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Shah KS, Saiman L, LiPuma JJ, Kosorok MR, Muhlebach MS. Association of Pseudomonas aeruginosa incident infections with adherence to cystic fibrosis foundation care guidelines. J Cyst Fibros 2024; 23:300-305. [PMID: 37953182 DOI: 10.1016/j.jcf.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/20/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Care guidelines for cystic fibrosis (CF) have been developed to enhance consistent care and to improve health outcomes. We determined if adherence to CF care guidelines predicted P. aeruginosa incidence rates (Pa-IR) at U.S. CF centers in 2018. METHODS This cross-sectional CF Foundation Patient Registry study included 82 adult and 132 pediatric centers. Adherence to 12 guidelines was defined categorically (guideline met) or as a continuous measure (proportion of patients being treated/evaluated per guideline). Association of adherence to individual guidelines with Pa-IR, accounted for center and patient characteristics relevant to Pa-IR and were modeled using random forests and weighted-least-squares (WLS) analyses. RESULTS The mean Pa-IR was 0.2 cases/patient-years at risk (SE 0.0074) for all centers combined. Guideline adherence was lowest for ≥4 bacterial cultures/year (54% of centers) and annual oral glucose tolerance test (OGTT) (48% of centers), and highest for annual non-tuberculous mycobacteria (NTM) sputum culture (98%). The mean number of guidelines met was 6.7 and higher for pediatric (7.3) than adult (5.6) centers, (p<0.001). The number of guidelines met correlated negatively with Pa-IR (β=-0.007, p = 0.043). Macrolide prescription and annual OGTT per guideline were associated with lower and higher Pa-IR, respectively. Centers with lower center-wide lung function, higher proportion of pwCF with low body-mass index, and location in the Southwest had higher Pa-IR. CONCLUSION Overall adherence to guidelines was high except for performing ≥4 bacterial cultures/year and OGTT. Higher Pa-IR was associated with center characteristics and lower guideline adherence. The lower Pa-IR with greater adherence to guidelines suggests that focusing on quality care can positively impact Pa-IR.
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Affiliation(s)
- Kushal S Shah
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - John J LiPuma
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48104, United States
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Marianne S Muhlebach
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, United States; Marisco Lung Institute, University of North Carolina, Chapel Hill, NC 27599, United States.
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2
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Xu C, Tang Y, Dong L, Shen Y. Clinical and genetic characteristics of children with cystic fibrosis in Henan China: A single-center retrospective analysis. Pediatr Pulmonol 2023; 58:2865-2870. [PMID: 37477516 DOI: 10.1002/ppul.26601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Despite the growing awareness of cystic fibrosis (CF) in China, few cases have been reported in Henan, which is the most populous province in the country. This study aimed to describe the clinical phenotype and genotype of children with CF in Henan. METHODS We retrospectively recruited 18 Chinese children with CF who presented to Children's Hospital affiliated to Zhengzhou University from January 2019 to June 2023. The demographic data, imaging examinations, and laboratory tests of the patients were reviewed to clarify the clinical phenotype. Whole exome sequencing was conducted to identify the genotype. RESULTS Respiratory diseases were the main clinical manifestation, including recurrent/persistent pneumonia (88.9%), sinusitis (77.8%), bronchiectasis (77.8%). CF-related liver disease and pancreatic insufficiency were less common. Infant cases had high frequency of pseudo-Bartter Syndrome (80.0%). Chest computed tomography showed bronchiectasis in older children and air trapping in infant cases. The most common pathogens in the airway were Pseudomonas aeruginosa (72.2%) and Staphylococcus aureus (66.7%). Twenty-five different cystic fibrosis transmembrane conductance regulator (CFTR) gene variants were detected, including five novel observations (c.1064C>G[p. Pro355Arg], c.1209+1G>C, c.1925C>G[p. Ser642X], c.2810T>G[p. Leu937Arg], and c.3792delA[p. Gly1265GlufsX13]). The most common variant was c.2909G>A(p. Gly970Asp), with a detected rate of 21.9%. CONCLUSION Children with CF in Henan had varied clinical phenotypes by age, with respiratory disease being predominant. The most frequent CFTR gene variant was c.2909G>A(p. Gly970Asp). This study is the first and most comprehensive one on the clinical phenotype and genotype of children with CF in Henan, China. We also reported the first CF case of Mycobacterium abscessus infection in China.
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Affiliation(s)
- Chunna Xu
- Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yu Tang
- Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Lili Dong
- Respiratory Department, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yuelin Shen
- Respiratory Department II, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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Oubaya N, Pombet T, Delestrain C, Remus N, Douvry B, Grenet D, Corvol H, Thouvenin G, Prulière-Escabasse V, Mounir H, Argoud D, Fretigne C, Costes L, Mackiewicz MP, Jung C, Ahamada L, Lanone S, Maitre B, Bégot AC, Epaud R. Impact of the COVID-19 pandemic and associated lockdown measures on the management, health, and behavior of the cystic fibrosis population in France during 2020 (MUCONFIN). Front Public Health 2022; 10:978627. [PMID: 36452951 PMCID: PMC9703073 DOI: 10.3389/fpubh.2022.978627] [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: 06/26/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Most of the studies on cystic fibrosis (CF) focused on SARS-CoV-2 prevalence and suggested a low incidence of infection in this population. We aimed to assess the impact of the pandemic and related lockdown measures implemented in May 2020 in response to the first wave of SARS-CoV-2 infection on healthcare access, health, and behavior in CF patients. Methods A national questionnaire opened online from May 15th, 2020 to June 11th, 2020 was completed by 751 CF-patients, aged 14 years and over. It comprised questions about access to healthcare, anxiety and depression, smoking, alcohol, drug and psychotropic drug consumption, adherence to CF treatment, and constraints. A semi-structured comprehensive interview was performed no later than 1 month after the end of the lockdown in 16 CF-patients. Results The mean age of the population was 28.0 [interquartile range (IQR) 20.0-37.0] years old. More than 75% of in-person consultations scheduled during the lockdown were canceled. Alternatively, 27% were postponed, and telehealth consultations were proposed and accepted in almost 40% of cases. More than 75% of the scheduled physiotherapy sessions were canceled and replaced mainly by self-drainage. Annual follow-up clinic visits were consistently postponed whereas required hospitalizations at CF centers for exacerbation were maintained in most cases. While 43.2% CF-patients had signs of anxiety, 51.0% presented symptoms of depression, both associated with increased use of psychotic medications and inversely correlated to COVID-19 prevalence. Among the lower and lower middle classes, very little medical information was obtained or requested by the patient, participation to sports or other activities was low, while excessive home confinement and isolation were more frequent. In contrast, in the upper middle and upper classes, individuals solicitated help to their CF centre, had more physical activities, and maintained contact with friends or families. Conclusion The first lockdown in France had only minimal impact on the management care of CF-patients but was associated with increased symptoms of anxiety and depression, together with behavioral changes that varied with social class. Trial registration NCT04463628.
