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Zhang D, Zhuang R, Li J, Lv Y, Yang X, Pan W, Zhang X. MicroSPECT Imaging-Guided Treatment of Idiopathic Pulmonary Fibrosis in Mice with a Vimentin-Targeting 99mTc-Labeled N-Acetylglucosamine-Polyethyleneimine. Mol Pharm 2021; 18:4140-4147. [PMID: 34657437 DOI: 10.1021/acs.molpharmaceut.1c00545] [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: 11/28/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic disease with poor prognosis. Evidence has shown that vimentin is a key regulator of lung fibrogenesis. 99mTc-labeled N-acetylglucosamine-polyethyleneimine (NAG-PEI), a vimentin-targeting radiotracer, was used for the early diagnosis of IPF, and NAG-PEI was also used as a therapeutic small interfering RNA (siRNA) delivery vector for the treatment of IPF in this study. Single-photon emission-computed tomography (SPECT) imaging of bleomycin (BM)- and silica-induced IPF mice with 99mTc-labeled NAG-PEI was performed to visualize pulmonary fibrosis and monitor the treatment efficiency of siRNA-loaded NAG-PEI, lipopolysaccharide (LPS, a tolerogenic adjuvant), or zymosan (ZYM, an immunostimulant). The lung uptakes of 99mTc-NAG-PEI in the BM- and silica-induced IPF mice were clearly and directly correlated with IPF progression. The lung uptake of 99mTc-NAG-PEI in the NAG-PEI/TGF-β1-siRNA treatment group or LPS treatment group was evidently lower than that in the control group, while the lung uptake of 99mTc-NAG-PEI was significantly higher in the ZYM treatment group compared to that in the control group. These results demonstrate that NAG-PEI is a potent MicroSPECT imaging-guided theranostic platform for IPF diagnosis and therapy.
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Affiliation(s)
- Deliang Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China.,Department of Nuclear Medicine, Xiang'an Hospital Affiliated to Xiamen University, Xiamen 361102, China
| | - Rongqiang Zhuang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Jindian Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China
| | - Yuting Lv
- Department of Nuclear Medicine, Xiang'an Hospital Affiliated to Xiamen University, Xiamen 361102, China.,School of Medicine, Xiamen University, Xiamen 361102, China
| | - Xia Yang
- Department of Nuclear Medicine, Xiang'an Hospital Affiliated to Xiamen University, Xiamen 361102, China.,School of Medicine, Xiamen University, Xiamen 361102, China
| | - Weimin Pan
- Department of Nuclear Medicine, Xiang'an Hospital Affiliated to Xiamen University, Xiamen 361102, China
| | - Xianzhong Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China
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Serum Krebs von den Lungen-6 level predicts disease progression in interstitial lung disease. PLoS One 2020; 15:e0244114. [PMID: 33332430 PMCID: PMC7746162 DOI: 10.1371/journal.pone.0244114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/03/2020] [Indexed: 11/22/2022] Open
Abstract
Disease progression (DP) in interstitial lung disease (ILD) is variable and difficult to predict. In previous reports, serum Krebs von den Lungen-6 (KL-6) was suggested to be useful in diagnosing and predicting survival in ILD. The aim of our study was to investigate the usefulness of serum KL-6 as a predictor of DP in ILD. Clinical data of 199 patients with ILD (idiopathic pulmonary fibrosis: 22.8%) were prospectively collected and serum KL-6 levels were measured. DP was defined as a relative decline in forced vital capacity (FVC) ≥ 10%, acute exacerbation, or death during follow-up. The median follow-up period was 11.1 months. The mean age of the subjects was 62.2 years, and 59.8% were male. DP occurred in 21.6% of patients. The progressed group showed lower FVC, lower diffusing capacity for carbon monoxide, lower the minimum oxygen saturation during the 6-minute walk test, higher fibrosis scores on high-resolution computed tomography, and higher KL-6 levels (826.3 vs. 629.0 U/mL; p < 0.001) than those of the non-progressed group. In receiver operating characteristic curve analysis, serum KL-6 levels were a significant predictor of DP in ILD (area under the curve = 0.629, p = 0.009, and the optimal cut-off level was 811 U/mL). In multivariable Cox analysis, high serum KL-6 levels (≥ 800 U/mL) were only independently associated with DP in ILD (HR 2.689, 95% CI 1.445–5.004, P = 0.002). Serum KL-6 levels might be useful to predict DP in patients with ILD.
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Assessment of Interstitial Lung Disease Using Lung Ultrasound Surface Wave Elastography: A Novel Technique With Clinicoradiologic Correlates. J Thorac Imaging 2020; 34:313-319. [PMID: 29877916 DOI: 10.1097/rti.0000000000000334] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Optimal strategies to detect early interstitial lung disease (ILD) are unknown. ILD is frequently subpleural in distribution and affects lung elasticity. Lung ultrasound surface wave elastography (LUSWE) is a noninvasive method of quantifying superficial lung tissue elastic properties. In LUWSE a handheld device applied at the intercostal space vibrates the chest at a set frequency, and the lung surface wave velocity is measured by an ultrasound probe 5 mm away in the same intercostal space. We explored LUWSE's ability to detect ILD and correlated LUSWE velocity with physiological, quantitative, and visual radiologic features of subjects with known ILD and of healthy controls. MATERIALS AND METHODS Seventy-seven subjects with ILD, mostly caused by connective tissue disease, and 19 healthy controls were recruited. LUSWE was performed on all subjects in 3 intercostal lung regions bilaterally. Comparison of LUSWE velocities pulmonary function testing, visual assessment, and quantitative analysis of recent computed tomographic imaging with Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER) software. RESULTS Sonographic velocities were higher in all lung regions for cases, with the greatest difference in the lateral lower lung. Median velocity in m/s was 5.84 versus 4.11 and 5.96 versus 4.27 (P<0.00001) for cases versus controls, left and right lateral lower lung zones, respectively. LUSWE velocity correlated negatively with vital capacity and positively with radiologist and CALIPER-detected interstitial abnormalities. CONCLUSIONS LUSWE is a safe and noninvasive technique that shows high sensitivity to detect ILD and correlated with clinical, physiological, radiologic, and quantitative assessments of ILD. Prospective study in detecting ILD is indicated.
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Horst C, Gholipour B, Nair A, Jacob J. Differential diagnoses of fibrosing lung diseases. BJR Open 2019; 1:20190009. [PMID: 33178941 PMCID: PMC7592484 DOI: 10.1259/bjro.20190009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/24/2019] [Accepted: 05/29/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To describe the challenges inherent in diagnosing fibrosing lung diseases (FLD) on CT imaging and methodologies by which the diagnostic process may be simplified. METHODS Extensive searches in online scientific databases were performed to provide relevant and contemporary evidence that describe the current state of knowledge related to FLD diagnosis. This includes descriptions of the utility of a working diagnosis for an individual case discussed in a multidisciplinary team (MDT) setting and challenges associated with the lack of consensus guidelines for diagnosing chronic hypersensitivity pneumonitis. RESULTS As well as describing imaging features that indicate the presence of a fibrosing lung disease, those CT characteristics that nuance a diagnosis of the various FLDs are considered. The review also explains the essential information that a radiologist needs to convey to an MDT when reading a CT scan. Lastly, we provide some insights as to the future directions the field make take in the upcoming years. CONCLUSIONS This review outlines the current state of FLD diagnosis and emphasizes areas where knowledge is limited, and more evidence is required. Fundamentally, however, it provides a guide for radiologists when tackling CT imaging in a patient with FLD. ADVANCES IN KNOWLEDGE This review encompasses advice from recent guideline statements and evidence from the latest studies in FLD to provide an up-to-date manual for radiologists to aid the diagnosis of FLD on CT imaging in an MDT setting.
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Affiliation(s)
- Carolyn Horst
- Department of Respiratory Medicine, University College London, UK
| | | | - Arjun Nair
- Centre for Medical Image Computing, University College London, UK
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Abstract
PURPOSE OF REVIEW The application of computer-based imaging analysis in patients with idiopathic pulmonary fibrosis is a rapidly developing field. The purpose of this review is to provide insights into the problems associated with visual interpretation of HRCT patterns and describe some of the current technologies used to provide objective quantification of disease on HRCT. Future directions are also discussed. RECENT FINDINGS Although there is strong evidence that visual quantification of disease on HRCT in idiopathic pulmonary fibrosis provides prognostic information, this approach is hampered by its subjective nature and interobserver variability. In contrast, computer-based quantification of disease on HRCT provides objective and reproducible data, which may help to predict mortality and time to decline in patients with idiopathic pulmonary fibrosis. The use of these technologies may also help to stratify clinical risk in patients enrolled in drug trials. SUMMARY The future of imaging-based biomarker research in idiopathic pulmonary fibrosis is undoubtedly computer-based HRCT evaluation. However, if this field is to continue to innovate, large, well annotated imaging datasets for developing and testing. new computer-based tools are needed as well as prospective trials for biomarker validation.
