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Cassibba J, Epaud R, Berteloot L, Aberbache S, Bitton L, Fletcher C, Fleury M, Delestrain C, Corvol H, de Becdelièvre A, Borie R, Legendre M, Coulomb l'Herminé A, Louvrier C, Lustremant C, Sari Hassoun M, Sileo C, Hadchouel A, Nathan N. The significance of multidisciplinary team meetings in diagnosing and managing childhood interstitial lung disease within the RespiRare network. Pediatr Pulmonol 2024; 59:417-425. [PMID: 37991126 DOI: 10.1002/ppul.26765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/12/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Childhood Interstitial Lung Disease (chILD) represents a rare and severe group of diseases for which the etiologic workup, classification, and management remain a challenge for most pediatric pulmonologists. In France in 2018, the RespiRare network established the first multidisciplinary team meetings (MDTm) dedicated to chILD. This study aims to investigate the impact of MDTm in chILD diagnosis and management as well as user satisfaction. METHODS The MDTm took place on a monthly basis through video conferences. The participants consisted of a quorum and included pediatric pulmonologists, radiologists, geneticists, and pulmonologists, with an average of 10.5 participants per meeting. Patients provided consent to participate in MDTm and for data collection. Data were retrospectively extracted from MDTm reports. To evaluate the usefulness of the MDTm and the satisfaction of the participants, a survey was sent by email at least 3 months after the MDTm to the participants. RESULTS A total of 216 chILD cases were discussed during 56 MDTm sessions. The median age of onset was 0.5 years (interquartile range 0-7). The MDTm sessions resulted in the correction of chILD etiology in 25% of cases (neuroendocrine cell hyperplasia of infancy 17%, surfactant metabolism disorder 8%, pulmonary alveolar proteinosis 4%, hemosiderosis 3%, sarcoidosis 3%, and others 34%), and chILD was ruled out in 7% of cases. A change in therapy was proposed for 46% of cases. User satisfaction was significant, particularly regarding their confidence in managing these rare diseases. DISCUSSION AND CONCLUSION Dedicated MDTm sessions offer a unique opportunity to enhance chILD etiologic diagnosis and management, leading to increased physician knowledge and confidence in managing these patients.
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Affiliation(s)
- Julie Cassibba
- Department of Pediatric Pulmonology and Reference Center for Rare Lung Diseases, RespiRare, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Ralph Epaud
- Department of Pediatric and Reference Center for Rare Lung Diseases, RespiRare, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- INSERM, IMRB, University Paris Est Créteil, Créteil, France
| | | | - Sabrina Aberbache
- French Reference Network for Rare Respiratory Diseases RespiFIL, Bicêtre Hospital, AP-HP, Kremlin-Bicêtre, France
| | - Lauren Bitton
- Department of Pediatric Pulmonology and Reference Center for Rare Lung Diseases, RespiRare, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Camille Fletcher
- Department of Pediatric Pulmonology and Reference Center for Rare Lung Diseases, RespiRare, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Manon Fleury
- Department of Pediatric Pulmonology and Reference Center for Rare Lung Diseases, RespiRare, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Céline Delestrain
- Department of Pediatric and Reference Center for Rare Lung Diseases, RespiRare, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- INSERM, IMRB, University Paris Est Créteil, Créteil, France
| | - Harriet Corvol
- Department of Pediatric Pulmonology and Reference Center for Rare Lung Diseases, RespiRare, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Centre De Recherche Saint Antoine (CRSA), Sorbonne University, Paris, France
| | - Alix de Becdelièvre
- INSERM, IMRB, University Paris Est Créteil, Créteil, France
- Molecular Genetics Department, Mondor Hospital, AP-HP, Paris, France
| | - Raphaël Borie
- Service de Pneumologie A, Centre constitutif du centre de référence des Maladies Pulmonaires Rares, Inserm, PHERE, Hôpital Bichat, APHP, FHU APOLLO, Université Paris Cité, Paris, France
| | - Marie Legendre
- Laboratory of Childhood Genetic Diseases, Inserm UMR_S933, Armand Trousseau Hospital, Sorbonne University, Paris, France
- Molecular Genetics Department, Armand Trousseau Hospital, AP-HP, Paris, France
| | | | - Camille Louvrier
- Laboratory of Childhood Genetic Diseases, Inserm UMR_S933, Armand Trousseau Hospital, Sorbonne University, Paris, France
- Molecular Genetics Department, Armand Trousseau Hospital, AP-HP, Paris, France
| | - Céline Lustremant
- French Reference Network for Rare Respiratory Diseases RespiFIL, Bicêtre Hospital, AP-HP, Kremlin-Bicêtre, France
| | - Meryem Sari Hassoun
- French Reference Network for Rare Respiratory Diseases RespiFIL, Bicêtre Hospital, AP-HP, Kremlin-Bicêtre, France
| | - Chiara Sileo
- Radiology Department, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
| | - Alice Hadchouel
- Pediatric Pulmonology Department and Reference Center for Rare Respiratory Diseases RespiRare, Hôpital Necker-Enfants Malades, APHP and Université Paris Cité, Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
| | - Nadia Nathan
- Department of Pediatric Pulmonology and Reference Center for Rare Lung Diseases, RespiRare, Armand Trousseau Hospital, APHP, Sorbonne University, Paris, France
- Laboratory of Childhood Genetic Diseases, Inserm UMR_S933, Armand Trousseau Hospital, Sorbonne University, Paris, France
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Freund O, Wand O, Schneer S, Barel N, Shalmon T, Borsekofsky S, Hershko T, Gershman E, Adir Y, Bar-Shai A, Shitrit D, Unterman A. Transbronchial Cryobiopsy Is Superior to Forceps Biopsy for Diagnosing both Fibrotic and Non-Fibrotic Interstitial Lung Diseases. Respiration 2023; 102:852-860. [PMID: 37634496 DOI: 10.1159/000533197] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/19/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) evaluation often requires lung biopsy for definite diagnosis. In recent years, transbronchial cryobiopsy (TBCB) emerged as a procedure with higher diagnostic yield than transbronchial forceps biopsy (TBFB), especially for fibrotic ILDs. Nonetheless, studies comparing these modalities in non-fibrotic ILDs and for specific ILD diagnoses are scarce. OBJECTIVES The aim of this study was to evaluate the diagnostic yield and safety of TBCB and TBFB in patients with fibrotic and non-fibrotic ILDs. METHOD An observational retrospective multicenter study including patients with ILD diagnosis by multidisciplinary discussion that underwent TBCB or TBFB between 2017 and 2021. Chest CT scans were reviewed by a chest radiologist. Biopsy specimens were categorized as diagnostic (with specific histological pattern), nondiagnostic, or without lung parenchyma. Nondiagnostic samples were reassessed by a second lung pathologist. TBCB and TBFB diagnostic yields were analyzed by multivariate regression. Procedural complications were evaluated as well. RESULTS 276 patients were included, 116 (42%) underwent TBCB and 160 (58%) TBFB. Fibrotic ILDs were present in 148 patients (54%). TBCB diagnostic yield was 78% and TBFB 48% (adjusted odds ratio [AOR] 4.2, 95% CI: 2.4-7.6, p < 0.01). The diagnostic yield of TBCB was higher than TBFB among patients with fibrotic ILD (AOR 3.8, p < 0.01), non-fibrotic ILD (AOR 5.8, p < 0.01), and across most ILD diagnoses. TBCB was associated with higher risk for significant bleeding (10% vs. 3%, p < 0.01), but similar risk for pneumothorax. CONCLUSIONS Diagnostic yield of TBCB was superior to that of TBFB for both fibrotic and non-fibrotic ILDs, and across most diagnoses.
