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Aoust L, Berteloot L, Drabent P, Garcelon N, Bodemer C, Molina TJ, Bader-Meunier B, Hadchouel A. Unclassifiable interstitial lung disease and autoimmunity: Towards IPAF in children? Pediatr Pulmonol 2023; 58:3303-3313. [PMID: 37701997 DOI: 10.1002/ppul.26660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/14/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Interstitial pneumonia with autoimmune features (IPAF) has been defined for adults with interstitial lung disease (ILD) and autoimmunity who do not meet the criteria for a specific connective tissue disease (CTD). We aimed to determine whether IPAF criteria could apply to children. METHODS We retrospectively studied patients with ILD and autoimmunity followed at Necker Hospital between 2008 and 2019. Children were classified according to specific CTD and IPAF criteria. The epidemiology and course of the disease were studied according to the final diagnosis. RESULTS Among 27 patients, 6 fulfilled the criteria for IPAF and represented 4.5% of all patients with ILD during the study period. Other diagnoses included juvenile dermatomyositis (30%), overlap syndromes (19%), systemic lupus erythematosus (15%), systemic sclerosis (7%), mixed CTD (4%), and rheumatoid arthritis (4%). IPAF patients were more frequently boys versus CTD-ILD patients (67% vs. 14%, p = .02). Two patients had severe respiratory distress that led to death for one of them. The course was favorable for the others, with a good response to steroids. The course tended to be more favorable for IPAF patients than for those with CTD-ILD (0% lung fibrosis in the IPAF group vs. 43% in the CTD-ILD group, p = .07). CONCLUSION We confirmed the existence of IPAF in children. Its prevalence was lower than in adults but comparable to that found for other pediatric series. Boys were more highly represented than in CTD-ILD. The course was favorable for most cases. Larger and more prospective studies are needed to confirm these results.
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Affiliation(s)
- Laura Aoust
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Centre de Référence pour les Maladies Respiratoires Rares de l'Enfant, Paris, France
| | - Laureline Berteloot
- Institut Imagine, INSERM UMRS 1163, Paris, France
- AP-HP, Service d'Imagerie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Philippe Drabent
- AP-HP, Hôpitaux Universitaires Necker-Enfants Malades et Robert Debré, Service d'Anatomie Pathologique, Paris, France
| | - Nicolas Garcelon
- Imagine Institute, Data Science Platform, INSERM UMR 1163, Université de Paris, Paris, France
| | - Christine Bodemer
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service de Dermatologie Pédiatrique, Paris, France
- Université Paris Cité, Paris, France
| | - Thierry Jo Molina
- Institut Imagine, INSERM UMRS 1163, Paris, France
- AP-HP, Hôpitaux Universitaires Necker-Enfants Malades et Robert Debré, Service d'Anatomie Pathologique, Paris, France
- Université Paris Cité, Paris, France
| | - Brigitte Bader-Meunier
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service d'Immunologie et Rhumatologie Pédiatriques, Paris, France
- Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), Paris Cité University, Paris, France
- Laboratory of Immunogenetics of Paediatric Autoimmunity, Imagine Institute, INSERM U1163, Paris Cité University, Paris, France
| | - Alice Hadchouel
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Centre de Référence pour les Maladies Respiratoires Rares de l'Enfant, Paris, France
- Université Paris Cité, Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
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He H, He X, Zhou M, Tang Y, Dai L, Xie Z, Wang Y, Xie C. Role of sPD-1 and sPD-Ls in the pathogenesis of connective tissue disease. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:444-454. [PMID: 37164928 PMCID: PMC10930081 DOI: 10.11817/j.issn.1672-7347.2023.220263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Indexed: 05/12/2023]
Abstract
Membrane-bound programmed cell death-1 (mPD-1) and membrane-bound programmed cell death-ligands (mPD-Ls) have soluble forms, which are soluble programmed cell death-1 (sPD-1) and soluble programmed cell death-ligands (sPD-Ls) [including soluble programmed cell death-ligand 1 (sPD-L1) and soluble programmed cell death-ligand 2 (sPD-L2)]. sPD-1 and sPD-L2 are mainly produced by alternative splicing isoforms of PD-1 mRNA, while sPD-L1 is produced by matrix metalloproteinases (MMPs) cutting membrane-bound programmed cell death-ligand 1 (mPD-L1). sPD-1 and sPD-Ls play an important role in autoimmune regulation via blocking the mPD-1 /mPD-L1 pathway, while connective tissue disease (CTD) is a kind of disease caused by autoimmune reaction, and abnormal function of mPD-1/mPD-L1 can occur in the occurrence and development of many autoimmune diseases. Therefore, sPD-1 and sPD-Ls play an important role in the pathogenesis of CTD caused by autoimmune reaction via blocking the mPD-1 /mPD-L1 pathway. It is of great practical significance to understand clinical value of sPD-1 and sPD-Ls in various CTDs for improving the quality of life of patients and the underlying mechanism.