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Affiliation(s)
- Nadia Oubaya
- Department of Public Health, AP-HP, Hôpitaux Henri-Mondor, Créteil, France,University Paris Est Créteil, INSERM, IMRB, Créteil, France
| | - Thibaud Pombet
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France,Faculté d'Éducation et de Formation, Institut Catholique de Paris (ICP), Paris, France
| | - Celine Delestrain
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Fédérations Hospitalo-Universitaires (FHU) Role of SENEscence in Chronic Diseases (SENEC), Créteil, France
| | - Natascha Remus
- Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France
| | - Benoit Douvry
- Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, Créteil, France
| | - Dominique Grenet
- Service de Pneumologie, CRCM-Centre de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Harriet Corvol
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Pediatric Pulmonary Department, Paris, France,Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Saint Antoine, Paris, France
| | - Guillaume Thouvenin
- Assistance Publique-Hôpitaux de Paris, Hôpital Trousseau, Pediatric Pulmonary Department, Paris, France
| | - Virginie Prulière-Escabasse
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service d'ORL, Créteil, France
| | - Hakima Mounir
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Dominique Argoud
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Cédric Fretigne
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Laurence Costes
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Marie-Pierre Mackiewicz
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Camille Jung
- Clinical Research Centre, Intercommunal Hospital of Créteil, Créteil, France
| | - Laitissia Ahamada
- Clinical Research Centre, Intercommunal Hospital of Créteil, Créteil, France
| | - Sophie Lanone
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Fédérations Hospitalo-Universitaires (FHU) Role of SENEscence in Chronic Diseases (SENEC), Créteil, France
| | - Bernard Maitre
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Fédérations Hospitalo-Universitaires (FHU) Role of SENEscence in Chronic Diseases (SENEC), Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie, Créteil, France
| | - Anne-Cécile Bégot
- Laboratoire Interdisciplinaire de Recherche sur les Transformations des Pratiques Éducatives et des Pratiques Sociales (LIRTES)-EA7313, Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Ralph Epaud
- University Paris Est Créteil, INSERM, IMRB, Créteil, France,Centre Hospitalier Intercommunal de Créteil, Service de Pédiatrie Générale, Créteil, France,Centre des Maladies Respiratoires Rares (RESPIRARE), CRCM, Créteil, France,Fédérations Hospitalo-Universitaires (FHU) Role of SENEscence in Chronic Diseases (SENEC), Créteil, France,*Correspondence: Ralph Epaud
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4
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Shen Y, Tang X, Chen Q, Xu H, Liu H, Liu J, Yang H, Li H, Zhao S. Genetic spectrum of Chinese children with cystic fibrosis: comprehensive data analysis from the main referral centre in China. J Med Genet 2022; 60:jmedgenet-2022-108501. [PMID: 35858753 PMCID: PMC9985745 DOI: 10.1136/jmg-2022-108501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES Cystic fibrosis (CF) is a heterogeneous disease with a diverse genetic spectrum among populations. Few patients with CF of Chinese origin have been reported worldwide. The objective of this study is to characterise the genotypic features of CF in Chinese children. METHODS We recruited and characterised the genetic manifestations of 103 Chinese children with CF in Beijing Children's Hospital from 2010 to 2022. Whole-exome sequencing were performed to define the genotypes. Meanwhile, other 99 genetically confirmed patients with Chinese origin described in 45 references were also summarised. RESULTS 158 different variants including 23 novel observations were identified after sequencing. The majority of CFTR variants (82.3%) in Chinese have been observed only once or twice. 43.7% of the variants were only identified in patients of Chinese origin. The c.2909G>A(p.Gly970Asp), c.1766+5G>T and c.1657C>T(p.Arg553X) were the most frequent variants among Chinese patients, with allele frequency of 12.1%, 5.4% and 3.6%, respectively. The first two variants both showed significant Chinese ethnic tendency, while the latter one most likely came from Europeans for historical reasons. They also demonstrated significant differences in geographical distribution. c.1521_1523delCTT(p.F508del) was rarely observed in patients of pure Chinese origin, with an allele frequency of 1.8%. Two de novo variants (c.960dupA[p.Ser321IlefsX43] and c.2491-2A>G) and two deep-intronic variants (c.3718-2477C>T and c.3874-4522A>G) were identified, which were also quite rare among Chinese. CONCLUSIONS The genetic spectrum of CF in Chinese is unique and quite different from that observed in Caucasians. The geographical distributions of the most frequent variants were reported for the first time.
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Affiliation(s)
- Yuelin Shen
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Xiaolei Tang
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Qionghua Chen
- Quanzhou Children's Hospital, Quanzhou, People's Republic of China
| | - Hui Xu
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Hui Liu
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Jinrong Liu
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Haiming Yang
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Huimin Li
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
| | - Shunying Zhao
- Department II of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China
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Gambazza S, Carta F, Ambrogi F, Bassotti G, Brivio A, Russo M, Colombo C. Limitations of the dichotomized 6-minute walk distance when computing lung allocation score for cystic fibrosis: a 16-year retrospective cohort study. Disabil Rehabil 2022:1-7. [PMID: 35830371 DOI: 10.1080/09638288.2022.2099588] [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: 11/03/2022]
Abstract
PURPOSE The 2010 Lung Allocation Score (LAS) version considers the estimated survival benefit offered by lung transplantation (LTx) and uses 6-minute Walk Test (6MWT) distance as a dichotomous covariate of whether an individual can walk more than 150 ft or 45.7 m in 6 min. This study aimed to provide evidence that 6MWT gives no clinically meaningful information to be used in the current LAS for candidates to LTx with cystic fibrosis (CF). MATERIALS AND METHODS We collected data from 6MWTs performed since 2003 at our CF centre. A joint model was fitted to describe the effect of changes in walked distance on the hazard of LTx or death. RESULTS Up to 2019, 552 6MWTs were performed on 163 individuals with CF. None of the individuals included walked for less than 45.7 m during the 6MWT. Based on the joint modelling, the association of walked distance with the hazard ratio (HR) of LTx or death was significant (HR 0.99, 95% Credible Interval [CI]: 0.99 to 1.00). CONCLUSIONS When adopted dichotomously for LAS calculation, walked distance does not add any useful information about exercise capacity. Longitudinal trajectories of walked distance may provide complementary information about prognosis in individuals with CF.Implications for rehabilitationDichotomized walked distance does not contribute to lung allocation score in candidates to lung transplantation with cystic fibrosisChanges in the longitudinal trajectory of walked distance can be clinically meaningful for prognostication.Sensitive outcomes to be incorporated in the lung allocation scoring system for individuals with CF are yet needed to catch rapid falls in functional capacity.