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Affiliation(s)
- Ophir Freund
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel,
| | - Ori Wand
- Division of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sonia Schneer
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion Institute of Technology, Haifa, Israel
| | - Nevo Barel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Shalmon
- Department of Radiology, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Sarah Borsekofsky
- Pathology Department, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tzlil Hershko
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Evgeni Gershman
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yochai Adir
- Pulmonary Division, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion Institute of Technology, Haifa, Israel
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - David Shitrit
- Pulmonary Department, Meir Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Avraham Unterman
- Center of Excellence for Interstitial Lung Diseases, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
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3
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Cottin V, Martinez FJ, Smith V, Walsh SLF. Multidisciplinary teams in the clinical care of fibrotic interstitial lung disease: current perspectives. Eur Respir Rev 2022; 31:220003. [PMID: 38743511 DOI: 10.1183/16000617.0003-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/04/2022] [Indexed: 11/05/2022] Open
Abstract
Multidisciplinary team (MDT) meetings, involving the integrated collaboration of healthcare professionals, are increasingly used in clinical practice to inform the diagnosis and treatment of interstitial lung diseases (ILDs). Over time, the assessment of patients with ILD has transitioned from discussions among clinicians, radiologists and pathologists to the inclusion of a broader range of clinical data and specialist expertise. Studies have shown that a multidisciplinary approach can have many benefits for the clinical care of patients with ILD by improving the diagnostic confidence for different ILDs and guiding treatment decisions. The utility of MDT discussions for diagnosis, monitoring disease progression and management decisions, will need to be considered based on how it is best positioned in the diagnostic and therapeutic process, as well as the practicality and challenges of its use. There are also uncertainties and heterogeneity concerning the optimal practices of MDT meetings in ILD care. In this review, we describe recent developments refining the approach to MDTs in clinical practice, including who should be involved in the MDTs, when it is most needed, their use in patient management, challenges in their implementation, and ongoing controversies in the field that need further research.
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Affiliation(s)
- Vincent Cottin
- Louis Pradel Hospital, Reference Centre for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
- Claude Bernard University Lyon 1, UMR754, INRAE, Member of OrphaLung, RespiFil, Radico-ILD and ERN-LUNG, Lyon, France
| | | | - Vanessa Smith
- Dept of Rheumatology, Ghent University Hospital Dept of Internal Medicine, Ghent, Belgium
| | - Simon L F Walsh
- National Heart and Lung Institute, Imperial College London, London, UK
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4
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Green J, Nath S, Semaan R. Recent Advances in Transbronchial Lung Cryobiopsy. CURRENT PULMONOLOGY REPORTS 2022. [DOI: 10.1007/s13665-022-00288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Guerrera F, Costardi L, Rosboch GL, Lyberis P, Ceraolo E, Solidoro P, Filippini C, Verri G, Brazzi L, Albera C, Ruffini E. Awake or intubated surgery in diagnosis of interstitial lung diseases? A prospective study. ERJ Open Res 2021; 7:00630-2020. [PMID: 34235209 PMCID: PMC8255540 DOI: 10.1183/23120541.00630-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background Risks associated with video-assisted surgical lung biopsy (VASLB) for interstitial lung disease (ILD) with endotracheal intubation and mechanical ventilation are not nil. Awake video-assisted surgical lung biopsy (Awake-VASLB) has been proposed as a method to obtain a precise diagnosis in several different thoracic diseases. Objectives To compare clinical outcomes of Awake-VASLB and Intubated-VASLB in patients with suspected ILDs. Methods From June 2016 to February 2020, all patients submitted to elective VASLB for suspected ILD were included. Differences in outcomes between Awake-VASLB and Intubated-VASLB were assessed through univariable, multivariable-adjusted, and a propensity score-matched analysis. Results Awake-VASLB was performed in 66 out of 100 patients, while 34 underwent Intubated-VASLB. The Awake-VASLB resulted in a lower post-operative morbidity (OR 0.025; 95% CI 0.001–0.35; p=0.006), less unexpected intensive care unit admission, less need for rescue therapy for pain, a reduced surgical and anaesthesiologic time, a reduced chest drain duration, and a lower post-operative length of stay. Conclusion Awake-VASLB in patients affected by ILD is feasible and seems safer than Intubated-VASLB. Awake surgical lung biopsy in patients affected by ILD is feasible and safer than intubated surgical lung biopsyhttps://bit.ly/2SnMATh
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Affiliation(s)
- Francesco Guerrera
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Lorena Costardi
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Giulio L Rosboch
- Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,These authors contributed equally to this work