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Affiliation(s)
- Haohua He
- Department of Rheumatology and Immunology, First Affiliated Hospital of Bengbu Medical College, Bengbu Anbui 233099.
| | - Xiaoyu He
- Department of Rheumatology and Immunology, First Affiliated Hospital of Bengbu Medical College, Bengbu Anbui 233099
| | - Mingjun Zhou
- Department of Clinical Medicine, Bengbu Medical College, Bengbu Anbui 233030
| | - Yingkai Tang
- Department of Human Anatomy, Bengbu Medical College, Bengbu Anbui 233030
| | - Li Dai
- Department of Rheumatology and Immunology, First Affiliated Hospital of Bengbu Medical College, Bengbu Anbui 233099
| | - Zhuobei Xie
- Department of Rheumatology and Immunology, First Affiliated Hospital of Bengbu Medical College, Bengbu Anbui 233099
| | - Yuanyuan Wang
- Department of Histology and Embryology, Bengbu Medical College, Bengbu Anbui 233030.
- Micromorphology Experiment Center, Bengbu Medical College, Bengbu Anbui 233030.
| | - Changhao Xie
- Department of Rheumatology and Immunology, First Affiliated Hospital of Bengbu Medical College, Bengbu Anbui 233099.
- Anhui Province Key Laboratory of Immunology in Chronic Diseases, Bengbu Medical College, Bengbu Anbui 233030, China.
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Interstitial Pneumonia with Autoimmune Features: Implications for Clinical Practice. CURRENT PULMONOLOGY REPORTS 2022. [DOI: 10.1007/s13665-022-00296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Assassi S, Shao N, Yin Z, Volkmann ER, Zoz DF, Leonard TB. Understanding diagnostic pathways in systemic sclerosis and systemic sclerosis-associated interstitial lung disease: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29993. [PMID: 35960051 PMCID: PMC9371507 DOI: 10.1097/md.0000000000029993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 01/04/2023] Open
Abstract
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is usually detected in a patient known to have SSc but may be diagnosed prior to SSc. We probed an insurance database to investigate documentation of ILD prior to SSc. Using Optum's Clinformatics® Data Mart Database, we identified patients with an SSc index date between January 1, 2010, and September 30, 2015, based on International Classification of Diseases (ICD)-9-Clinical Modification (CM) codes, ≥2 medical claims associated with SSc on different dates within 1 year, and ≥3 years of continuous enrollment prior to SSc index date (ICD-9-CM cohort). We identified an ICD-10-CM cohort comprising patients with an SSc index date between October 1, 2017, and June 30, 2019, based on ICD-10-CM codes, ≥2 medical claims associated with SSc on different dates within 1 year, and ≥2 years of continuous enrollment prior to SSc index date. ILD was defined as ≥2 medical claims associated with ILD on different dates. The ICD-9-CM and ICD-10-CM cohorts comprised 1779 and 1032 patients, respectively. In these cohorts, respectively, 7.6% and 9.3% of patients had their second medical claim associated with ILD prior to their SSc index date, and 4.3% and 5.6% of patients had their second medical claim associated with ILD >1 year prior to the SSc index date. In this analysis, 4% to 6% of patients with SSc had claims for ILD >1 year prior to a claim for SSc. These data show that SSc can affect the lung early and demonstrate the importance of screening patients with SSc for ILD and patients with ILD for SSc.