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Affiliation(s)
- Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Laboratory of Medical Statistics and Biometry, 'Giulio A. Maccacaro', Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Federica Carta
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milano, Italy
| | - Federico Ambrogi
- Laboratory of Medical Statistics and Biometry, 'Giulio A. Maccacaro', Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Giacomo Bassotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milano, Italy
| | - Anna Brivio
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milano, Italy
| | - Maria Russo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milano, Italy
| | - Carla Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre, Milano, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy
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Cheng HWB, Li CHR, Yeung KY, Lee T, Chan KP, Chung WKV, Hsu D, Chan OMI, Chui R, Man CW, Cheung KW, Wong C, Wu MP, Chan CHR. Transition to adult services for young people suffering from life-limiting neurodevelopmental disabilities: A case series. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2022.2066270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Chak Ho Rever Li
- Department of Pediatrics & Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - K. Y. Yeung
- Department of Pediatrics & Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - Tracy Lee
- Department of Pediatrics & Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ka Po Chan
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Wai Kei Vicky Chung
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Dany Hsu
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Oi Man Iman Chan
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ruby Chui
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ching Wah Man
- Department of Medicine & Geriatrics, Tuen Mun Hospital, New Territories, Hong Kong
| | - Ka Wai Cheung
- Palliative Home Care Team, Tuen Mun Hospital, New Territories, Hong Kong
| | - Cherry Wong
- Palliative Home Care Team, Tuen Mun Hospital, New Territories, Hong Kong
| | - M. P. Wu
- Palliative Home Care Team, Tuen Mun Hospital, New Territories, Hong Kong
| | - Chun Hung Red Chan
- Palliative Home Care Team, Tuen Mun Hospital, New Territories, Hong Kong
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7
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Analysis of Clinical Manifestations, Imaging Features, and Gene Mutation Characteristics of 6 Children with Cystic Fibrosis in China. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:7254391. [PMID: 34765005 PMCID: PMC8577894 DOI: 10.1155/2021/7254391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022]
Abstract
Objective To explore the clinical manifestations, imaging features, and gene mutation characteristics of 6 children with cystic fibrosis (CF) so as to improve the understanding and diagnosis awareness of CF in children and reduce the missed diagnosis and misdiagnosis. Methods The clinical manifestations, imaging, and gene mutation data of six children with CF were collected and retrospectively analyzed. Results Among the 6 cases of CF, there were 4 males and 2 females. Among the 6 children with CF, 5 cases presented with recurrent respiratory tract infection. Etiology suggested 3 cases of Pseudomonas aeruginosa and 2 cases of Staphylococcus aureus. 3 cases had pancreatic exocrine dysfunction, manifested as diarrhea and aliphatic diarrhea, of which 1 case had high lipase in blood examination, and pancreatic ultrasound showed rough and enhanced pancreatic echo, considering pancreatic cystic fibrosis. 2 cases of CF combined with pseudo-Bartter syndrome (PBS); 1 case involved only the biliary tract and started with cholestasis without other systemic involvement. In 2 cases of sweat test, sweat chloride ions were all >60 mmol/L. 3 cases underwent fiberoptic bronchoscopy, and a large number of sticky secretions were visible under the bronchoscopy. CT of the chest revealed thickening of the bronchial wall (3 cases), bronchiectasis (1 case), atelectasis (1 case), and thin bronchial lumen (2 cases). 1 patient was found to have small airway lesions and mosaic perfusion during follow-up. All 6 children with CF underwent genetic testing. A total of 12 CF transmembrane conductance regulator (CFTR) gene mutations were found, of which 4 mutations were not reported in the literature. Conclusion CF is a disease caused by CFTR mutation. The incidence of this disease in China is low, and the clinical manifestations have great differences. The main symptoms are respiratory symptoms. Some children have gastrointestinal symptoms and/or PBS, and some children only show a single systemic lesion.
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8
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Calvo-Lerma J, Boon M, Colombo C, de Koning B, Asseiceira I, Garriga M, Roca M, Claes I, Bulfamante A, Walet S, Pereira L, Ruperto M, Masip E, Asensio-Grau A, Giana A, Affourtit P, Heredia A, Vicente S, Andrés A, de Boeck K, Hulst J, Ribes-Koninckx C. Clinical evaluation of an evidence-based method based on food characteristics to adjust pancreatic enzyme supplements dose in cystic fibrosis. J Cyst Fibros 2020; 20:e33-e39. [PMID: 33279468 DOI: 10.1016/j.jcf.2020.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) and pancreatic insufficiency need pancreatic enzyme replacement therapy (PERT) for dietary lipids digestion. There is limited evidence for recommending the adequate PERT dose for every meal, and controlling steatorrhea remains a challenge. This study aimed to evaluate a new PERT dosing method supported by a self-management mobile-app. METHODS Children with CF recruited from 6 European centres were instructed to use the app, including an algorithm for optimal PERT dosing based on in vitro digestion studies for every type of food. At baseline, a 24h self-selected diet was registered in the app, and usual PERT doses were taken by the patient. After 1 month, the same diet was followed, but PERT doses were indicated by the app. Change in faecal fat and coefficient of fat absorption (CFA) were determined. RESULTS 58 patients (median age 8.1 years) participated. Baseline fat absorption was high: median CFA 96.9%, median 2.4g faecal fat). After intervention CFA did not significantly change, but range of PERT doses was reduced: interquartile ranges narrowing from 1447-3070 at baseline to 1783-2495 LU/g fat when using the app. Patients with a low baseline fat absorption (CFA<90%, n=12) experienced significant improvement in CFA after adhering to the recommended PERT dose (from 86.3 to 94.0%, p=0.031). CONCLUSION the use of a novel evidence-based PERT dosing method, based on in vitro fat digestion studies incorporating food characteristics, was effective in increasing CFA in patients with poor baseline fat absorption and could safely be implemented in clinical practice.
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Affiliation(s)
- Joaquim Calvo-Lerma
- Instituto de Investigación Sanitaria La Fe de Valencia. Cystic Fibrosis Unit. 46026 Valencia, Spain; Universitat Politècnica de València, Research Institute of Food Engineering for Development. 46022 Valencia, Spain.
| | - Mieke Boon
- Department of pediatrics, Center for Cystic Fibrosis, University Hospital Leuven. Leuven, Belgium
| | - Carla Colombo
- CF Center, Università degli Studi di Milano. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico. 20122 Milan, Italy
| | - Barbara de Koning
- Department of Pediatrics, div of Gastro-Enterology and div of Respiratory Medicine and Allergology, Erasmus MC- Sophia Children's Hospital, University Hospital Rotterdam. Rotterdam, the Netherlands
| | - Inês Asseiceira
- Centro de Fibrose Quística, Hospital de Santa Maria, Lisboa. Lisbon, Portugal
| | - Maria Garriga
- Hospital Universitario Ramón y Cajal. Cystic Fibrosis Unit. 28034 Madrid, Spain
| | - Maria Roca
- Instituto de Investigación Sanitaria La Fe de Valencia. Cystic Fibrosis Unit. 46026 Valencia, Spain
| | - Ine Claes
- Department of pediatrics, Center for Cystic Fibrosis, University Hospital Leuven. Leuven, Belgium
| | - Anna Bulfamante
- CF Center, Università degli Studi di Milano. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico. 20122 Milan, Italy
| | - Sylvia Walet
- Department of Pediatrics, div of Gastro-Enterology and div of Respiratory Medicine and Allergology, Erasmus MC- Sophia Children's Hospital, University Hospital Rotterdam. Rotterdam, the Netherlands