| | - Paraskevas Lyberis
- Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Edoardo Ceraolo
- Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Paolo Solidoro
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,Dept of Medical Sciences, University of Torino, Turin, Italy
| | | | - Giulia Verri
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Luca Brazzi
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Anesthesia, Intensive Care and Emergency, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Carlo Albera
- Division of Pulmonology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy.,Dept of Medical Sciences, University of Torino, Turin, Italy
| | - Enrico Ruffini
- Dept of Surgical Science, University of Torino, Turin, Italy.,Dept of Thoracic Surgery, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Turin, Italy
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6
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Ottaviani S, Khaleche S, Borie R, Debray MP, Dieudé P, Crestani B. Rheumatological evaluation of patients with interstitial lung disease. Scand J Rheumatol 2021; 51:34-41. [PMID: 34132624 DOI: 10.1080/03009742.2021.1907945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Interstitial lung disease (ILD) is a common feature of connective tissue disease (CTD). The diagnosis of CTD-ILD can be challenging and is important for therapeutic decisions. In this study, we aimed to determine whether a systematic rheumatological assessment could help pulmonologists in the diagnosis and care of ILD patients.Method: We conducted an observational single-centre study of patients with ILD. All patients underwent standardized pulmonary and rheumatological evaluations, including clinical evaluation (pulmonary symptoms and musculoskeletal signs), immunological screening, chest high-resolution computed tomography, pulmonary function tests, and ultrasonography (US) of joints and major salivary glands.Results: We included 100 consecutive ILD patients (47% women, mean ± sd age 67 ± 14 years); 15 patients already had CTD. The main extrapulmonary symptoms were joint pain (n = 52), joint swelling (n = 26), and sicca syndrome (n = 33). US of joints revealed synovitis, bone erosion, and tenosynovitis in 37, 17, and 13 patients, respectively. US of major salivary glands detected features associated with Sjögren's syndrome in 13 patients. After rheumatological evaluation, CTD-ILD was confidently diagnosed in 39 patients; diseases were mainly rheumatoid arthritis (n = 20), primary Sjögren's syndrome (n = 17), and inflammatory myopathies (n = 7). The diagnosis of CTD-ILD was associated with the presence of musculoskeletal symptoms and immunological and US abnormalities. The CTD diagnosis led to a therapeutic change in 21 patients.Conclusion: Our findings suggest that musculoskeletal symptoms are frequent in ILD patients, which supports multidisciplinary management, involving the rheumatologist, for evaluating patients with ILD.
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Affiliation(s)
- S Ottaviani
- Rheumatology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - S Khaleche
- Rheumatology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - R Borie
- Pulmonology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - M-P Debray
- Radiology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - P Dieudé
- Rheumatology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - B Crestani
- Pulmonology Department, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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7
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Ricci F, Cavallo AU, Luca P, Vincenzo DS, Monia P, D’Errico F, Benelli L, Paola R, Floris R, Chiocchi M. Radiological pitfalls associated with the diagnosis of usual interstitial pneumonia pattern on high-resolution computed tomography and associated findings: experience from a single Italian center. Acta Radiol 2021; 62:619-627. [PMID: 32586124 DOI: 10.1177/0284185120936270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The diagnostic algorithm for idiopathic pulmonary fibrosis (IPF) based on high-resolution computed tomography (HRCT) findings and multidisciplinary discussion (MDD) has been well established. PURPOSE To identify the causes of disagreement between non-thoracic and thoracic radiologist involved in MDD for the imaging diagnosis of usual interstitial pneumonia (UIP) patterns and associated findings on HRCT and to improve the understanding of IPF by non-expert radiologists through a more systematic approach to HRCT. MATERIAL AND METHODS This study included 68 patients who underwent MDD for suspected IPF. We compared the first reports generated before MDD by non-expert radiologists with the CT pattern and associated findings of IPF reported by thoracic radiologist involved in MDD. RESULTS Regarding the diagnosis of CT pattern by non-expert radiologists, 30/68 patients received a discordant diagnosis, and in another 28 reports, all features of the CT pattern were described without reaching a diagnostic conclusion. The first report was concordant in only 10 patients. For 63 cases in which associated findings were reported by expert radiologists in MDD, we documented discrepancies in 47 cases where associated findings were considered absent by the first non-thoracic radiologist. CONCLUSION We found significant discrepancies in the imaging diagnosis of UIP patterns and associated findings on HRCT between non-expert and thoracic radiologists included in MDD. Therefore, in this study, we analyzed and suggested diagnostic strategies to improve non-expert radiologists' approach to HRCT.