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Affiliation(s)
- Simon L F Walsh
- Department of Radiology, King's College Hospital Foundation Trust, Denmark Hill, Brixton, London SE5 9RS, United Kingdom
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Zhou B, Bartholmai BJ, Kalra S, Osborn TG, Zhang X. Lung US Surface Wave Elastography in Interstitial Lung Disease Staging. Radiology 2019; 291:479-484. [PMID: 30835191 DOI: 10.1148/radiol.2019181729] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Lung US surface wave elastography (SWE) can noninvasively quantify lung surface stiffness or fibrosis by evaluating the rate of surface wave propagation. Purpose To assess the utility of lung US SWE for evaluation of interstitial lung disease. Materials and Methods In this prospective study, lung US SWE was used to assess 91 participants (women, 51; men, 40; mean age ± standard deviation [SD], 62.4 years ± 12.9) with interstitial lung disease and 30 healthy subjects (women, 16; men, 14; mean age, 45.4 years ± 14.6) from February 2016 through May 2017. Severity of interstitial lung disease was graded as none (healthy lung [F0]), mild (F1), moderate (F2), or severe (F3) based on pulmonary function tests, high-resolution CT, and clinical assessments. We propagated surface waves on the lung through gentle mechanical excitation of the external chest wall and measured the lung surface wave speed with a US probe. Lung US SWE performance was assessed, and the optimal cutoff wave speed values for fibrosis grades F0 through F3 were determined with receiver operating characteristic (ROC) curve analysis. Results Lung US SWE had a sensitivity of 92% (95% confidence intervals [CI]: 84%, 96%; P < .001) and a specificity of 89% (95% CI: 81%, 94%; P < .001) for differentiating between healthy subjects (F0) and participants with any grade of interstitial lung disease (F1-F3). It had a sensitivity of 50% and a specificity of 81% for differentiating interstitial lung disease grades F0-F2 from F3. The sensitivity was 88% and the specificity was 97% for differentiating between F0 and F1. The highest area under the ROC curve (AUC) values were obtained at 200 Hz and ranged from 0.83 to 0.94 to distinguish between healthy subjects and study participants with any interstitial lung disease. Conclusion Lung US surface wave elastography may be adjunct to high-resolution CT for noninvasive evaluation of interstitial lung disease. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Verschakelen in this issue.
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Affiliation(s)
- Boran Zhou
- From the Departments of Radiology (B.Z., B.J.B., X.Z.), Pulmonary and Critical Care Medicine (S.K.), and Rheumatology (T.G.O.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Brian J Bartholmai
- From the Departments of Radiology (B.Z., B.J.B., X.Z.), Pulmonary and Critical Care Medicine (S.K.), and Rheumatology (T.G.O.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Sanjay Kalra
- From the Departments of Radiology (B.Z., B.J.B., X.Z.), Pulmonary and Critical Care Medicine (S.K.), and Rheumatology (T.G.O.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Thomas G Osborn
- From the Departments of Radiology (B.Z., B.J.B., X.Z.), Pulmonary and Critical Care Medicine (S.K.), and Rheumatology (T.G.O.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Xiaoming Zhang
- From the Departments of Radiology (B.Z., B.J.B., X.Z.), Pulmonary and Critical Care Medicine (S.K.), and Rheumatology (T.G.O.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Zhang X, Zhou B, Bartholmai B, Kalra S, Osborn T. A quantitative method for measuring the changes of lung surface wave speed for assessing disease progression of interstitial lung disease. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:741-748. [PMID: 30598191 PMCID: PMC6368867 DOI: 10.1016/j.ultrasmedbio.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 06/01/2023]
Abstract
Lung ultrasound surface wave elastography (LUSWE) is a novel non-invasive technique for measuring superficial lung tissue stiffness. The purpose of the study described here was to develop LUSWE for assessment of progression in patients with interstitial lung disease (ILD). In this study, LUSWE was used to measure changes in lung surface wave speeds at 100, 150 and 200 Hz through six intercostal lung spaces for 52 patients with ILD. The mean age was 63.1 ± 12.0 y (range: 20-85, 23 male and 29 female). The follow-up interval was 9.2 ± 3.5 mo depending on each patient's return appointment and availability. For each patient, disease progression between the baseline and follow-up tests was evaluated clinically using a 7-point Likert scale comprising three grades of improvement (mild, moderate, marked), unchanged status and three grades of worsening (mild, moderate, marked). Clinical assessments were based on changes in pulmonary function tests together with high-resolution computed tomography, echocardiography and clinical evaluations. This study illustrates the correlations between changes in lung surface wave speed and clinical assessments. Correlations of changes in lung surface wave speed at lower lateral and posterior portions of the lung portions with clinical assessments were good. LUSWE provides quantitative global and regional changes in lung surface wave speed that may be useful for quantitative assessment of progression of ILD.
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Affiliation(s)
- Xiaoming Zhang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Boran Zhou
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sanjay Kalra
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas Osborn
- Department of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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Wu X, Kim GH, Salisbury ML, Barber D, Bartholmai BJ, Brown KK, Conoscenti CS, De Backer J, Flaherty KR, Gruden JF, Hoffman EA, Humphries SM, Jacob J, Maher TM, Raghu G, Richeldi L, Ross BD, Schlenker-Herceg R, Sverzellati N, Wells AU, Martinez FJ, Lynch DA, Goldin J, Walsh SLF. Computed Tomographic Biomarkers in Idiopathic Pulmonary Fibrosis. The Future of Quantitative Analysis. Am J Respir Crit Care Med 2019; 199:12-21. [DOI: 10.1164/rccm.201803-0444pp] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Grace H. Kim
- Radiological Science, University of California Los Angeles School of Medicine, Los Angeles, California
| | | | | | | | - Kevin K. Brown
- Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, Colorado
| | | | | | | | | | - Eric A. Hoffman
- Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Joseph Jacob
- Respiratory Medicine and
- Centre for Medical Image Computing, University College London, London, United Kingdom
| | - Toby M. Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
- Associate Editor, AJRCCM
| | - Ganesh Raghu
- Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, Washington
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Brian D. Ross
- Radiology, University of Michigan Hospital, Ann Arbor, Michigan
| | | | - Nicola Sverzellati
- Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
| | | | | | - Jonathan Goldin
- Radiological Science, University of California Los Angeles School of Medicine, Los Angeles, California
| | - Simon L. F. Walsh
- Radiology, Kings College Hospital National Health Service Foundation Trust, London, United Kingdom
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Zhou B, Zhang X. Lung mass density analysis using deep neural network and lung ultrasound surface wave elastography. ULTRASONICS 2018; 89:173-177. [PMID: 29852466 PMCID: PMC6014933 DOI: 10.1016/j.ultras.2018.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/07/2018] [Accepted: 05/22/2018] [Indexed: 06/01/2023]
Abstract
Lung mass density is directly associated with lung pathology. Computed Tomography (CT) evaluates lung pathology using the Hounsfield unit (HU) but not lung density directly. We have developed a lung ultrasound surface wave elastography (LUSWE) technique to measure the surface wave speed of superficial lung tissue. The objective of this study was to develop a method for analyzing lung mass density of superficial lung tissue using a deep neural network (DNN) and synthetic data of wave speed measurements with LUSWE. The synthetic training dataset of surface wave speed, excitation frequency, lung mass density, and viscoelasticity from LUSWE (788,000 in total) was used to train the DNN model. The DNN was composed of 3 hidden layers of 1024 neurons for each layer and trained for 10 epochs with a batch size of 4096 and a learning rate of 0.001 with three types of optimizers. The test dataset (4000) of wave speeds at three excitation frequencies (100, 150, and 200 Hz) and shear elasticity of superficial lung tissue was used to predict the lung density and evaluate its accuracy compared with predefined lung mass densities. This technique was then validated on a sponge phantom experiment. The obtained results showed that predictions matched well with test dataset (validation accuracy is 0.992) and experimental data in the sponge phantom experiment. This method may be useful to analyze lung mass density by using the DNN model together with the surface wave speed and lung stiffness measurements.
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Affiliation(s)
- Boran Zhou
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Xiaoming Zhang
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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Jiang Y, Luo Q, Han Q, Huang J, Ou Y, Chen M, Wen Y, Mosha SS, Deng K, Chen R. Sequential changes of serum KL-6 predict the progression of interstitial lung disease. J Thorac Dis 2018; 10:4705-4714. [PMID: 30233842 DOI: 10.21037/jtd.2018.07.76] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Interstitial lung disease (ILD) is a slowly progressing fatal fibrotic lung disease with a widely variable clinical course and a poor prognosis. Clinicians and patients would benefit from a highly efficient and accurate predictor for ILD. The purpose of this study was to evaluate whether blood biomarkers can predict ILD progression. Methods In this study, 85 patients diagnosed as having ILD at the Guangzhou Institute of Respiratory Health participated, including 20 patients with idiopathic pulmonary fibrosis (IPF). During the mean follow-up time of 12 months, every patient was examined during four or five visits in our center. Serum samples were collected at baseline, and after 1, 2, 6, and 12 months and tested for the Klebs von den Lungen-6 (KL-6) concentration. Dynamic fluctuations in this biomarker concentration were examined using a logistic regression model to see if they reflected the progression of ILD. Results The baseline levels of serum KL-6 in the ILD patients were significantly increased compared to healthy controls. Serum KL-6 levels were significantly elevated in patients with progression of disease (1,985.2±1,497.8 vs. 1,387.6±1,313.1 µg/mL; P<0.001). Logistic regression revealed sequential changes of KL-6 was a significant predictor of ILD progression in the next follow-up (OR, 2.569; 95% CI, 2.260-2.880; P=0.001), and that sequential changes of KL-6 were significant predictors for the progression of IPF (OR, 3.611; 95% CI, 1.048-12.442; P<0.01). Baseline concentrations were not predictive for ILD or IPF. Univariate Cox analysis showed that KL-6 was significantly associated with survival [relative risk (RR), 1.901; 95% CI, 1.294-2.793; P<0.001], along with other variables. Conclusions Serum levels of KL-6 were elevated in ILD patients with severe respiratory function compared to those without. The rate of poor prognosis and mortality was associated with increased biomarker concentrations. Sequential measurements of biomarkers could be valuable in disease monitoring and evaluations in clinical management.