| | - Luisa Pereira
- Centro de Fibrose Quística, Hospital de Santa Maria, Lisboa. Lisbon, Portugal
| | - Mar Ruperto
- Hospital Universitario Ramón y Cajal. Cystic Fibrosis Unit. 28034 Madrid, Spain
| | - Etna Masip
- Instituto de Investigación Sanitaria La Fe de Valencia. Cystic Fibrosis Unit. 46026 Valencia, Spain
| | - Andrea Asensio-Grau
- Universitat Politècnica de València, Research Institute of Food Engineering for Development. 46022 Valencia, Spain
| | - Arianna Giana
- CF Center, Università degli Studi di Milano. Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico. 20122 Milan, Italy
| | - Philine Affourtit
- Department of Pediatrics, div of Gastro-Enterology and div of Respiratory Medicine and Allergology, Erasmus MC- Sophia Children's Hospital, University Hospital Rotterdam. Rotterdam, the Netherlands
| | - Ana Heredia
- Universitat Politècnica de València, Research Institute of Food Engineering for Development. 46022 Valencia, Spain
| | - Saioa Vicente
- Hospital Universitario Ramón y Cajal. Cystic Fibrosis Unit. 28034 Madrid, Spain
| | - Ana Andrés
- Universitat Politècnica de València, Research Institute of Food Engineering for Development. 46022 Valencia, Spain
| | - Kris de Boeck
- Department of pediatrics, Center for Cystic Fibrosis, University Hospital Leuven. Leuven, Belgium
| | - Jessie Hulst
- Department of Pediatrics, div of Gastro-Enterology and div of Respiratory Medicine and Allergology, Erasmus MC- Sophia Children's Hospital, University Hospital Rotterdam. Rotterdam, the Netherlands; Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Carmen Ribes-Koninckx
- Instituto de Investigación Sanitaria La Fe de Valencia. Cystic Fibrosis Unit. 46026 Valencia, Spain
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9
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Shen Y, Tang X, Liu J, Li H, Zhao S. Pseudo-Bartter syndrome in Chinese children with cystic fibrosis: Clinical features and genotypic findings. Pediatr Pulmonol 2020; 55:3021-3029. [PMID: 32761997 DOI: 10.1002/ppul.25012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To characterize the clinical and genotypic features of cystic fibrosis-associated pseudo-Bartter syndrome (CF-PBS) in Chinese children. METHODS We recruited and characterized the clinical manifestations of 12 Chinese children with CF-PBS. Sweat test, blood and urinary analysis, sputum culture, chest and sinus computed tomography, and abdominal ultrasonography were obtained. Whole-exome sequencing, bioinformatics analysis, and Sanger sequencing validation were performed to define the genotypes. RESULTS CF-PBS was accompanied by recurrent and/or persistent pneumonia (91.7%), pancreatitis (83.3%), vomiting and/or diarrhea (66.7%), failure to thrive and liver disease (58.3% respectively), among our patients. The predominant organisms found in the airways were Pseudomonas aeruginosa (83.3%) and Staphylococcus aureus (75.0%). The mean concentrations of blood gas and electrolytes were pH 7.58, bicarbonate 40.8 mmol/L, sodium 125.9 mmol/L, chloride 77.5 mmol/L, and potassium 2.6 mmol/L. A high recurrence rate (50.0%) of CF-PBS was observed despite continued electrolyte supplementation during follow-up. In all, 19 different variants of CFTR gene were identified, and 10 of these were found to be novel observations (c.262_266delTTATA[p.L88FfsX21], c.579+2insACAT, c.1210-3C>G, c.1733T>C[p.L578P], c.2236_2246delGAGGCGATACTinsAAAAATC[p.E746KfsX8], c.3068T>G [p.I1023R], c.3635delT[p.V1212AfsX16], c.3859delG[p.G1287EfsX2], c.3964-7A>G and ΔE23 [c.3718-?_3873+?del]). The c.2909G>A[p.G970D] was the most common variant, with an allele frequency of 16.6%. A homozygous genotype of c.1521_1523delCTT[p.F508del] was discovered for the first time in patients of Chinese origin. CONCLUSIONS In China, CF-PBS usually presents early and recurs frequently in infancy, accompanied by multiple comorbidities. Recurrence of CF-PBS in school-going patients does occur but is rare. The p.G970D is the most frequent variant, with a significant ethnic tendency of Chinese origin.
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Affiliation(s)
- Yuelin Shen
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaolei Tang
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Jinrong Liu
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Huiming Li
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shunying Zhao
- Department of Respiratory Medicine, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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10
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Managing Cystic Fibrosis in Polish Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207630. [PMID: 33092012 PMCID: PMC7589707 DOI: 10.3390/ijerph17207630] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 12/11/2022]
Abstract
The quality and length of life of patients with cystic fibrosis (CF) are determined by a number of factors including the quality of healthcare received by patients, as well as access to drug programs dedicated to this particular disease. The purpose of this paper is to present an overview of changes in the average life expectancy and mortality rate of the CF population in Poland between 2000 and 2018. Furthermore, we would like to evaluate access to healthcare services, including the drug program, guaranteed by public healthcare system, and funded by National Health Fund (NHF). The average life expectancy of patients with CF increased in the period in question from ca. 14.5 ± 7.6–24.5 ± 8.9 years (mean ± SD, p = 0.0001). We have observed a drop in the number of deaths in paediatric age during that period. Despite the increase in life expectancy, the use of health resources in patients with CF, especially the drug program, is dramatically low. Considering the fact that in Poland there was no active countrywide CF registry, now it is possible to estimate the frequency of use of CF healthcare services in various provinces exclusively on the basis of database maintained by the Polish NHF.
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11
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Muñoz-Pina S, Amorós P, Haskouri JE, Andrés A, Ros-Lis JV. Use of Silica Based Materials as Modulators of the Lipase Catalyzed Hydrolysis of Fats under Simulated Duodenal Conditions. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:nano10101927. [PMID: 32992446 PMCID: PMC7601910 DOI: 10.3390/nano10101927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 05/03/2023]
Abstract
The effect of silica materials and their functionalization in the lipase catalyzed fat hydrolysis has been scarcely studied. Fifteen silica materials were prepared and their effect on the fat hydrolysis was measured, under simulated duodenal conditions, using the pH-stat method. The materials are composed of the combination of three supports (Stöber massive silica nanoparticles, Stöber mesoporous nanoparticles and UVM-7) and four surface functionalizations (methyl, trimethyl, propyl and octyl). In addition, the non-functionalized materials were tested. The functional groups were selected to offer a hydrophobic character to the material improving the interaction with the fat globules and the lipase. The materials are able to modulate the lipase activity and their effect depending on the support topology and the organic covering, being able to increase or reduce the fat hydrolysis. Depending of the material, relative fat hydrolysis rates of 75 to 140% in comparison with absence of the material were obtained. The results were analyzed by Partial Least Square Regression and suggest that the alkyl modified mesopores are able to improve the fat hydrolysis, by contrast the non-porous nanoparticles and the textural pores tend to induce inhibition. The effects are more pronounced for materials containing long alkyl chains and/or in absence of taurodeoxycholate.
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Affiliation(s)
- Sara Muñoz-Pina
- Inorganic Chemistry Department, REDOLí Group, Universitat de València, Burjassot, 46100 Valencia, Spain;
| | - Pedro Amorós
- Instituto de Ciencia de Materiales, Universitat de València, C/Catedrático José Beltrán 2, 46980 Paterna Valencia, Spain; (P.A.); (J.E.H.)
| | - Jamal El Haskouri
- Instituto de Ciencia de Materiales, Universitat de València, C/Catedrático José Beltrán 2, 46980 Paterna Valencia, Spain; (P.A.); (J.E.H.)