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Affiliation(s)
- Francesca Ricci
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
| | - Armando Ugo Cavallo
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
| | - Pugliese Luca
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
| | - De Stasio Vincenzo
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
| | - Pasqualetto Monia
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
| | - Francesca D’Errico
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
| | - Leonardo Benelli
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
| | - Rogliani Paola
- Respiratory Medicine, Department of Systems Medicine, University of Rome “Tor Vergata,” Rome, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
| | - Marcello Chiocchi
- Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome “Tor Vergata,” Rome, Italy
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8
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Davidsen JR, Lund LC, Laursen CB, Hallas J, Henriksen DP. Dynamics in diagnoses and pharmacotherapy before and after diagnosing idiopathic pulmonary fibrosis. ERJ Open Res 2020; 6:00479-2020. [PMID: 33263059 PMCID: PMC7682713 DOI: 10.1183/23120541.00479-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/28/2020] [Indexed: 01/12/2023] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a well-characterised interstitial lung disease. Typically, IPF diagnosis is delayed due to nonspecific symptoms, but can also be delayed due to treatment attempts on false indication or due to treatment targeting common comorbidities. This observational study aimed to assess the dynamics in the medication and diagnosis patterns in the period before and after an IPF diagnosis. Methods We identified all Danish patients with IPF between 2002 and 2017. We evaluated new and ongoing drug treatments and incident diagnoses 36 months before and 12 months after an IPF diagnosis by use of Danish nationwide registries. To aid interpretation, 10 random controls were recruited for each case. Results A total of 650 IPF patients were identified (median age 73 years (interquartile range 65–78), 70.3% males). Prior to the IPF diagnosis, the most prevalent diagnoses were dyspnoea and non-IPF interstitial lung diseases. For drug use, IPF patients had higher initiation rates for antibiotics, oral corticosteroids and mucolytics. In terms of drug volume, IPF patients used more respiratory drugs, antibiotics, immunosuppressants, corticosteroids, proton pump inhibitors, benzodiazepines and opium alkaloids within the 6 months preceding their IPF diagnosis, compared to the controls. Overall drug use decreased after an IPF diagnosis, mainly due to a reduced glucocorticoid and cardiovascular drug use. Conclusion Among IPF patients, an increased drug use was observed for diagnoses with symptoms overlapping those of IPF, particularly this was observed during the last 6 months before an IPF diagnosis. This emphasises the need for an increased IPF awareness. Among IPF patients, an increased drug use was observed for diagnoses with symptoms overlapping those of IPF. Particularly this was observed during the last 6 months before an IPF diagnosis. This emphasises the need for an increased IPF awareness.https://bit.ly/3bAzveS
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Affiliation(s)
- Jesper Rømhild Davidsen
- South Danish Center for Interstitial Lung Diseases, Odense University Hospital, Odense, Denmark.,Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars Christian Lund
- Clinical Pharmacology and Pharmacy, Dept of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christian B Laursen
- South Danish Center for Interstitial Lung Diseases, Odense University Hospital, Odense, Denmark.,Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark.,Dept of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Dept of Public Health, University of Southern Denmark, Odense, Denmark.,Dept of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Daniel Pilsgaard Henriksen
- Clinical Pharmacology and Pharmacy, Dept of Public Health, University of Southern Denmark, Odense, Denmark.,Dept of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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9
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Glass DS, Grossfeld D, Renna HA, Agarwala P, Spiegler P, Kasselman LJ, Glass AD, DeLeon J, Reiss AB. Idiopathic pulmonary fibrosis: Molecular mechanisms and potential treatment approaches. Respir Investig 2020; 58:320-335. [PMID: 32487481 DOI: 10.1016/j.resinv.2020.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/17/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive disease with high mortality that commonly occurs in middle-aged and older adults. IPF, characterized by a decline in lung function, often manifests as exertional dyspnea and cough. Symptoms result from a fibrotic process driven by alveolar epithelial cells that leads to increased migration, proliferation, and differentiation of lung fibroblasts. Ultimately, the differentiation of fibroblasts into myofibroblasts, which synthesize excessive amounts of extracellular matrix proteins, destroys the lung architecture. However, the factors that induce the fibrotic process are unclear. Diagnosis can be a difficult process; the gold standard for diagnosis is the multidisciplinary conference. Practical biomarkers are needed to improve diagnostic and prognostic accuracy. High-resolution computed tomography typically shows interstitial pneumonia with basal and peripheral honeycombing. Gas exchange and diffusion capacity are impaired. Treatments are limited, although the anti-fibrotic drugs pirfenidone and nintedanib can slow the progression of the disease. Lung transplantation is often contraindicated because of age and comorbidities, but it improves survival when successful. The incidence and prevalence of IPF has been increasing and there is an urgent need for improved therapies. This review covers the detailed cellular and molecular mechanisms underlying IPF progression as well as current treatments and cutting-edge research into new therapeutic targets.
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Affiliation(s)
- Daniel S Glass
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
| | - David Grossfeld
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
| | - Heather A Renna
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
| | - Priya Agarwala
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
| | - Peter Spiegler
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
| | - Lora J Kasselman
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
| | - Amy D Glass
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
| | - Joshua DeLeon
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
| | - Allison B Reiss
- Department of Medicine and Winthrop Research Institute, NYU Long Island School of Medicine and NYU Winthrop Hospital, Mineola, NY, USA.
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10
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McLean AEB, Webster SE, Fry M, Lau EM, Corte P, Torzillo PJ, Troy LK, Jo HE, Geis M, Rhodes JE, Cleary S, Spencer L, Corte TJ. Priorities and expectations of patients attending a multidisciplinary interstitial lung disease clinic. Respirology 2020; 26:80-86. [PMID: 32803876 DOI: 10.1111/resp.13913] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 04/04/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The significant and progressive morbidity associated with ILD mean that patients often struggle with the impact of this disease on their QOL and independence. To date, no studies have investigated the importance of multidisciplinary care on patient experience in ILD. We aimed to determine the expectations and priorities of patients attending a tertiary referral centre multidisciplinary ILD clinic. In particular, we sought to learn how important the multidisciplinary element of the clinic was to patients and which aspects of the clinic were most valued. METHODS An 18-item patient questionnaire was developed in conjunction with expert physicians and specialist nurses involved in the ILD clinic and sent to all patients on the centre's ILD registry at the time of the study (n = 240). Patients rated the importance of different aspects of their experience of attending the clinic. Data collected were analysed using descriptive statistics. Comparisons across disease severity were made using two-sided Z-tests for independent proportions. RESULTS A total of 100 respondents comprised the study group. Almost all respondents valued the multidisciplinary aspect of the clinic. Obtaining an accurate diagnosis and improving their disease understanding was most important to respondents. The importance of the ILD specialist nurse for both education and support increased with worsening disease severity. CONCLUSION Our results suggest that a multidisciplinary approach to the management of ILD with additional focus on patient education, as well as tailoring care to disease severity, is a plausible pathway to improving the patient experience with ILD.