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Affiliation(s)
- Ying Jiang
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Qun Luo
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Qian Han
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Junting Huang
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Yonger Ou
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Miao Chen
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Yu Wen
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Silas Sethiel Mosha
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Kuimiao Deng
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
| | - Rongchang Chen
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou 510120, China
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Caron M, Hoa S, Hudson M, Schwartzman K, Steele R. Pulmonary function tests as outcomes for systemic sclerosis interstitial lung disease. Eur Respir Rev 2018; 27:170102. [PMID: 29769294 PMCID: PMC9488607 DOI: 10.1183/16000617.0102-2017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/24/2018] [Indexed: 01/17/2023] Open
Abstract
Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc). We performed a systematic review to characterise the use and validation of pulmonary function tests (PFTs) as surrogate markers for systemic sclerosis-associated interstitial lung disease (SSc-ILD) progression.Five electronic databases were searched to identify all relevant studies. Included studies either used at least one PFT measure as a longitudinal outcome for SSc-ILD progression (i.e. outcome studies) and/or reported at least one classical measure of validity for the PFTs in SSc-ILD (i.e. validation studies).This systematic review included 169 outcome studies and 50 validation studies. Diffusing capacity of the lung for carbon monoxide (DLCO) was cumulatively the most commonly used outcome until 2010 when it was surpassed by forced vital capacity (FVC). FVC (% predicted) was the primary endpoint in 70.4% of studies, compared to 11.3% for % predicted DLCO Only five studies specifically aimed to validate the PFTs: two concluded that DLCO was the best measure of SSc-ILD extent, while the others did not favour any PFT. These studies also showed respectable validity measures for total lung capacity (TLC).Despite the current preference for FVC, available evidence suggests that DLCO and TLC should not yet be discounted as potential surrogate markers for SSc-ILD progression.
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Affiliation(s)
- Melissa Caron
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Sabrina Hoa
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Kevin Schwartzman
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Russell Steele
- Dept of Mathematics and Statistics, McGill University, Montreal, QC, Canada
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Zhang X, Zhou B, Kalra S, Bartholmai B, Greenleaf J, Osborn T. An Ultrasound Surface Wave Technique for Assessing Skin and Lung Diseases. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:321-331. [PMID: 29195756 PMCID: PMC5743597 DOI: 10.1016/j.ultrasmedbio.2017.10.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 09/28/2017] [Accepted: 10/19/2017] [Indexed: 05/14/2023]
Abstract
Systemic sclerosis (SSc) is a multi-organ connective tissue disease characterized by immune dysregulation and organ fibrosis. Severe organ involvement, especially of the skin and lung, is the cause of morbidity and mortality in SSc. Interstitial lung disease (ILD) includes multiple lung disorders in which the lung tissue is fibrotic and stiffened. The purpose of this study was to translate ultrasound surface wave elastography (USWE) for assessing patients with SSc and/or ILD via measuring surface wave speeds of both skin and superficial lung tissue. Forty-one patients with both SSc and ILD and 30 healthy patients were enrolled in this study. An external harmonic vibration was used to generate the wave propagation on the skin or lung. Three excitation frequencies of 100, 150 and 200 Hz were used. An ultrasound probe was used to measure the wave propagation in the tissue non-invasively. Surface wave speeds were measured on the forearm and upper arm of both left and right arm, as well as the upper and lower lungs, through six intercostal spaces of patients and healthy patients. Viscoelasticity of the skin was calculated by the wave speed dispersion with frequency using the Voigt model. The magnitudes of surface wave speed and viscoelasticity of patients' skin were significantly higher than those of healthy patients (p <0.0001) for each location and each frequency. The surface wave speeds of patients' lung were significantly higher than those of healthy patients (p <0.0001) for each location and each frequency. USWE is a non-invasive and non-ionizing technique for measuring both skin and lung surface wave speed and may be useful for quantitative assessment of SSc and/or ILD.
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Affiliation(s)
- Xiaoming Zhang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.
| | - Boran Zhou
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sanjay Kalra
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - James Greenleaf
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas Osborn
- Department of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. THE LANCET RESPIRATORY MEDICINE 2018; 6:138-153. [DOI: 10.1016/s2213-2600(17)30433-2] [Citation(s) in RCA: 559] [Impact Index Per Article: 93.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 12/18/2022]
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14
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Robbie H, Daccord C, Chua F, Devaraj A. Evaluating disease severity in idiopathic pulmonary fibrosis. Eur Respir Rev 2017; 26:26/145/170051. [PMID: 28877976 DOI: 10.1183/16000617.0051-2017] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/16/2017] [Indexed: 12/27/2022] Open
Abstract
Accurate assessment of idiopathic pulmonary fibrosis (IPF) disease severity is integral to the care provided to patients with IPF. However, to date, there are no generally accepted or validated staging systems. There is an abundance of data on using information acquired from physiological, radiological and pathological parameters, in isolation or in combination, to assess disease severity in IPF. Recently, there has been interest in using serum biomarkers and computed tomography-derived quantitative lung fibrosis measures to stage disease severity in IPF. This review will focus on the suggested methods for staging IPF, at baseline and on serial assessment, their strengths and limitations, as well as future developments.
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Affiliation(s)
- Hasti Robbie
- Radiology Dept, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Cécile Daccord
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Respiratory Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Centre for Academic Radiology, Royal Brompton Hospital, London, UK
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15
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Zhang X, Osborn T, Zhou B, Meixner D, Kinnick RR, Bartholmai B, Greenleaf JF, Kalra S. Lung Ultrasound Surface Wave Elastography: A Pilot Clinical Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:1298-1304. [PMID: 28866480 PMCID: PMC5603798 DOI: 10.1109/tuffc.2017.2707981] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A lung ultrasound surface wave elastography (LUSWE) technique is developed to measure superficial lung tissue elastic properties. The purpose of this paper was to translate LUSWE into clinical studies for assessing patients with interstitial lung disease (ILD) and present the pilot data from lung measurements on 10 healthy subjects and 10 patients with ILD. ILD includes multiple lung disorders in which the lung tissue is distorted and stiffened by tissue fibrosis. Chest radiography and computed tomography are the most commonly used techniques for assessing lung disease, but they are associated with radiation and cannot directly measure lung elastic properties. LUSWE provides a noninvasive and nonionizing technique to measure the elastic properties of superficial lung tissue. LUSWE was used to measure regions of both lungs through six intercostal spaces for patients and healthy subjects. The data are presented as wave speed at 100, 150, and 200 Hz at the six intercostal spaces. As an example, the surface wave speeds are, respectively, 1.88 ± 0.11 m/s at 100 Hz, 2.74 ± 0.26 m/s at 150 Hz, and 3.62 ± 0.13 m/s at 200 Hz for a healthy subject in the upper right lung; this is in comparison to measurements from an ILD patient of 3.3 ± 0.37 m/s at 100 Hz, 4.38 ± 0.33 m/s at 150 Hz, and 5.24 ± 0.44 m/s at 200 Hz in the same lung space. Significant differences in wave speed between healthy subjects and ILD patients were found. LUSWE is a safe and noninvasive technique which may be useful for assessing ILD.
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16
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Bhansing KJ, Vonk-Noordegraaf A, Oosterveer FP, van Riel PL, Vonk MC. Pulmonary arterial hypertension, a novelty in idiopathic inflammatory myopathies: insights and first experiences with vasoactive therapy. RMD Open 2017; 3:e000331. [PMID: 28879041 PMCID: PMC5574416 DOI: 10.1136/rmdopen-2016-000331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 01/05/2017] [Accepted: 02/05/2017] [Indexed: 12/31/2022] Open
Abstract
To characterise the different types of pulmonary hypertension (PH) among idiopathic inflammatory myopathy (IIM). A retrospective case series with assessment of PH by right heart catheterisation, extent of interstitial lung disease (ILD) and outcome of vasoactive therapy.The group of patients with IIM with PH (n=9) showed a median age at PH diagnosis of 62 years (IQR 48–71 years; eight women), seven diagnosed with polymyositis and two with dermatomyositis; median disease duration of 5.7 years and five patients with a positive anti-Jo1 antibody. We found one patient to be classified in PH WHO group 2 (left heart disease), five patients in WHO group 3 (lung disease) and three patients in WHO group 1 (pulmonary arterial hypertension (PAH)). During median observed follow-up of 24 months, mortality for the total group was 44%. Surprisingly, we found a relevant group (33%) of patients with IIM who suffered from non-ILD-PH, which reflects the presence of PAH phenotype. This result should lead to more awareness among treating physicians that complaints of dyspnoea among patient with IIM could be related to PAH and not only ILD. The role of vasoactive therapy remains to be defined in patients with IIM suffering from PAH or PH-ILD.
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Affiliation(s)
- Kavish J Bhansing
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank Pt Oosterveer
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
| | - Piet Lcm van Riel
- Scientific Institute for Quality of Health Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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18
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Nair A, Walsh SLF, Desai SR. Imaging of pulmonary involvement in rheumatic disease. Rheum Dis Clin North Am 2015; 41:167-96. [PMID: 25836636 DOI: 10.1016/j.rdc.2014.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Lung disease commonly occurs in connective tissue diseases (CTD) and is an important cause of morbidity and mortality. Imaging is central to the evaluation of CTD-associated pulmonary complications. In this article, a general discussion of radiologic considerations is followed by a description of the pulmonary appearances in individual CTDs, and the imaging appearances of acute and nonacute pulmonary complications. The contribution of imaging to monitoring disease, evaluating treatment response, and prognostication is reviewed. Finally, we address the role of imaging in the challenging multidisciplinary evaluation of interstitial lung disease where there is an underlying suspicion of an undiagnosed CTD.