| | - Ana Andrés
- Instituto Universitario de Ingeniería de Alimentos para el Desarrollo (IUIAD-UPV), Universitat Politècnica de València Camino de Vera s/n, 46022 Valencia, Spain;
| | - José V. Ros-Lis
- Inorganic Chemistry Department, REDOLí Group, Universitat de València, Burjassot, 46100 Valencia, Spain;
- Correspondence:
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12
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El Bar Aluma B, Sarouk I, Senderowitz H, Cohen-Cymberknoh M, Khazanov N, Dagan A, Bezalel Y, Ashkenazi M, Keler S, Efrati O. Phenotypic and molecular characteristics of CF patients carrying the I1234V mutation. Respir Med 2020; 170:106027. [DOI: 10.1016/j.rmed.2020.106027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/29/2020] [Accepted: 05/16/2020] [Indexed: 11/29/2022]
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13
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Martinez-Millana A, Zettl A, Floch J, Calvo-Lerma J, Sevillano JL, Ribes-Koninckx C, Traver V. The Potential of Self-Management mHealth for Pediatric Cystic Fibrosis: Mixed-Methods Study for Health Care and App Assessment. JMIR Mhealth Uhealth 2019; 7:e13362. [PMID: 30998222 PMCID: PMC6495294 DOI: 10.2196/13362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/05/2019] [Accepted: 03/29/2019] [Indexed: 12/23/2022] Open
Abstract
Background Remote care services and patient empowerment have boosted mobile health (mHealth). A study of user needs related to mHealth for pediatric cystic fibrosis (PCF) identified the set of preferred features mobile apps should support; however, the potential use of PCF apps and their suitability to fit into PCF clinical management remains unexplored. Objective We examine whether PCF holds potential for the implementation of mHealth care. Methods The study is based on a literature review and qualitative analysis of content and was conducted in two parts: (1) we reviewed scientific and gray literature to explore how European countries manage PCF and conducted a qualitative study of 6 PCF units and (2) we performed a systematic review of apps available in the myhealthapps.net repository searching for cystic fibrosis (CF) management and nutrition apps, which we analyzed for characteristics, business models, number of downloads, and usability. Results European CF routine care guidelines are acknowledged in most European countries, and treatments are fully covered in almost all countries. The majority of teams in CF units are interdisciplinary. With respect to the systematic review of apps, we reviewed 12 apps for CF management and 9 for general nutrition management in the myhealthapps.net directory. All analyzed apps provided functionalities for recording aspects related to the disease and nutrition such as medication, meals, measurements, reminders, and educational material. None of the apps reviewed in this study supported pancreatic enzyme replacement therapy. CF apps proved to be less appealing and usable than nutrition apps (2.66 [SD 1.15] vs 4.01 [SD 0.90]; P<.001, z-value: –2.6). User needs detected in previous research are partially matched by current apps for CF management. Conclusions The health care context for PCF is a unique opportunity for the adoption of mHealth. Well-established clinical guidelines, heterogeneous clinical teams, and coverage by national health care systems provide a suitable scenario for the use of mHealth solutions. However, available apps for CF self-management do not cover essential aspects such as nutrition and education. To increase the adoption of mHealth for CF self-management, new apps should include these features. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2016-014931
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Affiliation(s)
- Antonio Martinez-Millana
- Instituto ITACA, Universitat Politècnica de València, Valencia, Spain.,Unidad Mixta de Reingeniería de Procesos Sociosanitarios, Instituto de Investigación Sanitaria del Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | | | | | | | - Jose Luis Sevillano
- Department of Architecture and Technology of Computers, University of Seville, Seville, Spain
| | | | - Vicente Traver
- Instituto ITACA, Universitat Politècnica de València, Valencia, Spain.,Unidad Mixta de Reingeniería de Procesos Sociosanitarios, Instituto de Investigación Sanitaria del Hospital Universitario y Politecnico La Fe, Valencia, Spain
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14
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Li H, Lin L, Hu X, Li C, Zhang H. Liver Failure in a Chinese Cystic Fibrosis Child With Homozygous R553X Mutation. Front Pediatr 2019; 7:36. [PMID: 30842938 PMCID: PMC6391319 DOI: 10.3389/fped.2019.00036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/28/2019] [Indexed: 12/25/2022] Open
Abstract
Cystic fibrosis (CF) is a relatively rare disease in Asians with various clinical characteristics, including CF-associated liver disease (CFLD), which is a common early non-pulmonary complication. This case report describes a Chinese CF patient harboring a homozygous nonsense mutation (c.1657C>T, p.R553X) who was failure to thrive and had intermittently diarrhea during the first year after birth. Liver function test of the patient showed the mildly and intermittently elevated alanine aminotransferase (ALT) levels ranging from 70 to 92 U/L and aspartate aminotransferase (AST) levels ranging from 80 to 90 U/L, which began at 8 months of age and lasted for 4 years without CF diagnosis. In addition, abdominal computed tomography (CT) revealed diffuse fatty infiltration of the liver at 4 years old and gradually developed hepatic cirrhosis. Subsequently, cirrhosis rapidly progressed with obvious splenomegaly and pancreatic insufficiency and the patient died of liver failure with coagulopathy by the age of 6 years old. Pediatricians should remain vigilant to avoid failure to diagnose CF, the occurrence of which may be underestimated, and pay greater attention to the patients with atypical clinical manifestations in Asian countries.
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Affiliation(s)
- Haiyan Li
- Department of Pediatric Pulmonology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li Lin
- Department of Pediatric Pulmonology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoguang Hu
- Department of Pediatric Pulmonology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Changchong Li
- Department of Pediatric Pulmonology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hailin Zhang
- Department of Pediatric Pulmonology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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15
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McCarthy C, Lara Gallego B, Trapnell BC, McCormack FX. Epidemiology of Rare Lung Diseases: The Challenges and Opportunities to Improve Research and Knowledge. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1031:419-442. [PMID: 29214586 DOI: 10.1007/978-3-319-67144-4_24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rare lung diseases encompass a broad spectrum of conditions and affect an estimated 1.2-2.5 million people in North America and 1.5-3 million people in Europe. While individual rare lung diseases affect less than 1 in 2000 individuals, collectively they have a significant impact upon the population at large. Hence it is vital to understand firstly the epidemiology and subsequently the pathogenesis and clinical course of these disorders. Through a greater understanding of these aspects of disease, progress can be made in reducing symptoms, containing healthcare costs and utilizing resources efficiently. Furthermore, a greater understanding of the pathobiology of rare lung diseases can inform both the pathogenesis and management of more common pulmonary disorders.In this chapter we review how epidemiological approaches and the utilization of patient registries has improved the knowledge and management of rare lung diseases. We further focus on the epidemiology of several of the more widely known rare pulmonary disorders, including idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF) and alpha-1 antitrypsin deficiency (AATD). To conclude we describe how patient advocacy groups and foundations have driven advances in research and management of ultra-rare lung diseases, namely, the major strides made in the management and understanding of lymphangioleiomyomatosis (LAM) and pulmonary alveolar proteinosis (PAP).We conclude that the models used to study some of the rarest of diseases may be successfully adopted by other rare and common disease communities, leading to improved care and the possibility of novel therapeutic options.