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Affiliation(s)
- Anna E B McLean
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Susanne E Webster
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Research and Practice Development, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Edmund M Lau
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Peter Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Paul J Torzillo
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lauren K Troy
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Helen E Jo
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Monika Geis
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jessica E Rhodes
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Shannon Cleary
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lissa Spencer
- Discipline of Physiotherapy, Faculty of Health Science, University of Sydney, Sydney, NSW, Australia.,Department of Physiotherapy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Tamera J Corte
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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11
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Suryadevara V, Nazeer SS, Sreedhar H, Adelaja O, Kajdacsy-Balla A, Natarajan V, Walsh MJ. Infrared spectral microscopy as a tool to monitor lung fibrosis development in a model system. BIOMEDICAL OPTICS EXPRESS 2020; 11:3996-4007. [PMID: 33014581 PMCID: PMC7510888 DOI: 10.1364/boe.394730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 06/11/2023]
Abstract
Tissue fibrosis is a progressive and destructive disease process that can occur in many different organs including the liver, kidney, skin, and lungs. Fibrosis is typically initiated by inflammation as a result of chronic insults such as infection, chemicals and autoimmune diseases. Current approaches to examine organ fibrosis are limited to radiological and histological analyses. Infrared spectroscopic imaging offers a potential alternative approach to gain insight into biochemical changes associated with fibrosis progression. In this study, we demonstrate that IR imaging of a mouse model of pulmonary fibrosis can identify biochemical changes observed with fibrosis progression and the beginning of resolution using K-means analysis, spectral ratios and multivariate data analysis. This study demonstrates that IR imaging may be a useful approach to understand the biochemical events associated with fibrosis initiation, progression and resolution for both the clinical setting and for assessing novel anti-fibrotic drugs in a model system.
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Affiliation(s)
- Vidyani Suryadevara
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Shaiju S. Nazeer
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Hari Sreedhar
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Oluwatobi Adelaja
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - André Kajdacsy-Balla
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Viswanathan Natarajan
- Department of Pharmacology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Contributed equally as senior co-authors
| | - Michael J. Walsh
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Pathology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Contributed equally as senior co-authors
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12
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Cheema TJ, Young M, Rabold E, Barbieri AN, Baldwin N, Steen VD. Patient and Physician Perspectives on Systemic Sclerosis-Associated Interstitial Lung Disease. Clin Med Insights Circ Respir Pulm Med 2020; 14:1179548420913281. [PMID: 32214863 PMCID: PMC7081464 DOI: 10.1177/1179548420913281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/23/2020] [Indexed: 12/22/2022] Open
Abstract
Systemic sclerosis-associated interstitial lung disease is challenging to diagnose and treat. Patients and physicians can perceive the disease differently and have different views on its management. Communication issues between them can lead to suboptimal disease management. Despite a clear need for improvement in the speed and accuracy of the diagnostic workup, the heterogeneity of clinical symptoms renders the process long and challenging. When considering treatment options, physicians may be more focused on the evidence supporting a particular treatment or on a patient's pulmonary function test results, as opposed to the realities of the patient's difficulties with symptoms or the psychosocial effects of systemic sclerosis-associated interstitial lung disease. Disease management plans should be determined by the patient's own preferences and goals as well as the objective clinical situation. Health care providers must consider their patients as partners on a journey in which treatment decisions are reached jointly. This review will focus on the perspectives of physicians and patients in relation to the diagnosis and management of systemic sclerosis-associated interstitial lung disease. Similarities and differences in these perspectives will be identified, and strategies for achieving optimal disease management will be proposed.
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Affiliation(s)
- Tariq J Cheema
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Meilin Young
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Erica Rabold
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ashley N Barbieri
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Virginia D Steen
- Division of Rheumatology, Department of Medicine, School of Medicine, Georgetown University, Washington, DC, USA
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13
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Sul B, Flors L, Cassani J, Morris MJ, Reifman J, Altes T, Wallqvist A. Volumetric characteristics of idiopathic pulmonary fibrosis lungs: computational analyses of high-resolution computed tomography images of lung lobes. Respir Res 2019; 20:216. [PMID: 31604436 PMCID: PMC6787976 DOI: 10.1186/s12931-019-1189-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease involving progressive degeneration of lung capacity. Current diagnosis of IPF heavily relies on visual evaluation of fibrotic features in high-resolution computed tomography (HRCT) images of the lungs. Although the characteristics of this disease have been studied at the molecular and cellular levels, little is known about the mechanical characteristics of IPF lungs inferred from HRCT images. To this end, we performed a pilot study to investigate the radiographic and volumetric characteristics of lungs in subjects with IPF. METHODS We collected HRCT images of healthy (N = 13) and IPF (N = 9) lungs acquired at breath-holds after full inspiration (expanded state) and full expiration (contracted state). We performed statistical analyses on Hounsfield unit (HU) histograms, lobar volumes (V: lobe volume normalized by the lung volume), and lobar flows (Q: the difference in lobe volume divided by the difference in lung volume between the expanded and contracted states). RESULTS Parameters characterizing the HU histograms (i.e., mean, median, skewness, and kurtosis) significantly differed between healthy and IPF subjects, for all lobes in both expanded and contracted states. The distribution of V across lobes differed significantly between the groups in both states. The distribution of Q also differed significantly between the groups: Q values of the lower lobes for the IPF group were 33% (right) and 22% (left) smaller than those for the healthy group, consistent with the observation that radiographic scores were highest in the lower lung section in IPF. Notably, the root-mean-squared difference (RMSD) of Q, a measure of distance from the mean value of the healthy group, clearly distinguished the IPF subjects (RMSD of Q > 1.59) from the healthy group (RMSD of Q < 0.67). CONCLUSION This study shows that lung volume and flow distribution change heterogeneously across the lung lobes of IPF subjects, with reduced capacity in the lower lobes. These volumetric changes may improve our understanding of the pathophysiology in IPF lungs.