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Affiliation(s)
- Shervin Assassi
- Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Nan Shao
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Ziwei Yin
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Elizabeth R. Volkmann
- Department of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donald F. Zoz
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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Andersen M, Lund TK, Jensen THL, Iversen M, Perch M, Baslund B. The utility of transbronchial lung biopsies to guide the treatment decision in patients with rheumatic inflammatory diseases: a retrospective cross-sectional study. Rheumatol Int 2022; 42:1955-1963. [PMID: 35416492 DOI: 10.1007/s00296-022-05131-2] [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: 03/03/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
The role of transbronchial lung biopsies (TBB) in the diagnostic workup of systemic inflammatory rheumatic disease-associated interstitial lung disease (SIRD-ILD) is unclear and TBB is not generally recommended. The study objective was to examine the utility of TBB to guide treatment in a population of patients with SIRD-ILD. All patients from the Department of Rheumatology, Rigshospitalet, Denmark, who had TBB performed, from 2002 to 2016 were identified. Patient demographics as well as smoking status, previous lung disease, pulmonary function test, SIRD-diagnosis, imaging results and immunomodulatory therapy pre- and post-bronchoscopy were obtained. Histology findings were used to dichotomize patients into a high-inflammatory group or a low-inflammatory group. The high-inflammation group primarily consisted of non-specific interstitial pneumonia, organizing pneumonia, lymphocytic infiltrating pneumonia and granulomatous inflammation whereas the low inflammation group primarily consisted of histological findings of usual interstitial pneumonitis and biopsies describing fibrosis and/or sparse unspecific inflammation. Therapeutic consequence was defined as intensification of therapy. Differences in treatment intensification were calculated using a binominal logistic regression model. Ninety-six patients had TBB performed. Biopsies from 55 patients were categorized as high inflammatory and 41 as low inflammatory, respectively. In the high-inflammatory group, 38 (69%) had their therapy intensified compared to 6 (14%) in the low-inflammatory group (Odds ratio 8.0, 95% confidence limits 3.2-20.0, P < 0.001). No procedure-related complications were registered. TBB findings can guide treatment strategy in SIRD-ILD patients with suspected activity in the pulmonary disease. TBB appears safe and could be considered as part of the diagnostic workup.