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Affiliation(s)
- Arjun Nair
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Simon L F Walsh
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Sujal R Desai
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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19
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Khanna D, Nagaraja V, Tseng CH, Abtin F, Suh R, Kim G, Wells A, Furst DE, Clements PJ, Roth MD, Tashkin DP, Goldin J. Predictors of lung function decline in scleroderma-related interstitial lung disease based on high-resolution computed tomography: implications for cohort enrichment in systemic sclerosis-associated interstitial lung disease trials. Arthritis Res Ther 2015; 17:372. [PMID: 26704522 PMCID: PMC4718035 DOI: 10.1186/s13075-015-0872-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The extent of lung involvement visualized by high-resolution computed tomography (HRCT) is a predictor of decline in forced vital capacity (FVC) in scleroderma-interstitial lung disease. Our objective was to evaluate the performance of three different HRCT-defined staging systems in the Scleroderma Lung Study I (SLS I) over a 1-year period. METHODS We assessed two visual semiquantitative scores: the maximum fibrosis score (MaxFib, the fibrosis score in the zone of maximal lung involvement) and visual assessment of total lung involvement (TLI) as proposed by Goh and Wells. In addition, we evaluated the computer-aided diagnosis and calculated the quantitative percentage with fibrosis (QLF) and TLI. RESULTS The mean duration of the disease was 3.2 years, and the mean FVC was 67.7 %. Regardless of the staging system used, a greater degree of fibrosis/TLI on HRCT scans was associated with a greater decline in FVC in the placebo group. Using the MaxFib and QLF, the mean absolute changes in FVC from baseline were 0.1% and -1.4%, respectively, in <25% lung involvement vs. a change of -6.2% and -6.9%, respectively, with >25% involvement (negative score denotes worsening in FVC). Conversely, cyclophosphamide was able to stabilize decline in FVC in subjects with greater degree of involvement detected by HRCT. Using the visual MaxFib and QLF, the mean absolute improvements in FVC were 1.2 and 1.1, respectively, with >25% involvement. CONCLUSIONS HRCT-defined lung involvement was a predictor of decline in FVC in SLS I. The choice of staging system for cohort enrichment in a clinical trial depends on feasibility. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00004563 (Scleroderma Lung Study I) ISRCTN15982171. Registered 19 Aug 2015.
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Affiliation(s)
- Dinesh Khanna
- University of Michigan Scleroderma Program, Division of Rheumatology, Department of Internal Medicine, University of Michigan, Suite 7C27, 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA.
| | - Vivek Nagaraja
- Division of Rheumatology, University of Toledo, Toledo, OH, USA.
| | - Chi-Hong Tseng
- Department of Biostatistics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Fereidoun Abtin
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Robert Suh
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Grace Kim
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Athol Wells
- Division of Pulmonary and Critical Care, Royal Brompton Hospital, London, UK.
| | - Daniel E Furst
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Philip J Clements
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Michael D Roth
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Jonathan Goldin
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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20
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Gibelin A, Parrot A, Maitre B, Brun-Buisson C, Mekontso Dessap A, Fartoukh M, de Prost N. Acute respiratory distress syndrome mimickers lacking common risk factors of the Berlin definition. Intensive Care Med 2015; 42:164-72. [PMID: 26408150 DOI: 10.1007/s00134-015-4064-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/06/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Some patients presenting with acute respiratory failure and meeting the Berlin criteria for acute respiratory distress syndrome (ARDS) lack exposure to common risk factors (CRF). These so-called ARDS mimickers often lack histological diffuse alveolar damage. We aimed to describe such ARDS mimickers lacking CRF (ARDS CRF-) in comparison with others (ARDS CRF+). METHODS Retrospective study including all patients receiving invasive mechanical ventilation for ARDS admitted to the intensive care units (ICUs) of two tertiary care centers from January 2003 to December 2012. RESULTS The prevalence of ARDS CRF- was 7.5 % (95 % CI [5.5-9.5]; n = 50/665). On the basis of medical history, bronchoalveolar lavage fluid cytology, and chest CT scan patterns, four etiological categories were identified: immune (n = 18; 36 %), drug-induced (n = 13; 26 %), malignant (n = 7; 14 %), and idiopathic (n = 12; 24 %). Although the ARDS CRF- patients had a lower logistic organ dysfunction score (4 [3-8] vs. 10 [6-13]; p < 0.0001) and less often shock upon ICU admission (44 vs. 80 %; p < 0.0001) than their counterparts, their overall ICU mortality rate was very high (66 % [46-74]), and the absence of CRF remained associated with ICU mortality by multivariable logistic regression analysis (adjusted OR = 2.06; 95 % CI [1.02-4.18]; p = 0.044). Among ARDS CRF- patients, the presence of potentially reversible lung lesions with corticosteroids (aOR = 0.14; 95 % CI [0.03-0.62]) was associated with ICU survival. CONCLUSIONS The absence of CRF among patients with ARDS is common and associated with a higher risk of mortality. For such atypical ARDS, a complete diagnostic workup, including bronchoalveolar lavage fluid cytology and chest CT scan patterns, should be performed to identify those patients who might benefit from specific therapies, including corticosteroids.
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Affiliation(s)
- Aude Gibelin
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, 75970, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Antoine Parrot
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, 75970, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Bernard Maitre
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Antenne de Pneumologie, 94010, Créteil, France
| | - Christian Brun-Buisson
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.,Collégium Gallilée, Groupe de Recherche Clinique CARMAS (CArdiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Université Paris Est Créteil, Faculté de Médecine de Créteil, 94010, Créteil, France
| | - Armand Mekontso Dessap
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France.,Collégium Gallilée, Groupe de Recherche Clinique CARMAS (CArdiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Université Paris Est Créteil, Faculté de Médecine de Créteil, 94010, Créteil, France
| | - Muriel Fartoukh
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation Médico-Chirurgicale, Pôle Thorax Voies aériennes, Groupe Hospitalier des Hôpitaux Universitaires de l'Est Parisien, 75970, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, Paris, France. .,Collégium Gallilée, Groupe de Recherche Clinique CARMAS (CArdiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Université Paris Est Créteil, Faculté de Médecine de Créteil, 94010, Créteil, France.
| | - Nicolas de Prost
- Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, 94010, Créteil, France. .,Collégium Gallilée, Groupe de Recherche Clinique CARMAS (CArdiovascular and Respiratory Manifestations of Acute lung injury and Sepsis), Université Paris Est Créteil, Faculté de Médecine de Créteil, 94010, Créteil, France.
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21
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Yousif M, Habib R, Esaely H, Yasin R, Sonbol A. Interleukin-6 in systemic sclerosis and potential correlation with pulmonary involvement. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Yabuuchi H, Matsuo Y, Tsukamoto H, Horiuchi T, Sunami S, Kamitani T, Jinnouchi M, Nagao M, Akashi K, Honda H. Evaluation of the extent of ground-glass opacity on high-resolution CT in patients with interstitial pneumonia associated with systemic sclerosis: Comparison between quantitative and qualitative analysis. Clin Radiol 2014; 69:758-64. [DOI: 10.1016/j.crad.2014.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 11/27/2022]
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23
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Abstract
Dyspnea is a subjective and nonspecific symptom, yet very distressing for those who experience it. Acute onset dyspnea and exacerbation of chronic dyspnea from heart or lung disease significantly add to the number of emergency department visits and inpatient admissions. Although dyspnea may appear to be a simple condition to evaluate and manage, it is actually complex in description and quality. As such, dyspnea is the first symptom of many diseases. The onset of dyspnea can be due to a new acute disease, the exacerbation of an existing chronic illness, or a new disease compounding a chronic illness. Finding the cause of dyspnea is generally more difficult than it originally may appear. Therefore, the purpose of this article is to discuss the differential diagnoses associated with dyspnea.
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Affiliation(s)
- Beth Croucher
- Beth Croucher is Nurse Practitioner, Medical Intensive Care, Department of Pulmonary/Critical Care, Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210
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24
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Hodnett PA, Naidich DP. Fibrosing Interstitial Lung Disease. A Practical High-Resolution Computed Tomography–based Approach to Diagnosis and Management and a Review of the Literature. Am J Respir Crit Care Med 2013; 188:141-9. [DOI: 10.1164/rccm.201208-1544ci] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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25
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Henke MO, Vogelmeier CF. [Heart and lungs : cardinal symptom dyspnea]. Herz 2013; 38:279-90. [PMID: 23615840 DOI: 10.1007/s00059-013-3800-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Dyspnea is one of the major clinical symptoms which patients report to general practitioners, internists, cardiologists and hospitals. In this review article we discuss the evidence of medical history, laboratory procedures and diagnostic investigations to approach patients with acute or chronic dyspnea and try to structure this complex symptom dyspnea to reach the etiology of the underlying disease.
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Affiliation(s)
- M O Henke
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, UKGM Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland.
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26
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Abstract
The role of fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) in the diagnosis, staging, and monitoring of neoplastic conditions is well established. The clinical utility of PET/CT has now expanded to the diagnosis of autoimmune, inflammatory, infectious, as well as non-neoplastic conditions, such as the vasculitides, atherosclerosis, and granulomatous conditions, including sarcoidosis and inflammatory bowel disease, in addition to a variety of neurologic disorders. The availability of new PET radiotracers is expected to expand PET/CT applications to a variety of other clinical domains. New radioligands for studying inflammation and neurodegenerative processes are under development. Here, we discuss the evolving potential role of PET imaging for the evaluation and monitoring of miscellaneous conditions, including osteoarthritis, interstitial lung disease, vascular thromboses, and osteoporosis.
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Affiliation(s)
- Mandana Hashefi
- Division of Rheumatology, George Washington University, Washington, District of Columbia, USA.
