defined by permanent and abnormal widening of the bronchi. This process occurs in the context of chronic airway infection and inflammation. It is usually diagnosed using computed tomography scanning to visualize the larger bronchi. Bronchiectasis is also characterized by mild to moderate airflow obstruction. This review will describe the pathophysiology of noncystic fibrosis bronchiectasis. Studies have demonstrated that the small airways in bronchiectasis are obstructed from an inflammatory infiltrate in the wall. As most of the bronchial tree is composed of small airways, the net effect is obstruction. The bronchial wall is typically thickened by an inflammatory infiltrate of lymphocytes and macrophages which may form lymphoid follicles. It has recently been demonstrated that patients with bronchiectasis have a progressive decline in lung function. There are a large number of etiologic risk factors associated with bronchiectasis. As there is generally a long-term retrospective history, it may be difficult to determine the exact role of such factors in the pathogenesis. Extremes of age and smoking/chronic obstructive pulmonary disease may be important considerations. There are a variety of different pathogens involved in bronchiectasis, but a common finding despite the presence of purulent sputum is failure to identify any pathogenic microorganisms. The bacterial flora appears to change with progression of disease.
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Affiliation(s)
- Paul T King
- Department of Medicine, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia.
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