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Affiliation(s)
- Bora Sul
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.,The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, 20817, MD, USA
| | - Lucia Flors
- Department of Radiology, University of Missouri, Columbia, 65211, MO, USA
| | - Joanne Cassani
- Department of Radiology, University of Missouri, Columbia, 65211, MO, USA
| | - Michael J Morris
- Pulmonary/Critical Care, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, 78234, TX, USA
| | - Jaques Reifman
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA.
| | - Talissa Altes
- Department of Radiology, University of Missouri, Columbia, 65211, MO, USA
| | - Anders Wallqvist
- Department of Defense Biotechnology High Performance Computing Software Applications Institute, Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, FCMR-TT, 504 Scott Street, Fort Detrick, MD, 21702-5012, USA
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14
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Human disorders associated with inflammation and the evolving role of natural products to overcome. Eur J Med Chem 2019; 179:272-309. [PMID: 31255927 DOI: 10.1016/j.ejmech.2019.06.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
Inflammation is a biological function which triggered after the mechanical tissue disruption or from the responses by the incidence of physical, chemical or biological negotiator in body. These responses are essential act provided by the immune system during infection and tissue injury to maintain normal tissue homeostasis. Inflammation is a quite complicated process at molecular level with the involvement of several proinflammatory expressions. Several health problems are associated with prolonged inflammation, which effects nearly all major to minor diseases. The molecular and epidemiological studies jagged that the inflammation is closely associated with several disorders with their specific targets. It would be great achievement for human health around the world to overcome on inflammation. Mostly used anti-inflammatory drugs are at high risk of side effects and also expensive. Hence, the plant-based formulations gained a wide acceptance by the public and medical experts to treat it. Due to extensive dispersal, chemical diversity and systematically established biological potentials of natural products have induced renewed awareness as a gifted source for medications. However, today's urgent need to search for cheaper, more potent and safe anti-inflammatory medications to overcome on current situation. The goal of this review to compile an update on inflammation, associated diseases, molecular targets, inflammatory mediators and role of natural products. The entire text concise the involvement of various cytokines in pathogenesis of various human disorders. This assignment discussed about 321 natural products with their promising anti-inflammatory potential discovered during January 2009 to December 2018 with 262 citations.
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15
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Gohar A. Response to ‘Reply to Gohar on “Lungs, methotrexate and psoriasis”, a comment on “Fatal, incidental, idiopathic pulmonary fibrosis in a patient receiving long‐term low‐dose methotrexate for psoriasis”’. Clin Exp Dermatol 2019; 44:948. [DOI: 10.1111/ced.14002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 12/22/2022]
Affiliation(s)
- A. Gohar
- Hosary Medical Charity Centre Giza Egypt
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16
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Schulze AB, Evers G, Kümmel A, Rosenow F, Sackarnd J, Hering JP, Schülke C, Engelbertz JA, Görlich D, Barth PJ, Lenz G, Becker H, Mohr M, Schmidt LH. Cyclophosphamide pulse therapy as treatment for severe interstitial lung diseases. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:157-166. [PMID: 32476949 DOI: 10.36141/svdld.v36i2.7636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/24/2019] [Indexed: 11/02/2022]
Abstract
Introduction Besides invasive or non-invasive ventilation, treatment of severe forms of interstitial lung diseases (ILD) includes immunosuppressive medication. In case of refractory organ- or life-threatening courses of disease, cyclophosphamide pulse therapy can serve as a rescue treatment option. Objectives To investigate therapeutic and prognostic effects of cyclophosphamide for the treatment of severe forms of ILD on intensive care unit (ICU) we performed this analysis. Methods Between 2009 and 2017 we identified 14 patients, who were treated on intensive care unit (ICU) with severe forms of ILD. Retrospectively, clinical, radiologic and prognostic data were collected and evaluated. Results Our analysis demonstrated a prognostic impact of cyclophosphamide on the ILD in general. Whereas pulmonary manifestations of both systemic sclerosis (SSc) and ANCA-associated vasculitis had an improved outcome, a reduced overall survival was found for Goodpasture syndrome (GPS), dermatomyositis (DM), cryptogenic organizing pneumonia (COP) and drug reaction with eosinophilia and systemic symptoms (DRESS; p=0.040, logrank test). Besides, additional plasmapheresis and initiation of cyclophosphamide within ten days following initial diagnosis of ILD were associated with improved prognosis. Conclusion Positive prognostic effects of cyclophosphamide pulse therapy in ICU treated patients suffering from severe respiratory failure due to pulmonary manifestations of both SSc and ANCA-associated-vasculitis were observed. Further prognostic and therapeutic data are needed for cyclophosphamide for this indication in order to prevent patients from its toxic side-effects, who most likely will not benefit from its application.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as first authors
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as first authors
| | - Andreas Kümmel
- Department of Hematology, Medical Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Philipp Hering
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Christoph Schülke
- Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany
| | - Jonas Andreas Engelbertz
- Unit of Cytostatic Reconstitution, Hospital pharmacy, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - Peter J Barth
- Gerhard-Domagk-Institute of Pathology, University Hospital Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,Cluster of Excellence EXC 1003, Cells in Motion, Muenster, Germany
| | - Heidemarie Becker
- Department of Medicine D, Nephrology, Rheumatology and Hypertensiology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as senior authors
| | - Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany.,these authors are contributed equally to this work as senior authors
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17
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Levi Y, Israeli-Shani L, Kuchuk M, Epstein Shochet G, Koslow M, Shitrit D. Rheumatological Assessment Is Important for Interstitial Lung Disease Diagnosis. J Rheumatol 2018; 45:1509-1514. [PMID: 30111640 DOI: 10.3899/jrheum.171314] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Interstitial lung diseases (ILD) form a diverse group of parenchymal lung disorders. Currently, a multidisciplinary team (MDT) including pulmonologists, radiologists, and pathologists is the gold standard for ILD diagnosis. Recently, additional subtypes of connective tissue disease (CTD)-ILD with autoimmune features were defined, making the rheumatological assessment increasingly important. We aimed to assess the effect of adding a rheumatologist to the MDT for routine rheumatology assessment. METHODS A prospective study that assessed newly diagnosed ILD patients by 2 parallel blinded arms; all patients were evaluated by both MDT (e.g., history, physical examination, blood tests, pulmonary function tests, and biopsies, if needed) and a rheumatologist (e.g., history, physical examination, blood and serological tests). RESULTS Sixty patients were assessed with the mean age of 67.3 ± 12 years, 55% male, and 28% smokers. The rheumatological assessment reclassified 21% of the idiopathic pulmonary fibrosis as CTD. Moreover, the number of CTD-ILD with autoimmune features was increased by 77%. These included antineutrophil cytoplasmic antibody-associated vasculitis, antisynthetase syndrome, and IgG4-related ILD. Retrospectively, rheumatological evaluation could have saved 7 bronchoscopies and 1 surgical biopsy. CONCLUSION Adding routine rheumatology assessments could significantly increase diagnostic accuracy and reduce invasive procedures.