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Affiliation(s)
- Martin Andersen
- Department of Rheumatology, Lupus and Vasculitis Clinic, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Thomas K Lund
- Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Thomas H L Jensen
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Martin Iversen
- Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Michael Perch
- Department of Cardiology, Section for Lung Transplantation and Respiratory Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bo Baslund
- Department of Rheumatology, Lupus and Vasculitis Clinic, Copenhagen University Hospital, Rigshospitalet, Denmark
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Ademhan Tural D, Emiralioglu N, Ozsezen B, Sunman B, Nayir Buyuksahin H, Guzelkas I, Oguz B, Bilginer Y, Orhan D, Yalcin E, Dogru D, Ozcelik U, Ozen S, Kiper N. Clinical spectrum of children with interstitial pneumonia with autoimmune features. Respir Med 2021; 187:106566. [PMID: 34416614 DOI: 10.1016/j.rmed.2021.106566] [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: 01/15/2021] [Revised: 06/08/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Interstitial pneumonia with autoimmune features (IPAF) is a term used to describe adult patients with interstitial lung disease (ILD) who display some clinical or serological features of autoimmune diseases and who do not meet the full criteria for a specific connective tissue disease (CTD). The aim of this study was to define the demographic, clinical, radiologic, serologic and histopathologic features and assess treatment in children with IPAF. METHODS This retrospective cohort study was conducted at a tertiary referral pediatric pulmonology center between January 2010 and August 2020. Children with proven interstitial pneumonia with no known etiologies were evaluated for IPAF according to European Respiratory Society/American Thoracic Society research statement of IPAF. RESULTS Among 132 children with ILD, 17 patients were evaluated in detail for IPAF criteria and six patients were further diagnosed as having IPAF. The incidence of IPAF in our patients with ILD was 4.5%. Four of these patients were female. The median age at the time of ILD diagnosis was 10.5 years. The most common initial symptom was shortness of breath, and the most common physical examination sign was crackles in both lungs. Steroid therapy was given to all patients and four patients received other immunosuppressive agents for steroid sparing. Two of those patients died because of respiratory insufficiency during the follow-up. CONCLUSION Children with interstitial pneumonia and certain clinical, serologic, and/or morphologic features should raise suspicion for the presence of an underlying systemic autoimmune disease. IPAF is also seen in children and should be categorized in chILD classifications.
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Affiliation(s)
- Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pediatric Pathology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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Interstitial pneumonia with autoimmune features: from research classification to diagnosis. Curr Opin Pulm Med 2021; 27:374-387. [PMID: 34183525 DOI: 10.1097/mcp.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The term interstitial pneumonia with autoimmune features (IPAF) was first proposed by an international task force in 2015 as a research classification to standardise nomenclature regarding patients with idiopathic interstitial pneumonia and features of connective tissue disease. However, how the use of this term and its proposed definition translates to clinical practice remains uncertain. This review will provide a comprehensive overview of studies of IPAF cohorts to date, discuss the consideration of IPAF as a distinct diagnostic entity and outline a suggested approach to patient management. RECENT FINDINGS Considerable heterogeneity exists between published IPAF cohorts, with some cohorts exhibiting similarities to those with connective tissue disease-associated interstitial lung disease (CTD-ILD), and others more similar to idiopathic interstitial pneumonias including idiopathic pulmonary fibrosis (IPF). Little data exist to inform the management of patients who fulfil the IPAF criteria. Preliminary data supports pragmatic management of these patients as having a working clinical diagnosis of either idiopathic interstitial pneumonia or CTD-ILD. Future research studies into this approach are required. SUMMARY The term IPAF, and its definition, have been of fundamental benefit to facilitating research in this diverse patient group. However, to date, there remain many unanswered questions regarding their natural histories and response to treatment.
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Peredo RA, Mehta V, Beegle S. Interstitial Lung Disease Associated with Connective Tissue Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1304:73-94. [PMID: 34019264 DOI: 10.1007/978-3-030-68748-9_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pulmonary manifestations of connective tissue diseases (CTD) carry high morbidity and potential mortality, and the most serious pulmonary type is interstitial lung disease (ILD). Identifying and promptly intervening CTD-ILD with immune suppressor therapy will change the natural course of the disease resulting in survival improvement. Compared to idiopathic pulmonary fibrosis, the most common presentation of idiopathic interstitial pneumonia (IIP), CTD-ILD carries a better prognosis due to the response to immune suppressor therapy. Nonspecific interstitial pneumonia (NSIP) is the most common type of CTD-ILD that is different from the fibrotic classical presentation of IPF, known as usual interstitial pneumonia (UIP). An exception is rheumatoid arthritis that presents more frequently with UIP type. Occasionally, IPF may not have typical radiographic features of UIP, and a full assessment to differentiate IPF from CTD-ILD is necessary, including the intervention of a multidisciplinary team and the histopathology. Interstitial pneumonia with autoimmune features (IPAF) shows promising advantages to identify patients with ILD who have some features of a CTD without a defined autoimmune disease and who may benefit from immune suppressors. A composition of clinical, serological, and morphologic features in patients presenting with ILD will fulfill criteria for IPAF. In summary, the early recognition and treatment of CTD-ILD, differentiation from IPF-UIP, and identification of patients with IPAF fulfill the assessment by the clinician for an optimal care.