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27
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Abstract
Pulmonary involvement is second in frequency only to esophageal involvement as a visceral complication of systemic sclerosis (SSc) and has surpassed renal involvement as the most common cause of death. Interstitial lung disease and pulmonary vascular disease, particularly pulmonary arterial hypertension, are the most commonly encountered types of lung involvement. Chronic aspiration, airway disease, neuromuscular weakness, extrinsic pulmonary restrictive pathology, pleural effusions, pneumothorax, and lung cancer cause clinically significant disease and occur commonly enough to be routinely considered in the assessment of the SSc patient with respiratory symptoms. Affected patients have a significantly worse prognosis than patients with SSc who are free of pulmonary involvement.
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MESH Headings
- Familial Primary Pulmonary Hypertension
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/pathology
- Hypertension, Pulmonary/therapy
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/epidemiology
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/pathology
- Lung Diseases, Interstitial/therapy
- Lung Neoplasms/etiology
- Lung Neoplasms/pathology
- Prevalence
- Prognosis
- Respiratory Aspiration/etiology
- Respiratory Aspiration/pathology
- Risk Factors
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/epidemiology
- Scleroderma, Systemic/pathology
- Scleroderma, Systemic/therapy
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Affiliation(s)
- Jérôme Le Pavec
- Université Paris-Sud, Centre National de Référence de l'Hypertension Artérielle Pulmonaire, Service de Pneumologie et Réanimation Respiratoire, Hôpital Antoine-Béclère, Assistance Publique, Hôpitaux de Paris, Clamart, France.
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28
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Prognostic value of immunohistochemical surfactant protein A expression in regenerative/hyperplastic alveolar epithelial cells in idiopathic interstitial pneumonias. Diagn Pathol 2011; 6:25. [PMID: 21435274 PMCID: PMC3072304 DOI: 10.1186/1746-1596-6-25] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 03/25/2011] [Indexed: 11/22/2022] Open
Abstract
Background It is difficult to predict survival in patients with idiopathic pulmonary fibrosis. Recently, several proteins, such as surfactant protein (SP) and KL-6, have been reported to be useful biologic markers for prediction of prognosis for interstitial pneumonias. It is not clear whether there is any relationship between expression of these proteins in regenerative/hyperplastic alveolar epithelial cells and prognosis of idiopathic interstitial pneumonias (IIPs). Objectives This study aimed to elucidate the clinical significance of the expression of such lung secretory proteins as SP-A and KL-6 in lung tissues of patients with IIPs. Methods We retrospectively investigated the immunohistochemical expression of SP-A, KL-6, cytokeratin (CK), and epithelial membrane antigen (EMA) in alveolar epithelial cells in lung tissues obtained from surgical lung biopsy in 43 patients with IIPs, and analyzed the correlation between expression of these markers and the prognosis of each IIP patient. CK and EMA were used as general markers for epithelial cells. Results In patients with usual interstitial pneumonia (UIP), the ratio of SP-A positive epithelial cells to all alveolar epithelial cells (SP-A positive ratio) in the collapsed and mural fibrosis areas varied, ranging from cases where almost all alveolar epithelial cells expressed SP-A to cases where only a few did. On the other hand, in many patients with nonspecific interstitial pneumonia (NSIP), many of the alveolar epithelial cells in the diseased areas expressed SP-A. The SP-A positive ratio was significantly lower in patients who died from progression of UIP than in patients with UIP who remained stable or deteriorated but did not die. In NSIP patients, a similar tendency was noted between the SP-A positive ratio and prognosis. Conclusions The results suggest that the paucity of immunohistochemical SP-A expression in alveolar epithelial cells in diseased areas (i.e. regenerative/hyperplastic alveolar epithelial cells) may predict a worse prognosis for patients with IIPs, especially patients with UIP. A prospective study is needed to confirm these results.
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29
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Amital A, Shitrit D, Adir Y. The lung in rheumatoid arthritis. Presse Med 2010; 40:e31-48. [PMID: 21196098 DOI: 10.1016/j.lpm.2010.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 11/05/2010] [Accepted: 11/08/2010] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis (RA) is a common inflammatory disease, affecting about 1% of the population. Although a major portion of the disease burden including excess mortality is due to its extra-articular manifestations, the prevalence of RA-associated lung disease is increasing. RA can affect the lung parenchyma, airways, and the pleura; and pulmonary complications are directly responsible for 10 to 20% of all mortality. Even though pulmonary infection and drug toxicity are frequent complications of RA, lung disease directly associated with the underlying RA is more common. The prevalence of a particular complication varies based on the characteristics of the population studied, the definition of lung disease used, and the sensitivity of the clinical investigations employed. An overview of lung disease associated with RA is presented here with an emphasis on parenchymal lung disease, pleural effusion, and airway involvement.
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Affiliation(s)
- Anat Amital
- Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
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30
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Lung involvement in systemic sclerosis. Presse Med 2010; 40:e3-e17. [PMID: 21195581 DOI: 10.1016/j.lpm.2010.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 08/25/2010] [Accepted: 08/27/2010] [Indexed: 01/22/2023] Open
Abstract
Scleroderma is a multisystem disease characterized by a severe inflammatory process and exuberant fibrosis. Lung involvement is a frequent complication and a leading cause of morbidity and mortality in this syndrome. Two major pulmonary syndromes are associated with scleroderma; a pulmonary vascular disorder evolving over time into relatively isolated pulmonary arterial hypertension (PAH), and interstitial lung disease (ILD). Each syndrome, when present, is a cause of morbidity and significantly reduces survival of scleroderma patients when compared to patients free of lung complication. When pulmonary hypertension and ILD are combined, survival is further reduced. Current therapy appears to have no meaningful effect on either condition and, thus, there is a need for better understanding of underlying pathogenic mechanisms. This review focuses on clinical, diagnostic, and therapeutic features of PAH and ILD as well as other frequent but less debilitating lung complications of scleroderma.
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31
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Thomeer M, Grutters JC, Wuyts WA, Willems S, Demedts MG. Clinical use of biomarkers of survival in pulmonary fibrosis. Respir Res 2010; 11:89. [PMID: 20584284 PMCID: PMC2907324 DOI: 10.1186/1465-9921-11-89] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2010] [Accepted: 06/28/2010] [Indexed: 11/15/2022] Open
Abstract
Background Biologic predictors or biomarkers of survival in pulmonary fibrosis with a worse prognosis, more specifically in idiopathic pulmonary fibrosis would help the clinician in deciding whether or not to treat since treatment carries a potential risk for adverse events. These decisions are made easier if accurate and objective measurements of the patients' clinical status can predict the risk of progression to death. Method A literature review is given on different biomarkers of survival in interstitial lung disease, mainly in IPF, since this disease has the worst prognosis. Conclusion Serum biomarkers, and markers measured by medical imaging as HRCT, pertechnegas, DTPA en FDG-PET are not ready for clinical use to predict mortality in different forms of ILD. A baseline FVC, a change of FVC of more than 10%, and change in 6MWD are clinically helpful predictors of survival.
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Affiliation(s)
- Michiel Thomeer
- Department of Respiratory Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium.
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Abstract
The idiopathic interstitial pneumonias (IIPs) are a group of diffuse parenchymal lung diseases of unknown etiology characterized by the presence of various degrees of inflammation and fibrosis. Confident definitive diagnosis of the various IIPs requires dynamic interaction among clinicians, radiologists, and pathologists to arrive at a clinico-radiologic-pathologic diagnosis. The aims of this manuscript are to summarize the characteristic clinical and histologic manifestations, and to describe and illustrate the high-resolution computed tomography manifestations of the IIPs. The focus will be on idiopathic pulmonary fibrosis (idiopathic usual interstitial pneumonia), nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, and acute interstitial pneumonia. High-resolution computed tomography plays an important role in the initial diagnosis, the assessment of disease extent, the likelihood of response to treatment and prognosis, and the assessment of complications.
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Afeltra A, Zennaro D, Garzia P, Gigante A, Vadacca M, Ruggiero A, Dardes N, Navajas MF, Zobel BB, Amoroso A. Prevalence of interstitial lung involvement in patients with connective tissue diseases assessed with high‐resolution computed tomography. Scand J Rheumatol 2009; 35:388-94. [PMID: 17062440 DOI: 10.1080/03009740600844381] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To assess the prevalence of interstitial lung disease (ILD) in patients with different forms of connective tissue disease (CTD) using non-invasive procedures including high-resolution computed tomography (HRCT) and to evaluate the relationship between the imaging and functional status of the patients. METHODS Eighty-one subjects with CTD (47 inpatients and 34 outpatients) were evaluated with pulmonary function tests (PFT) and radiological investigations. The extent and severity of lung disease was quantified with an HRCT scoring system previously used in patients with systemic sclerosis (SSc). Interstitial lung involvement was defined as predominantly fibrotic or inflammatory based on HRCT abnormalities. RESULTS HRCT abnormalities suggestive of ILD were observed in 69 patients (85.1%), whereas PFT and plain radiograph alterations occurred less frequently (40.7%). The most frequent HRCT abnormalities were septal/subpleural lines and ground-glass appearance whereas lesions consistent with advanced fibrosis were observed in a minority of patients. The HRCT score was higher in patients with abnormal PFT (p<0.001). Thirty-five patients had predominant fibrosis and 34 patients predominantly inflammatory abnormalities. A score of 10 points represented the best compromise between sensitivity and specificity in predicting functional impairment. CONCLUSIONS A high prevalence of ILD was found based on HRCT abnormalities. However, HRCT scans characterized by minor abnormalities have poor specificity for clinically significant disease and functional findings should also be considered. The large number of patients with predominantly inflammatory HRCT abnormalities suggests that many cases of ILD may be diagnosed in a relatively early stage of the disease.
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Affiliation(s)
- A Afeltra
- Department of Clinical Medicine, University Campus Bio-Medico, Rome, Italy.