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Affiliation(s)
- Cormac McCarthy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, 45267-0564, USA. .,Translational Pulmonary Science Center Cincinnati Children's Hospital, 3333 Burnet Avenue, CCRF S4621, 45229-3039, Cincinnati, OH, USA. .,Rare Lung Diseases Clinical (RLDC), Cincinnati, OH, USA.
| | - Beatriz Lara Gallego
- Respiratory Medicine Department, Coventry University Hospital, Third Floor, East wing. Clifford Bridge Road, Coventry, CV2 2DX, Warwickshire, UK
| | - Bruce C Trapnell
- Translational Pulmonary Science Center Cincinnati Children's Hospital, 3333 Burnet Avenue, CCRF S4621, 45229-3039, Cincinnati, OH, USA.,Rare Lung Diseases Clinical (RLDC), Cincinnati, OH, USA.,Medicine and Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, CCRF R4029, 45229-3039, Cincinnati, OH, USA
| | - Francis X McCormack
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, 45267-0564, USA
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16
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Walicka-Serzysko K, Peckova M, Noordhoek JJ, Sands D, Drevinek P. Insights into the cystic fibrosis care in Eastern Europe: Results of survey. J Cyst Fibros 2018; 17:475-477. [PMID: 29681443 DOI: 10.1016/j.jcf.2018.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND The European cystic fibrosis (CF) Society Standards of Care were set to facilitate the delivery of high-quality care throughout Europe. However, their implementation may be difficult for less economically advantaged countries. This survey was performed to explore the gap in the knowledge of the level of CF care in Eastern Europe. METHODS Questionnaires were sent online to one CF professional and one CF patient representative for every Eastern European country. RESULTS Although most respondents indicated the presence of CF centres, disparities in their framework among individual countries and between them and the European CF Standards of Care became apparent. A minority of countries achieved CF centre recognition by the government (6 of 16), provided CF care for adults (6 countries) and had a multidisciplinary team with all team members represented (2 countries). Patients were significantly more critical in the evaluation of various aspects of CF care than physicians, especially in the Balkan region. CONCLUSIONS The survey results indicate that the organization and level of CF care across Eastern Europe is largely variable and lacks some of its fundamental attributes in several countries.
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Affiliation(s)
| | - Monika Peckova
- Institute of Applied Mathematics and Information Technologies, Faculty of Science, Charles University, Prague, Czech Republic
| | | | - Dorota Sands
- Institute of Mother and Child, Warsaw, Poland; Cystic Fibrosis Centre, Dziekanów Leśny, Poland
| | - Pavel Drevinek
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
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17
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Abstract
Cystic fibrosis (CF) is the most frequent lethal genetic disorder among Caucasians, but is considered to be a very rare disease in Chinese population. Here, we present an 11-year-old Chinese CF patient with disseminated bronchiectasis and salty sweat, for whom exon sequencing followed by multiplex ligation-dependent probe amplification analysis of the CFTR gene was applied for mutation screening. A homozygous deletion involving exon 20 of CFTR was observed in the patient's genome. Molecular characterization of the breakpoints indicated that both alleles of this locus had an identical novel complex rearrangement (c.3140-454_c.3367+249del931ins13, p.R1048_G1123del), leading to an in-frame removal of 76 amino acid residues in the second transmembrane domains of the CFTR protein. Although a same haplotype containing this complex rearrangement was observed on both of the maternal and paternal alleles, the parents denied any blood relationship as far as they know. Genome-wide homozygosity mapping was performed through SNP microarray and only a single homozygous interval of ~14.1 Mb at chromosome 7 containing the CFTR gene was observed, indicating the possible origin of the deletion from a common ancestor many generations ago. This study expands the mutation spectrum of CFTR in patients of Chinese origin and further emphasizes the necessity of MLPA analysis in mutation screening for CF patients.
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18
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Calvo-Lerma J, Martinez-Jimenez CP, Lázaro-Ramos JP, Andrés A, Crespo-Escobar P, Stav E, Schauber C, Pannese L, Hulst JM, Suárez L, Colombo C, Barreto C, de Boeck K, Ribes-Koninckx C. Innovative approach for self-management and social welfare of children with cystic fibrosis in Europe: development, validation and implementation of an mHealth tool (MyCyFAPP). BMJ Open 2017; 7:e014931. [PMID: 28302638 PMCID: PMC5372031 DOI: 10.1136/bmjopen-2016-014931] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION For the optimal management of children with cystic fibrosis, there are currently no efficient tools for the precise adjustment of pancreatic enzyme replacement therapy, either for advice on appropriate dietary intake or for achieving an optimal nutrition status. Therefore, we aim to develop a mobile application that ensures a successful nutritional therapy in children with cystic fibrosis. METHODS AND ANALYSIS A multidisciplinary team of 12 partners coordinate their efforts in 9 work packages that cover the entire so-called 'from laboratory to market' approach by means of an original and innovative co-design process. A cohort of 200 patients with cystic fibrosis aged 1-17 years are enrolled. We will develop an innovative, clinically tested mobile health application for patients and health professionals involved in cystic fibrosis management. The mobile application integrates the research knowledge and innovative tools for maximising self-management with the aim of leading to a better nutritional status, quality of life and disease prognosis. Bringing together different and complementary areas of knowledge is fundamental for tackling complex challenges in disease treatment, such as optimal nutrition and pancreatic enzyme replacement therapy in cystic fibrosis. Patients are expected to benefit the most from the outcomes of this innovative project. ETHICS AND DISSEMINATION The project is approved by the Ethics Committee of the coordinating organisation, Hospital Universitari La Fe (Ref: 2014/0484). Scientific findings will be disseminated via journals and conferences addressed to clinicians, food scientists, information and communications technology experts and patients. The specific dissemination working group within the project will address the wide audience communication through the website (http://www.mycyfapp.eu), the social networks and the newsletter.
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Affiliation(s)
- Joaquim Calvo-Lerma
- Instituto de Investigación Sanitaria La Fe. Avenida Fernando Abril Martorell, Valencia, Spain
- Instituto de Ingeniería de Alimentos para el Desarrollo, Universitat Politècnica de València, Valencia, Spain
| | - Celia P Martinez-Jimenez
- University of Cambridge, Cancer Research UK Cambridge Institute, Cambridge, UK
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
| | | | - Ana Andrés
- Instituto de Ingeniería de Alimentos para el Desarrollo, Universitat Politècnica de València, Valencia, Spain
| | - Paula Crespo-Escobar
- Instituto de Investigación Sanitaria La Fe. Avenida Fernando Abril Martorell, Valencia, Spain
| | | | | | | | - Jessie M Hulst
- Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lucrecia Suárez
- Servicio Madrileño de Salud—Hospital Universitario Ramón y Cajal, Colmenar Viejo, Spain
| | - Carla Colombo
- Università degli Studi di Milano. Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Celeste Barreto
- Associação Portuguesa para a Investigação e Desenvolvimento da Faculdade de Medicina, Lisbon, Portugal
| | - Kris de Boeck
- Department of Paediatrics, University Hospital of Leuven, University of Leuven, Leuven, Belgium
| | - Carmen Ribes-Koninckx
- Instituto de Investigación Sanitaria La Fe. Avenida Fernando Abril Martorell, Valencia, Spain
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Shani-Levi C, Alvito P, Andrés A, Assunção R, Barberá R, Blanquet-Diot S, Bourlieu C, Brodkorb A, Cilla A, Deglaire A, Denis S, Dupont D, Heredia A, Karakaya S, Giosafatto CVL, Mariniello L, Martins C, Ménard O, El SN, Vegarud GE, Ulleberg E, Lesmes U. Extending in vitro digestion models to specific human populations: Perspectives, practical tools and bio-relevant information. Trends Food Sci Technol 2017. [DOI: 10.1016/j.tifs.2016.10.017] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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3 Jahre Mukoviszidose-Screening für Neugeborene in Mecklenburg-Vorpommern. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Borawska-Kowalczyk U, Bodnar R, Meszaros A, Sands D. Comparison of health-related quality of life among children with cystic fibrosis and their parents in two Eastern European countries. J Cyst Fibros 2015; 14:798-804. [DOI: 10.1016/j.jcf.2015.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
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22
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Singh M, Rebordosa C, Bernholz J, Sharma N. Epidemiology and genetics of cystic fibrosis in Asia: In preparation for the next-generation treatments. Respirology 2015; 20:1172-81. [PMID: 26437683 DOI: 10.1111/resp.12656] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 06/18/2015] [Accepted: 07/27/2015] [Indexed: 12/11/2022]
Abstract
Cystic fibrosis (CF) in the Asian population is less frequently reported due to under-diagnosis and lack of centralized CF patient registries. Clinical studies on CF cases from Asia have documented a severe course of the disease. The spectrum of the cystic fibrosis transmembrane conductance regulator (CFTR) variants in this population is quite heterogeneous. In total, 166 variants have been reported on approximately 3700 Asian CF chromosomes. The frequency of F508del among Asians is low compared with Caucasians. Recent in vitro studies have shown promise of small molecule correction and potentiation of 45 different CFTR variants. Of these variants, 16 (including G551D and F508del) have also been observed among Asian CF individuals. We suggest undertaking molecular studies extensively to annotate CFTR variants that will help Asian CF individuals to benefit from the precision medicine gaining momentum in the Western countries.