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Affiliation(s)
- Yair Levi
- From the Internal Medicine Department E and Pulmonary Department, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Internal Medicine Department A, Hillel Yaffe Medical Center, Hadera, Israel; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Y. Levi, MD, Internal Medicine Department E, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; L. Israeli-Shani, MD, Pulmonary Department, Meir Medical Center; M. Kuchuk, MD, Internal Medicine Department A, Hillel Yaffe Medical Center; G. Epstein Shochet, PhD, Pulmonary Department, Meir Medical Center; M. Koslow, MD, Pulmonary and Critical Care Medicine, Mayo Clinic; D. Shitrit, MD, Pulmonary Department, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University. Y. Levi and L. Israeli-Shani contributed equally to this study
| | - Lilach Israeli-Shani
- From the Internal Medicine Department E and Pulmonary Department, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Internal Medicine Department A, Hillel Yaffe Medical Center, Hadera, Israel; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Y. Levi, MD, Internal Medicine Department E, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; L. Israeli-Shani, MD, Pulmonary Department, Meir Medical Center; M. Kuchuk, MD, Internal Medicine Department A, Hillel Yaffe Medical Center; G. Epstein Shochet, PhD, Pulmonary Department, Meir Medical Center; M. Koslow, MD, Pulmonary and Critical Care Medicine, Mayo Clinic; D. Shitrit, MD, Pulmonary Department, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University. Y. Levi and L. Israeli-Shani contributed equally to this study
| | - Michael Kuchuk
- From the Internal Medicine Department E and Pulmonary Department, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Internal Medicine Department A, Hillel Yaffe Medical Center, Hadera, Israel; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Y. Levi, MD, Internal Medicine Department E, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; L. Israeli-Shani, MD, Pulmonary Department, Meir Medical Center; M. Kuchuk, MD, Internal Medicine Department A, Hillel Yaffe Medical Center; G. Epstein Shochet, PhD, Pulmonary Department, Meir Medical Center; M. Koslow, MD, Pulmonary and Critical Care Medicine, Mayo Clinic; D. Shitrit, MD, Pulmonary Department, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University. Y. Levi and L. Israeli-Shani contributed equally to this study
| | - Gali Epstein Shochet
- From the Internal Medicine Department E and Pulmonary Department, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Internal Medicine Department A, Hillel Yaffe Medical Center, Hadera, Israel; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Y. Levi, MD, Internal Medicine Department E, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; L. Israeli-Shani, MD, Pulmonary Department, Meir Medical Center; M. Kuchuk, MD, Internal Medicine Department A, Hillel Yaffe Medical Center; G. Epstein Shochet, PhD, Pulmonary Department, Meir Medical Center; M. Koslow, MD, Pulmonary and Critical Care Medicine, Mayo Clinic; D. Shitrit, MD, Pulmonary Department, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University. Y. Levi and L. Israeli-Shani contributed equally to this study
| | - Matthew Koslow
- From the Internal Medicine Department E and Pulmonary Department, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Internal Medicine Department A, Hillel Yaffe Medical Center, Hadera, Israel; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Y. Levi, MD, Internal Medicine Department E, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; L. Israeli-Shani, MD, Pulmonary Department, Meir Medical Center; M. Kuchuk, MD, Internal Medicine Department A, Hillel Yaffe Medical Center; G. Epstein Shochet, PhD, Pulmonary Department, Meir Medical Center; M. Koslow, MD, Pulmonary and Critical Care Medicine, Mayo Clinic; D. Shitrit, MD, Pulmonary Department, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University. Y. Levi and L. Israeli-Shani contributed equally to this study
| | - David Shitrit
- From the Internal Medicine Department E and Pulmonary Department, Meir Medical Center, Kfar Saba; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv; Internal Medicine Department A, Hillel Yaffe Medical Center, Hadera, Israel; Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA. .,Y. Levi, MD, Internal Medicine Department E, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University; L. Israeli-Shani, MD, Pulmonary Department, Meir Medical Center; M. Kuchuk, MD, Internal Medicine Department A, Hillel Yaffe Medical Center; G. Epstein Shochet, PhD, Pulmonary Department, Meir Medical Center; M. Koslow, MD, Pulmonary and Critical Care Medicine, Mayo Clinic; D. Shitrit, MD, Pulmonary Department, Meir Medical Center, and Sackler Faculty of Medicine, Tel Aviv University. Y. Levi and L. Israeli-Shani contributed equally to this study.
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18
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Jones KD. Unclassifiable interstitial lung disease: a pathologist's perspective. Eur Respir Rev 2018; 27:27/147/170132. [DOI: 10.1183/16000617.0132-2017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/26/2017] [Indexed: 12/21/2022] Open
Abstract
Classifying pulmonary fibrotic disease into various diagnostic categories provides the clinician with expectations for both prognosis and proper treatment. Despite years of experience with histological, radiological and clinical guidelines, a group of patients remains with unclassifiable interstitial lung disease. In this article, the possible barriers to classification will be explored, and some strategies will be discussed to aid in overcoming these barriers.