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Groves AM, Win T, Screaton NJ, Berovic M, Endozo R, Booth H, Kayani I, Menezes LJ, Dickson JC, Ell PJ. Idiopathic pulmonary fibrosis and diffuse parenchymal lung disease: implications from initial experience with 18F-FDG PET/CT. J Nucl Med 2009; 50:538-45. [PMID: 19289428 DOI: 10.2967/jnumed.108.057901] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED The purpose of this study was to evaluate integrated (18)F-FDG PET/CT in patients with idiopathic pulmonary fibrosis (IPF) and diffuse parenchymal lung disease (DPLD). METHODS Thirty-six consecutive patients (31 men and 5 women; mean age +/- SD, 68.7 +/- 9.4 y) with IPF (n = 18) or other forms of DPLD (n = 18) were recruited for PET/CT and high-resolution CT (HRCT), acquired on the same instrument. The maximal pulmonary (18)F-FDG metabolism was measured as a standardized uptake value (SUV(max)). At this site, the predominant lung parenchyma HRCT pattern was defined for each patient: ground-glass or reticulation/honeycombing. Patients underwent a global health assessment and pulmonary function tests. RESULTS Raised pulmonary (18)F-FDG metabolism in 36 of 36 patients was observed. The parenchymal pattern on HRCT at the site of maximal (18)F-FDG metabolism was predominantly ground-glass (7/36), reticulation/honeycombing (26/36), and mixed (3/36). The mean SUV(max) in patients with ground-glass and mixed patterns was 2.0 +/- 0.4, and in reticulation/honeycombing it was 3.0 +/- 1.0 (Mann-Whitney U test, P = 0.007). The mean SUV(max) in patients with IPF was 2.9 +/- 1.1, and in other DPLD it was 2.7 +/- 0.9 (Mann-Whitney U test, P = 0.862). The mean mediastinal lymph node SUV(max) (2.7 +/- 1.3) correlated with pulmonary SUV(max) (r = 0.63, P < 0.001). Pulmonary (18)F-FDG uptake correlated with the global health score (r = 0.50, P = 0.004), forced vital capacity (r = 0.41, P = 0.014), and transfer factor (r = 0.37, P = 0.042). CONCLUSION Increased pulmonary (18)F-FDG metabolism in all patients with IPF and other forms of DPLD was observed. Pulmonary (18)F-FDG uptake predicts measurements of health and lung physiology in these patients. (18)F-FDG metabolism was higher when the site of maximal uptake corresponded to areas of reticulation/honeycomb on HRCT than to those with ground-glass patterns.
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Affiliation(s)
- Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, United Kingdom
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HRCT and scleroderma: semiquantitative evaluation of lung damage and functional abnormalities. Radiol Med 2009; 114:190-203. [DOI: 10.1007/s11547-009-0367-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 05/09/2008] [Indexed: 10/21/2022]
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36
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Corte TJ, Wells AU. Treatment of idiopathic interstitial pneumonias. Expert Rev Respir Med 2009; 3:81-91. [PMID: 20477284 DOI: 10.1586/17476348.3.1.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The idiopathic interstitial pneumonias can be grouped, for treatment purposes, into primary inflammatory disorders, fibrotic nonspecific interstitial pneumonia (in which inflammation is thought to precede and progress to fibrosis) as well as the most common of the idiopathic interstitial pneumonia subgroups, idiopathic pulmonary fibrosis. Over the past decade, there have been several paradigm shifts in the understanding of idiopathic interstitial pneumonias and their treatment. In particular, we highlight changes in the use of prognostic markers, clinical trial end points and the understanding of pathogenesis of idiopathic pulmonary fibrosis. We outline a practical approach to the treatment of these three patient groups.
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Affiliation(s)
- Tamera J Corte
- Clinical Research Fellow, Department of Interstitial Lung Disease, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK.
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Caccavo D, Afeltra A, Rigon A, Vadacca M, Zobel BB, Zennaro D, Arcarese L, Buzzulini F, Pellegrino NM, Amoroso A. Antibodies to carbonic anhydrase in patients with connective tissue diseases: relationship with lung involvement. Int J Immunopathol Pharmacol 2008; 21:659-67. [PMID: 18831934 DOI: 10.1177/039463200802100320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study is to evaluate the presence of antibodies to carbonic anhydrase I and/or II (ACAI and ACAII) in patients affected by connective tissue diseases (CTD) and to investigate their association with lung involvement evaluated by High resolution CT scan (HRCT). Ninety-six patients affected by CTD were studied, i.e. 33 rheumatoid arthritis (RA), 8 psoriatic arthritis (PA), 8 ankylosing spondilitis (AS), 23 Systemic Lupus Erythematosus (SLE), 10 Sjogren Syndrome (SS), and 14 Systemic Sclerosis (SSc). ACA were detected by ELISA. The lung involvement was evaluated by means of a previously described HRCT score. According to a receiver operator characteristic curve, patients were divided into those with HRCT score > or = 10 and those with HRCT score < 10, where HRCT score > or = 10 was predictive of interstitial lung disease. ACAI and/or ACAII were detected in 30/96 patients (31.2%) (P < 0.0001 in comparison with controls). In particular, the prevalence of ACAI and/or ACAII was significantly higher in patients with RA (P = 0.002), PA (P < 0.0001), SLE (P = 0.0003) and SSc (P < 0.0001). A positive correlation was found between HRCT scores and CRP or ACAI levels (P = < 0.0001 and P = 0.004, respectively). Thirty-nine of 96 patients (40.6%) showed a HRCT score > or = 10 and both their CRP and ACAI levels were significantly higher when compared with patients showing a HRCT score less than 10 (P < 0.0006 and P = 0.0009, respectively). Moreover, C3 and C4 complement fractions inversely correlated with HRCT scores (P = 0.0004 and P < 0.0001, respectively) and lower values of C3 and C4 complement fractions were found in patients with HRCT score > or = 10 than in those with HRCT score less than 10 (P = 0.014 and P = 0.007, respectively). Due to the lower levels of complement fractions detected in patients with HRCT score > or = 10, a possible immune-complex-mediated pathogenic mechanism of lung involvement could be suggested.
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Affiliation(s)
- D Caccavo
- Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari, Bari, Italy.
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PENG S, LI Z, KANG J, HOU X. Cross-sectional and longitudinal construct validity of the Saint George's Respiratory Questionnaire in patients with IPF. Respirology 2008; 13:871-9. [DOI: 10.1111/j.1440-1843.2008.01359.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Antoniou KM, Tzanakis N, Tzortzaki EG, Malagari K, Koutsopoulos AV, Alexandrakis M, Wells AU, Siafakas NM. Different angiogenic CXC chemokine levels in bronchoalveolar lavage fluid after interferon gamma-1b therapy in idiopathic pulmonary fibrosis patients. Pulm Pharmacol Ther 2008; 21:840-4. [PMID: 18644457 DOI: 10.1016/j.pupt.2008.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Revised: 06/24/2008] [Accepted: 06/30/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Pulmonary fibrosis is a devastating disease with few treatment options. Angiogenesis that leads to aberrant vascular remodeling is regulated by an opposing balance of angiogenic and angiostatic factors. The present study aims to evaluate the role of three angiogenic (IL-8, ENA-78 and GRO-a) and three angiostatic (MIG, IP-10, ITAC) chemokines in bronchoalveolar lavage fluid (BALF), before and after treatment with Interferon gamma-1b (IFN gamma-1b). PATIENTS AND METHODS We studied prospectively 20 patients (16 males, 4 females) of median age 68 years (range, 40-75) with histologically confirmed IPF/UIP. Patients were assigned to receive IFN gamma-1b 200 microg sc thrice a week. Angiogenic and angiostatic mediators' levels were measured by ELISA kits. RESULTS The levels of the angiogenic chemokines significantly decreased after 12 months (mo) of IFN-gamma-1b treatment (median values in pg/ml, IL-8/CXCL8: 640 vs. 81, p<0.05, ENA-78/CXCL5: 191 vs. 51, p<0.005 and GRO-alpha: 1827 vs. 710, p<0.005). No significant differences were detected in the levels of the angiostatic chemokines after therapy (median values in pg/ml, IP-10/CXCL10: 56 vs. 56.5, p=0.6, ITAC/CXCL11: 43 vs. 47, p=0.11). However, a significant decrease in the MIG/CXCL9: 66 vs. 31, p=0.006, has been detected. CONCLUSION These findings support the notion that IFN gamma may be one of the important mediators regulating angiogenetic balance in IPF. However, IFN gamma-1b decreases MIG levels, finding that in association with no alteration in IP-10 and I-TAC levels, could explain in part the nonbeneficial effect of this drug in IPF.