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Affiliation(s)
- Meenu Singh
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Cristina Rebordosa
- Department of Epidemiology, Division of Drug Safety and Epidemiology, Novartis Farmaceutica S.A., Barcelona, Spain
| | - Juliane Bernholz
- Department of Development, Division of Pharma, Novartis Pharma AG, Basel, Switzerland
| | - Neeraj Sharma
- McKusick-Nathans Institute of Genetic Medicine and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Abstract
Cystic fibrosis is an autosomal recessive, monogenetic disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The gene defect was first described 25 years ago and much progress has been made since then in our understanding of how CFTR mutations cause disease and how this can be addressed therapeutically. CFTR is a transmembrane protein that transports ions across the surface of epithelial cells. CFTR dysfunction affects many organs; however, lung disease is responsible for the vast majority of morbidity and mortality in patients with cystic fibrosis. Prenatal diagnostics, newborn screening and new treatment algorithms are changing the incidence and the prevalence of the disease. Until recently, the standard of care in cystic fibrosis treatment focused on preventing and treating complications of the disease; now, novel treatment strategies directly targeting the ion channel abnormality are becoming available and it will be important to evaluate how these treatments affect disease progression and the quality of life of patients. In this Primer, we summarize the current knowledge, and provide an outlook on how cystic fibrosis clinical care and research will be affected by new knowledge and therapeutic options in the near future. For an illustrated summary of this Primer, visit: http://go.nature.com/4VrefN.
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Translating rare-disease therapies into improved care for patients and families: what are the right outcomes, designs, and engagement approaches in health-systems research? Genet Med 2015; 18:117-23. [DOI: 10.1038/gim.2015.42] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 02/23/2015] [Indexed: 01/04/2023] Open
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Alicandro G, Frova L, Di Fraia G, Colombo C. Cystic fibrosis mortality trend in Italy from 1970 to 2011. J Cyst Fibros 2015; 14:267-74. [DOI: 10.1016/j.jcf.2014.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 11/29/2022]
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Comparative ex vivo, in vitro and in silico analyses of a CFTR splicing mutation: Importance of functional studies to establish disease liability of mutations. J Cyst Fibros 2015; 15:21-33. [PMID: 25735457 DOI: 10.1016/j.jcf.2015.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/09/2015] [Accepted: 02/04/2015] [Indexed: 11/23/2022]
Abstract
The Cystic Fibrosis p.Ile1234Val missense mutation actually creates a new dual splicing site possibly used either as a new acceptor or donor. Here, we aimed to test the accuracy of in silico predictions by comparing them with in vitro and ex vivo functional analyses of this mutation for an accurate CF diagnosis/prognosis. To this end, we applied a new in vitro strategy using a CFTR mini-gene which includes the complete CFTR coding sequence plus intron 22 (short version) which allows the assessment of alternatively spliced mRNA levels as well as the properties of the resulting abnormal CFTR protein regarding processing, intracellular localization and function. Our data demonstrate that p.Ile1234Val leads to usage of the alternative splicing donor (but not acceptor) resulting in alternative CFTR transcripts lacking 18 nts of exon 22 which produce a truncated CFTR protein with residual Cl- channel function. These results recapitulate data from native tissues of a CF patient. In conclusion, the existing in silico prediction models have limited application and ex vivo functional assessment of mutation effects should be made. Alternatively the in vitro strategy adopted here can be applied to assess the disease liability of mutations for an accurate CF diagnosis/prognosis.
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Justicia JL, Solé A, Quintana-Gallego E, Gartner S, de Gracia J, Prados C, Máiz L. Management of pulmonary exacerbations in cystic fibrosis: still an unmet medical need in clinical practice. Expert Rev Respir Med 2015; 9:183-94. [PMID: 25692532 DOI: 10.1586/17476348.2015.1016504] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pulmonary exacerbation (PEx) is a hallmark of cystic fibrosis. Although several criteria have been proposed for the definition of PEx, no consensus has yet been reached. Very often, many PEx cases go unreported. A standardized and validated definition is needed to reduce variability in clinical practice. The pathophysiology of recurrent episodes remains unclear, and both onset and risk are multifactorial. PEx leads to increased healthcare costs, impaired quality of life and a cycle in which PEx causes loss of lung function, which predisposes to further episodes. The number of episodes affects survival. Although early diagnosis and aggressive treatment are highly recommended, measures to prevent the emergence of new PEx are even more important. In particular, inhaled antibiotics administered under new treatment schedules could play a key role in preventing exacerbations and thus delay decline in lung function and reduce mortality. The primary objective is zero exacerbations.
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Conway S, Balfour-Lynn IM, De Rijcke K, Drevinek P, Foweraker J, Havermans T, Heijerman H, Lannefors L, Lindblad A, Macek M, Madge S, Moran M, Morrison L, Morton A, Noordhoek J, Sands D, Vertommen A, Peckham D. European Cystic Fibrosis Society Standards of Care: Framework for the Cystic Fibrosis Centre. J Cyst Fibros 2015; 13 Suppl 1:S3-22. [PMID: 24856776 PMCID: PMC7105239 DOI: 10.1016/j.jcf.2014.03.009] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A significant increase in life expectancy in successive birth cohorts of people with cystic fibrosis (CF) is a result of more effective treatment for the disease. It is also now widely recognized that outcomes for patients cared for in specialist CF Centres are better than for those who are not. Key to the effectiveness of the specialist CF Centre is the multidisciplinary team (MDT), which should include consultants, clinical nurse specialist, microbiologist, physiotherapist, dietitian, pharmacist, clinical psychologist, social worker, clinical geneticist and allied healthcare professionals, all of whom should be experienced in CF care. Members of the MDT are also expected to keep up to date with developments in CF through continued professional development, attendance at conferences, auditing and involvement in research. Specialists CF Centres should also network with other Centres both nationally and internationally, and feed Centre data to registries in order to further the understanding of the disease. This paper provides a framework for the specialist CF Centre, including the organisation of the Centre and the individual roles of MDT members, as well as highlighting the value of CF organisations and disease registries.