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Affiliation(s)
- Ruben A Peredo
- Division of Rheumatology, Department of Medicine, Albany Medical College, Albany, NY, USA.
| | - Vivek Mehta
- Rheumatology, Alaska Native Medical Center, Anchorage, AK, USA
| | - Scott Beegle
- Division of Pulmonary & Critical Care Medicine, Albany Medical College, Albany, NY, USA
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Borzykh OB, Petrova MM, Karpova EI, Shnayder NA. Connective tissue disease in the practice of a cosmetologist and dermatologist. Features of diagnosis and management of patients. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
In the practice of a cosmetologist and a dermatologist, the functional features of the skin are of extremely important. At the same time, monogenic connective tissue disorders (hereditary connective tissue dysplasia) that underlie hereditary syndromes have been known for a long time, but in recent years more attention has been paid to genetic defects that, together with other internal and external factors, lead to manifestations of connective tissue dysfunction. Such disorders are called multifactorial, as a result, a general clinic of connective tissue dysplasia can develop. It is important for dermatologists and cosmetologists to diagnose the presence and risk of connective tissue pathology in time, since these disorders require special features in the clinical management of such patients. To date, there is a slight difference in the understanding of connective tissue pathology in Russia and abroad. Thus, the purpose of this review was to integrate ideas about connective tissue dysplasia in Russia and abroad, as well as to provide dermatologists and cosmetologists with an algorithm for diagnosing and managing patients with connective tissue dysfunction.
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Shan J, Wang X, Zhang X, Zhang J. Effects of dexmedetomidine on the onset and duration of action in non-depolarizing neuromuscular relaxant rocuronium. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To determine the impact of two varying doses of dexmedetomidine (DEX) on the onset and duration of neuromuscular blockade of rocuronium (ROC) under the condition of sevoflurane anesthesia. Eighty-one patients, American Society of Anesthesiologists Class I–II, were stochastically allocated to control group (group C) and two DEX groups (group D1 and group D2). In group D1 and group D2, DEX (0.5 and 1.0 µg/kg, respectively) was administrated 10 min before induction of general anesthesia. In group C, equivalent saline was infused by the same way. We monitored heart rate (HR), blood pressure, and train-of-four (TOF) values of all subjects in the period of anesthesia. We recorded times to reach TOF value 0 (T0, from injection of ROC to disappearance of all four twitches) as the onset time and TOF value 25% (T25, ratio of fourth twitch to first twitch,) as clinical duration of neuromuscular blockade. A total of 81 patients were randomized, 75 of whom accepted treatment, including group D1 ( n = 25), D2 ( n = 25), and C ( n = 25). T0 time of three groups was found to be similar. The duration of action for ROC in group D2 was 62.76 ± 6.33 min, which was much longer than that in group D1 and group C, which were 42.64 ± 3.92 and 42.56 ± 4.04 min ( p < 0.05), respectively. At T2 (after DEX administration) and T4 time point (10 min after trachea intubation), compared with group C, the changes of heart rate (HR) and blood pressure in DEX groups (group D1 and group D2) show greatly differences. Otherwise, there were no obvious differences among different groups at the other monitoring point-in-time. DEX infusion in general anesthesia has no obvious effect on the onset of ROC, but it is capable of prolonging its clinical effect time, which can provide reference for rational application of DEX and ROC in general anesthesia.
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Affiliation(s)
- Jiaqi Shan
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, P.R. China
| | - Xiaofeng Wang
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, P.R. China
| | - Xiaoli Zhang
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, P.R. China
| | - Junfeng Zhang
- Department of Anesthesiology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, P.R. China
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