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Affiliation(s)
- Katerina M Antoniou
- Department of Thoracic Medicine, University General Hospital, Medical School, University of Crete, Heraklion, 71110 Crete, Greece
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Grgic A, Lausberg H, Heinrich M, Koenig J, Uder M, Sybrecht GW, Wilkens H. Progression of fibrosis in usual interstitial pneumonia: serial evaluation of the native lung after single lung transplantation. ACTA ACUST UNITED AC 2007; 76:139-45. [PMID: 17851227 DOI: 10.1159/000108440] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Accepted: 06/14/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a poor prognosis. Usual interstitial pneumonia (UIP) is the histopathological pattern identifying patients with the clinical entity of IPF. Despite aggressive immunosuppressive therapy the clinical course is usually dismal. For selected patients only lung transplantation improves prognosis and quality of life. After lung transplantation patients often receive a potent cyclosporine-based immunosuppressive therapy. Some reports suggest that cyclosporine has the potential to prevent progression of fibrosis. OBJECTIVE In patients with single lung transplantation (sLTx) for UIP we evaluated the effect of cyclosporine-based immunosuppressive therapy on progression of fibrosis using a high-resolution computed tomography (HRCT) scoring system. METHODS This retrospective observational study included 13 patients (24-64 years old) with histologically confirmed UIP who had HRCT scans preceding and following sLTx and who survived at least 6 months after sLTx. All patients were initially treated with cyclosporin A, prednisone and azathioprine. Three radiologists analyzed HRCT scans by setting a score regarding fibrosis [fibrosis score (FS); range 0-5 for each lobe] and ground-glass opacity [ground-glass score (GGS); range 0-5 for each lobe]. A comparison of serial changes (interval: 12-96 months posttransplant, 2-4 HRCT examinations/patient) was performed with the sign test. RESULTS Mean pretransplant FS and GGS of the nontransplanted lung were 1.80 and 1.61, respectively. Comparing pre- and posttransplant HRCT scans, mean lung FS significantly increased (0.35 +/- 0.15/year; p = 0.00024), while GGS tended to decrease (0.06 +/- 0.26/year; p = 0.5). CONCLUSION A cyclosporin A based triple immunosuppressive regimen following sLTx does not seem to prevent progression of the fibrotic changes of the native lung in patients with IPF.
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Affiliation(s)
- Aleksandar Grgic
- Klinik für Nuklearmedizin, Universitätsklinikum des Saarlandes, Homburg, Saar, Deutschland.
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Goh NSL, Veeraraghavan S, Desai SR, Cramer D, Hansell DM, Denton CP, Black CM, du Bois RM, Wells AU. Bronchoalveolar lavage cellular profiles in patients with systemic sclerosis-associated interstitial lung disease are not predictive of disease progression. ACTA ACUST UNITED AC 2007; 56:2005-12. [PMID: 17530640 DOI: 10.1002/art.22696] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the prognostic value of bronchoalveolar lavage (BAL) cellular profiles in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD). METHODS BAL cellularity was examined in relation to mortality (n = 141), serial pulmonary function findings (n = 134), and "progression-free survival" (n = 134), by proportional hazards analysis. Baseline severity was quantified according to the extent of disease on high-resolution computed tomography, the diffusing capacity for carbon monoxide, and the presence or absence of pulmonary hypertension. Mortality was subclassified into overall mortality (during 10 years of followup), early mortality (occurring within 2 years of presentation), and late mortality (occurring 2-10 years after presentation). RESULTS Overall mortality was associated with neutrophilia on BAL (hazard ratio 2.23 [95% confidence interval 1.20-4.14], P = 0.01), but this effect was lost when disease severity was taken into account. Early mortality was associated with neutrophilia on BAL (hazard ratio 8.40 [95% confidence interval 1.91-36.95], P = 0.005), independent of disease severity. Late mortality was not associated with neutrophilia on BAL. The presence of neutrophilia on BAL was not associated with time to decline in pulmonary function or progression-free survival. Neither eosinophilia nor lymphocytosis on BAL was associated with mortality, rapidity of functional deterioration, or progression-free survival. These findings were unaltered when treatment status was taken into account. CONCLUSION BAL findings provide only limited prognostic information in SSc-ILD. Neutrophilia on BAL is linked to early mortality, but BAL findings are not linked to long-term survival or the rapidity of progression of lung disease. The usefulness of BAL to define alveolitis in SSc is questionable.
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Affiliation(s)
- Nicole S L Goh
- Royal Brompton Hospital and National Heart and Lung Institute, London, UK
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42
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Danoff SK, Terry PB, Horton MR. A Clinicianʼs Guide to the Diagnosis and Treatment of Interstitial Lung Diseases. South Med J 2007; 100:579-87. [PMID: 17591311 DOI: 10.1097/smj.0b013e3180485c62] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Interstitial lung disease (ILD) is a final common pathway for a large number of lung insults. It is characterized by progressive scarring of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are nonspecific (cough and progressive dyspnea on exertion) and are often attributed to other diseases, thus delaying diagnosis and timely therapy. ILD occurs most commonly in older individuals and is increasingly encountered by internists. Both the diagnosis and treatment can be daunting: patients frequently have irreversibly impaired lung function at diagnosis, and therapeutic modalities are limited and associated with significant adverse effects. This review will assist internists in the recognition and management of ILD, provide a benchmark for pulmonary referrals, and offer guidance in advising patients with this life-threatening disorder.
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Affiliation(s)
- Sonye K Danoff
- Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, 5th floor, Baltimore, MD 21205, USA
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Camiciottoli G, Orlandi I, Bartolucci M, Meoni E, Nacci F, Diciotti S, Barcaroli C, Conforti ML, Pistolesi M, Matucci-Cerinic M, Mascalchi M. Lung CT densitometry in systemic sclerosis: correlation with lung function, exercise testing, and quality of life. Chest 2007; 131:672-681. [PMID: 17356079 DOI: 10.1378/chest.06-1401] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND To ascertain if analysis of lung density histograms in thin-section CT was more reproducible than visual assessment of lung changes in systemic sclerosis (SSc), and if such density histogram parameters as mean lung attenuation (MLA), skewness, and kurtosis could more closely reflect pulmonary function as well as exercise and quality of life impairment. METHODS The intraoperator and interoperator reproducibility of visual and densitometric lung CT analysis in 48 SSc patients examined with CT were evaluated by means of weighted kappa statistics. Univariate and multivariate regression analyses were applied to evaluate the relationship of visual and densitometric CT measurements with functional parameters including functional residual capacity (FRC), FVC, FEV(1), diffusion capacity of the lung for carbon monoxide (Dlco), 6-min walking testing (6MWT), and health-related quality of life questionnaire (QLQ) parameters. RESULTS The intraoperator and interoperator reproducibility of MLA (intraobserver weighted kappa = 0.97; interobserver weighted kappa = 0.96), skewness (intraobserver weighted kappa = 0.89; interobserver weighted kappa = 0.88), and kurtosis (intraobserver weighted kappa = 0.89; interobserver weighted kappa = 0.88) were higher than those of visual assessment (intraobserver weighted kappa = 0.71; interobserver weighted kappa = 0.69). In univariate analysis, only densitometric measurements were correlated with some exercise and QLQ parameters. In multivariate analysis, MLA (square regression coefficient corrected [R(2)c] = 0.70), skewness (R(2)c = 0.78), and kurtosis (R(2)c = 0.77) were predicted by FRC, FVC, Dlco, 6MWT, and QLQ parameters, while visual assessment was associated only with FRC and FVC (R(2)c = 0.40). CONCLUSIONS In SSc, densitometric analysis is more reproducible than visual assessment of lung changes in thin-section CT and more closely correlated to pulmonary function testing, 6MWT, and QLQ. Density histogram parameters may be useful for cross-sectional and longitudinal studies of lung involvement in SSc.
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Affiliation(s)
- Gianna Camiciottoli
- Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy.
| | - Ilaria Orlandi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Maurizio Bartolucci
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Eleonora Meoni
- Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy
| | - Francesca Nacci
- Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electronics and Telecommunications, University of Florence, Florence, Italy
| | - Chiara Barcaroli
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Maria Letizia Conforti
- Rheumatology Unit, Department of Internal Medicine, University of Florence, Florence, Italy
| | - Massimo Pistolesi
- Respiratory Medicine Unit, Department of Critical Care, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Rheumatology Unit, Department of Internal Medicine, University of Florence, Florence, Italy
| | - Mario Mascalchi
- Radiodiagnostic Section, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Churg A, Müller NL. Cellular vs fibrosing interstitial pneumonias and prognosis: a practical classification of the idiopathic interstitial pneumonias and pathologically/radiologically similar conditions. Chest 2006; 130:1566-70. [PMID: 17099039 DOI: 10.1378/chest.130.5.1566] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Andrew Churg
- Department of Pathology, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5.
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Systemischer Lupus erythematodes im Kindesalter. Monatsschr Kinderheilkd 2006. [DOI: 10.1007/s00112-006-1438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Copley SJ, Lee YCG, Hansell DM, Sivakumaran P, Rubens MB, Newman Taylor AJ, Rudd RM, Musk AW, Wells AU. Asbestos-induced and smoking-related disease: apportioning pulmonary function deficit by using thin-section CT. Radiology 2006; 242:258-66. [PMID: 17090711 DOI: 10.1148/radiol.2421051167] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To retrospectively correlate the extent of individual diseases seen at thin-section computed tomography (CT) with pulmonary function in an initial group of patients with asbestos-related parenchymal disease (asbestosis) and to test these findings in a subsequent group of patients whose CT scans were retrospectively identified. MATERIALS AND METHODS This retrospective study had Institutional Review Board approval; informed consent was not required. The study included 133 individuals who had been exposed to asbestos. In the initial study group (81 patients; 79 men, two women; median age, 67 years), two observers used a CT scoring system to quantify the extent of pulmonary fibrosis, diffuse pleural thickening, small-airways disease, and emphysema. Multivariate equations were formulated by using independent CT variables to predict changes in total lung capacity (TLC) and carbon monoxide diffusing capacity (Dlco). The validity of these equations was then tested in a subsequent group of patients (52 patients; all men; median age, 60 years). RESULTS At thin-section CT, the extent of asbestos-induced pleuropulmonary disease and emphysema correlated significantly with physiologic impairment (P<.001). Combined CT variables predicted 58% and 57% of the variability in TLC and Dlco, respectively, despite considerable variation in the proportion of coexisting pathologic conditions. When predictive equations with CT variables derived from the initial study group were applied to the subsequent study group, predicted TLC (rho=0.75, P<.001) and Dlco (rho=0.64, P<.001) correlated strongly with measured values. CONCLUSION The proposed CT system provides a semiquantitative method for assessing the relative contribution of asbestos-induced pleuropulmonary disease and smoking-related emphysema to functional impairment.