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Affiliation(s)
- Steven Conway
- Paediatric and Adult CF Units, Leeds Teaching Hospitals Trust, UK.
| | | | | | - Pavel Drevinek
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic; University Hospital Motol, Prague, Czech Republic
| | - Juliet Foweraker
- Department of Microbiology, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | | | - Harry Heijerman
- HagaZiekenhuis, Department of Pulmonology & Cystic Fibrosis, The Hague, The Netherlands
| | - Louise Lannefors
- Copenhagen CF Centre, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Anders Lindblad
- Gothenburg CF Centre, Queen Silvia Children's Hospital, Göteborg, Sweden
| | - Milan Macek
- Department of Biology and Medical Genetics, University Hospital Motol, Prague, Czech Republic; Second School of Medicine, Charles University Prague, Prague, Czech Republic
| | - Sue Madge
- Department of Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London, UK
| | - Maeve Moran
- National Referral Centre for Adult Cystic Fibrosis, Pharmacy Department, St. Vincent's University Hospital, Ireland
| | - Lisa Morrison
- Gartnavel General Hospital, West of Scotland Adult CF Unit, Glasgow, UK
| | - Alison Morton
- Adult Cystic Fibrosis Unit, St James's Hospital, Leeds, UK
| | | | - Dorota Sands
- Department of Pediatrics, Institute of Mother and Child, Warsaw, Poland
| | | | - Daniel Peckham
- Adult Cystic Fibrosis Unit, St James's Hospital, Leeds, UK
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Pulmonary Nocardiosis in an Immunocompetent Patient with Cystic Fibrosis. Case Rep Pulmonol 2015; 2015:984171. [PMID: 25960909 PMCID: PMC4414227 DOI: 10.1155/2015/984171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/26/2015] [Accepted: 04/02/2015] [Indexed: 11/18/2022] Open
Abstract
Nocardiaspp. are bacteria of low virulence that cause infection classically in immunocompromised hosts with the lungs as the primary site of infection in the majority of cases. Patients with cystic fibrosis have pulmonary disease characterized by frequent and progressive bacterial infections. Reports ofNocardiaspp. isolation in CF are rare in the literature and may represent colonization or active infection, the significance and optimal treatment of which are unknown. We report the second case to date ofNocardia transvalensispulmonary infection in an immunocompetent patient with CF and the first in a child under the age of eighteen.
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Bell SC, De Boeck K, Amaral MD. New pharmacological approaches for cystic fibrosis: Promises, progress, pitfalls. Pharmacol Ther 2015; 145:19-34. [DOI: 10.1016/j.pharmthera.2014.06.005] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 12/17/2022]
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ESCF Care Guidelines beyond Europe. J Cyst Fibros 2014; 13:359-60. [DOI: 10.1016/j.jcf.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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CFTR mutations spectrum and the efficiency of molecular diagnostics in Polish cystic fibrosis patients. PLoS One 2014; 9:e89094. [PMID: 24586523 PMCID: PMC3935850 DOI: 10.1371/journal.pone.0089094] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 01/15/2014] [Indexed: 01/20/2023] Open
Abstract
Cystic fibrosis (CF) is caused by mutations in the cystic fibrosis transmembrane regulator gene (CFTR). In light of the strong allelic heterogeneity and regional specificity of the mutation spectrum, the strategy of molecular diagnostics and counseling in CF requires genetic tests to reflect the frequency profile characteristic for a given population. The goal of the study was to provide an updated comprehensive estimation of the distribution of CFTR mutations in Polish CF patients and to assess the effectiveness of INNOLiPA_CFTR tests in Polish population. The analyzed cohort consisted of 738 patients with the clinically confirmed CF diagnosis, prescreened for molecular defects using INNOLiPA_CFTR panels from Innogenetics. A combined efficiency of INNOLiPA CFTR_19 and CFTR_17_TnUpdate tests was 75.5%; both mutations were detected in 68.2%, and one mutation in 14.8% of the affected individuals. The group composed of all the patients with only one or with no mutation detected (109 and 126 individuals, respectively) was analyzed further using a mutation screening approach, i.e. SSCP/HD (single strand conformational polymorphism/heteroduplex) analysis of PCR products followed by sequencing of the coding sequence. As a result, 53 more mutations were found in 97 patients. The overall efficiency of the CF allele detection was 82.5% (7.0% increase compared to INNOLiPA tests alone). The distribution of the most frequent mutations in Poland was assessed. Most of the mutations repetitively found in Polish patients had been previously described in other European populations. The most frequent mutated allele, F508del, represented 54.5% of Polish CF chromosomes. Another eight mutations had frequencies over 1%, 24 had frequencies between 1 and 0.1%; c.2052-2053insA and c.3468+2_3468+3insT were the most frequent non-INNOLiPA mutations. Mutation distribution described herein is also relevant to the Polish diaspora. Our study also demonstrates that the reported efficiency of mutation detection strongly depends on the diagnostic experience of referring health centers.
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King SJ, Nyulasi IB, Bailey M, Kotsimbos T, Wilson JW. Loss of fat-free mass over four years in adult cystic fibrosis is associated with high serum interleukin-6 levels but not tumour necrosis factor-alpha. Clin Nutr 2013; 33:150-5. [PMID: 23664115 DOI: 10.1016/j.clnu.2013.04.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 03/21/2013] [Accepted: 04/09/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Malnutrition is associated with poorer outcome in cystic fibrosis (CF). This follow-up study aimed to document nutritional status changes, including fat-free mass (FFM), in adults with CF; and to identify predictors of FFM loss. METHODS Fifty-eight non-transplanted CF adults (mean ± SD forced expiratory volume in one second (FEV1) 63.7 ± 21.4%predicted; mean ± SD age 30.3 ± 7.7years at baseline) were studied at baseline and 3.6 ± 0.4 years later. Body composition was measured using dual-energy X-ray absorptiometry. At follow-up, blood was analysed for interleukin-6 and tumour necrosis factor-α (TNF-α) on three occasions over six months and averaged for each participant. Associations with annual percentage change in FFM (ann%ΔFFM), including cytokines, CF genotype and annual change in FEV1%predicted (annΔFEV1%), were determined. RESULTS Mean FFM was 49.5 ± 8.8 kg at baseline and 49.6 ± 8.9 kg at follow-up (p = 0.66). Ann%ΔFFM ranged from -2.0 to +3.6%. FEV1%predicted declined by 1.2 ± 2.4% per year. Forty percent of participants had elevated average interleukin-6 levels. Ann%ΔFFM was negatively correlated with interleukin-6 levels (rho -0.34, p = 0.008), but not TNF-α or annΔFEV1%. F508DEL homozygote or heterozygote participants had greater FFM loss than those carrying no F508DEL allele (p = 0.01). CONCLUSION Higher serum interleukin-6 and presence of the F508DEL mutation, but not TNF-α, were associated with FFM loss in adults with CF.
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Affiliation(s)
- Susannah J King
- Nutrition Department, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Dietetics and Human Nutrition, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Ibolya B Nyulasi
- Nutrition Department, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Michael Bailey
- Department of Epidemiology and Preventive Medicine, Monash University, Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Tom Kotsimbos
- Department of Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
| | - John W Wilson
- Department of Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia; Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
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Sheppard DN. EuroCareCF: working together to improve patient care and therapy development. J Cyst Fibros 2011; 10 Suppl 2:S1-4. [PMID: 21658628 DOI: 10.1016/s1569-1993(11)00089-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guiding principles on how to manage relevant psychological aspects within a CF team: Interdisciplinary approaches. J Cyst Fibros 2011; 10 Suppl 2:S45-52. [DOI: 10.1016/s1569-1993(11)60008-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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