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Affiliation(s)
- Susan J Copley
- Department of Radiology, Hammersmith Hospital, and Center for Respiratory Research, University College London, London, England
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Vasakova M, Striz I, Dutka J, Slavcev A, Jandova S, Kolesar L, Sulc J. Cytokine gene polymorphisms and high-resolution-computed tomography score in idiopathic pulmonary fibrosis. Respir Med 2006; 101:944-50. [PMID: 17056243 DOI: 10.1016/j.rmed.2006.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Revised: 08/14/2006] [Accepted: 09/10/2006] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a serious disease with unknown cause and the influence of cytokine gene polymorphisms is presumed in the etiology and pathogenesis of the disease. We used high-resolution computed tomography (HRCT) as a marker of disease stage and progression and compared the alveolar and interstitial score with IL-1, IL-4, IL-12, IL-1RA and IL-4RA cytokine gene polymorphisms. SUBJECTS AND METHODS The IPF patients were all Caucasians from the Czech Republic and consisted of 20 females and 10 males, with a mean age of 65 years, range 36-85. The HRCT results were evaluated by an experienced viewer using the interstitial and alveolar score scales, which were based on the IPF HRCT description system from Gay SE, Kazerooni EA, Tows GB, Lynch JP, Gross BH, Cascade PN, et al. [Idiopathic pulmonary fibrosis. Predicting response to therapy and survival. Am J Respir Crit Care Med 1998;157:1063-72]. We evaluated the polymorphisms of cytokine genes utilizing a PCR with sequence-specific primers method. RESULTS The HRCT alveolar score was more pronounced in IL-4 RA (+1902) AG heterozygotes. The HRCT interstitial score was less severe in the IL-12 (-1188) AA homozygotes. According to progression of the HRCT interstitial score, the CC homozygosity at IL-1 RA (mspa 111100), the AA homozygosity at IL-4 RA (+1902) and CC homozygosity at IL-4(+33) positions were more frequent in patients with stable disease compared to those with progressive disease. CONCLUSIONS We assume from our data that the polymorphisms of IL-4, IL-4RA, IL-1RA and IL-12 genes (genes of cytokines with regulatory activity) might influence the phenotype of IPF as shown by measurable changes in HRCT investigations.
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Affiliation(s)
- Martina Vasakova
- Department of Respiratory Diseases, 1st Medical School, Charles University, University Thomayer Hospital, Videnska 800, 140 59 Prague 4, Czech Republic.
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Yokoyama A, Kondo K, Nakajima M, Matsushima T, Takahashi T, Nishimura M, Bando M, Sugiyama Y, Totani Y, Ishizaki T, Ichiyasu H, Suga M, Hamada H, Kohno N. Prognostic value of circulating KL-6 in idiopathic pulmonary fibrosis. Respirology 2006; 11:164-8. [PMID: 16548901 DOI: 10.1111/j.1440-1843.2006.00834.x] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Circulating levels of KL-6, a high MW glycoprotein (MUC1 mucin), are elevated in a majority of patients with a number of interstitial lung diseases, including idiopathic pulmonary fibrosis (IPF). However, KL-6 levels vary from patient to patient. The aim of the present study was to determine whether the serum KL-6 level at the time of diagnosis predicts prognosis in IPF. METHODS The relationship between clinical variables and prognosis in 27 patients with IPF were analysed retrospectively. The diagnosis was made by histological examination (n = 16) or on clinical findings including high-resolution CT scanning (n = 11). All patients were followed up for at least 3 years. Variables such as age, FVC%, PaO(2) at rest, initial LDH level, C-reactive protein and KL-6 were used for analysis. RESULTS At the cut-off level determined by receiver operating characteristic curves, LDH and KL-6 showed a significant correlation with the patient's prognosis by univariate analysis. However, multivariate analysis revealed that only KL-6 was a predictor of prognosis. The patients were categorized by their serum KL-6 levels (as above or below the cut-off level of 1000 U/mL) and their survival estimated using the Kaplan-Meier method. The difference in median survival between the two groups was significant. The median survival of patients with low KL-6 was more than 36 months, whereas that of patients with high KL-6 was only 18 months. CONCLUSION These results suggest that initial evaluation of serum KL-6 level can predict survival in patients with IPF.
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Affiliation(s)
- Akihito Yokoyama
- Department of Molecular and Internal Medicine, Hiroshima University, Hiroshima, Japan.
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Antoniou KM, Malagari K, Tzanakis N, Perisinakis K, Symvoulakis EK, Karkavitsas N, Siafakas NM, Bouros D. Clearance of technetium-99m-DTPA and HRCT findings in the evaluation of patients with Idiopathic Pulmonary Fibrosis. BMC Pulm Med 2006; 6:4. [PMID: 16483363 PMCID: PMC1386704 DOI: 10.1186/1471-2466-6-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Accepted: 02/16/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clearance of inhaled technetium-labeled diethylenetriamine pentaacetate (99mTc-DTPA) is a marker of epithelial damage and an index of lung epithelial permeability. The aim of this study was to investigate the role of 99mTc-DTPA scan in patients with Idiopathic Pulmonary Fibrosis (IPF). Our hypothesis is that the rate of pulmonary 99mTc-DTPA clearance could be associated with extent of High Resolution Computed Tomography (HRCT) abnormalities, cell differential of bronchoalveolar lavage fluid (BALF) and pulmonary function tests (PFTs) in patients with IPF. METHODS We studied prospectively 18 patients (14 male, 4 female) of median age 67 yr (range 55-81) with histologically proven IPF. HRCT scoring included the mean values of extent of disease. Mean values of these percentages represented the Total Interstitial Disease Score (TID). DTPA clearance was analyzed according to a dynamic study using a Venticis II radioaerosol delivery system. RESULTS The mean (SD) TID score was 36 +/- 12%, 3 patients had mild, 11 moderate and 4 severe TID. Abnormal DTPA clearance half-time (t1/2 < 40 min) was found in 17/18 (94.5%) [mean (SD) 29.1 +/- 8.6 min]. TID was weakly correlated with the DTPA clearance (r = -0.47, p = 0.048) and with % eosinophils (r = 0.475, p = 0.05). No correlation was found between TID score or DTPA and PFTs in IPF patients. CONCLUSION Our data suggest that 99mTc-DTPA lung scan is not well associated with HRCT abnormalities, PFTs, and BALF cellularity in patients with IPF. Further studies in large scale of patients are needed to define the role of this technique in pulmonary fibrosis.
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Affiliation(s)
- Katerina M Antoniou
- Department of Thoracic Medicine, University Hospital of Heraklion Crete, Greece
| | - Katerina Malagari
- Department of Radiology, Medical School University of Athens, Greece
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine, University Hospital of Heraklion Crete, Greece
| | - Kostas Perisinakis
- Department of Nuclear Medicine, Medical School University of Crete, Greece
| | | | | | - Nikolaos M Siafakas
- Department of Thoracic Medicine, University Hospital of Heraklion Crete, Greece
| | - Demosthenes Bouros
- Department of Pneumonology, Democritus University of Thrace, Alexandroupolis, Greece
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50
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Demedts M, Behr J, Buhl R, Costabel U, Dekhuijzen R, Jansen HM, MacNee W, Thomeer M, Wallaert B, Laurent F, Nicholson AG, Verbeken EK, Verschakelen J, Flower CDR, Capron F, Petruzzelli S, De Vuyst P, van den Bosch JMM, Rodriguez-Becerra E, Corvasce G, Lankhorst I, Sardina M, Montanari M. High-dose acetylcysteine in idiopathic pulmonary fibrosis. N Engl J Med 2005; 353:2229-42. [PMID: 16306520 DOI: 10.1056/nejmoa042976] [Citation(s) in RCA: 615] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis is a chronic progressive disorder with a poor prognosis. METHODS We conducted a double-blind, randomized, placebo-controlled multicenter study that assessed the effectiveness over one year of a high oral dose of acetylcysteine (600 mg three times daily) added to standard therapy with prednisone plus azathioprine. The primary end points were changes between baseline and month 12 in vital capacity and in single-breath carbon monoxide diffusing capacity (DL(CO)). RESULTS A total of 182 patients were randomly assigned to treatment (92 to acetylcysteine and 90 to placebo). Of these patients, 155 (80 assigned to acetylcysteine and 75 to placebo) had usual interstitial pneumonia, as confirmed by high-resolution computed tomography and histologic findings reviewed by expert committees, and did not withdraw consent before the start of treatment. Fifty-seven of the 80 patients taking acetylcysteine (71 percent) and 51 of the 75 patients taking placebo (68 percent) completed one year of treatment. Acetylcysteine slowed the deterioration of vital capacity and DL(CO): at 12 months, the absolute differences in the change from baseline between patients taking acetylcysteine and those taking placebo were 0.18 liter (95 percent confidence interval, 0.03 to 0.32), or a relative difference of 9 percent, for vital capacity (P=0.02), and 0.75 mmol per minute per kilopascal (95 percent confidence interval, 0.27 to 1.23), or 24 percent, for DL(CO) (P=0.003). Mortality during the study was 9 percent among patients taking acetylcysteine and 11 percent among those taking placebo (P=0.69). There were no significant differences in the type or severity of adverse events between patients taking acetylcysteine and those taking placebo, except for a significantly lower rate of myelotoxic effects in the group taking acetylcysteine (P=0.03). CONCLUSIONS Therapy with acetylcysteine at a dose of 600 mg three times daily, added to prednisone and azathioprine, preserves vital capacity and DL(CO) in patients with idiopathic pulmonary fibrosis better than does standard therapy alone.
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Affiliation(s)
- Maurits Demedts
- University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium.
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