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19
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Walsh SLF. Multidisciplinary evaluation of interstitial lung diseases: current insights: Number 1 in the Series "Radiology" Edited by Nicola Sverzellati and Sujal Desai. Eur Respir Rev 2017; 26:26/144/170002. [PMID: 28515041 DOI: 10.1183/16000617.0002-2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/18/2017] [Indexed: 11/05/2022] Open
Abstract
Multidisciplinary team (MDT) diagnosis is regarded as the diagnostic reference standard for interstitial lung disease (ILD). Several studies have reported that MDT diagnosis is associated with higher levels of diagnostic confidence and better interobserver agreement when compared to the individual components of the MDT in isolation. Although this recommendation is widely accepted, no guideline statement specifies what constitutes an MDT meeting and how its participants should govern it. Furthermore, the precise role of an MDT meeting in the setting of ILD may vary from one group to another. For example, in some cases, the meeting will confine its discussion to characterising the disease and formulating diagnosis. In others, management decisions may also be part of the discussion. Surprisingly, there is no consensus on how MDT diagnosis is validated. As multidisciplinary evaluation contains all the available clinical information on an individual patient, there is no reference standard against which the veracity of MDT diagnosis can be tested. Finally, many of these uncertainties surrounding MDT meeting practice are unlikely to be answered by traditional evidence-based studies, which create difficulties when generating guideline recommendations. There is clearly a need for expert consensus on what constitutes acceptable MDT meeting practice. This consensus will need to be flexible to accommodate the variability in resources available to fledgling MDT groups and the variable nature of patients requiring discussion.
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20
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Tomassetti S, Ravaglia C, Poletti V. Diffuse parenchymal lung disease. Eur Respir Rev 2017; 26:26/144/170004. [PMID: 28446601 DOI: 10.1183/16000617.0004-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/01/2017] [Indexed: 12/16/2022] Open
Abstract
Between September 2015 and August 2016 there were >1500 publications in the field of diffuse parenchymal lung diseases (DPLDs). For the Clinical Year in Review session at the European Respiratory Society Congress that was held in London, UK, in September 2016, we selected only five articles. This selection, made from the enormous number of published papers, does not include all the relevant studies that will significantly impact our knowledge in the field of DPLDs in the near future. This review article provides our personal view on the following topics: early diagnosis of idiopathic pulmonary fibrosis, current knowledge on the multidisciplinary team diagnosis of DPLDs and the diagnostic role of transbronchial cryobiopsy in this diagnostic setting, insights on the new entity of interstitial pneumonia with autoimmune features, and new therapeutic approaches for scleroderma-related interstitial lung disease.
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Affiliation(s)
- Sara Tomassetti
- Dept of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Claudia Ravaglia
- Dept of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Venerino Poletti
- Dept of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy.,Dept of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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Walsh SLF, Wells AU, Desai SR, Poletti V, Piciucchi S, Dubini A, Nunes H, Valeyre D, Brillet PY, Kambouchner M, Morais A, Pereira JM, Moura CS, Grutters JC, van den Heuvel DA, van Es HW, van Oosterhout MF, Seldenrijk CA, Bendstrup E, Rasmussen F, Madsen LB, Gooptu B, Pomplun S, Taniguchi H, Fukuoka J, Johkoh T, Nicholson AG, Sayer C, Edmunds L, Jacob J, Kokosi MA, Myers JL, Flaherty KR, Hansell DM. Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study. THE LANCET RESPIRATORY MEDICINE 2016; 4:557-565. [PMID: 27180021 DOI: 10.1016/s2213-2600(16)30033-9] [Citation(s) in RCA: 293] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diffuse parenchymal lung disease represents a diverse and challenging group of pulmonary disorders. A consistent diagnostic approach to diffuse parenchymal lung disease is crucial if clinical trial data are to be applied to individual patients. We aimed to evaluate inter-multidisciplinary team agreement for the diagnosis of diffuse parenchymal lung disease. METHODS We did a multicentre evaluation of clinical data of patients who presented to the interstitial lung disease unit of the Royal Brompton and Harefield NHS Foundation Trust (London, UK; host institution) and required multidisciplinary team meeting (MDTM) characterisation between March 1, 2010, and Aug 31, 2010. Only patients whose baseline clinical, radiological, and, if biopsy was taken, pathological data were undertaken at the host institution were included. Seven MDTMs, consisting of at least one clinician, radiologist, and pathologist, from seven countries (Denmark, France, Italy, Japan, Netherlands, Portugal, and the UK) evaluated cases of diffuse parenchymal lung disease in a two-stage process between Jan 1, and Oct 15, 2015. First, the clinician, radiologist, and pathologist (if lung biopsy was completed) independently evaluated each case, selected up to five differential diagnoses from a choice of diffuse lung diseases, and chose likelihoods (censored at 5% and summing to 100% in each case) for each of their differential diagnoses, without inter-disciplinary consultation. Second, these specialists convened at an MDTM and reviewed all data, selected up to five differential diagnoses, and chose diagnosis likelihoods. We compared inter-observer and inter-MDTM agreements on patient first-choice diagnoses using Cohen's kappa coefficient (κ). We then estimated inter-observer and inter-MDTM agreement on the probability of diagnosis using weighted kappa coefficient (κw). We compared inter-observer and inter-MDTM confidence of patient first-choice diagnosis. Finally, we evaluated the prognostic significance of a first-choice diagnosis of idiopathic pulmonary fibrosis (IPF) versus not IPF for MDTMs, clinicians, and radiologists, using univariate Cox regression analysis. FINDINGS 70 patients were included in the final study cohort. Clinicians, radiologists, pathologists, and the MDTMs assigned their patient diagnoses between Jan 1, and Oct 15, 2015. IPF made up 88 (18%) of all 490 MDTM first-choice diagnoses. Inter-MDTM agreement for first-choice diagnoses overall was moderate (κ=0·50). Inter-MDTM agreement on diagnostic likelihoods was good for IPF (κw=0·71 [IQR 0·64-0·77]) and connective tissue disease-related interstitial lung disease (κw=0·73 [0·68-0·78]); moderate for non-specific interstitial pneumonia (NSIP; κw=0·42 [0·37-0·49]); and fair for hypersensitivity pneumonitis (κw=0·29 [0·24-0·40]). High-confidence diagnoses (>65% likelihood) of IPF were given in 68 (77%) of 88 cases by MDTMs, 62 (65%) of 96 cases by clinicians, and in 57 (66%) of 86 cases by radiologists. Greater prognostic separation was shown for an MDTM diagnosis of IPF than compared with individual clinician's diagnosis of this disease in five of seven MDTMs, and radiologist's diagnosis of IPF in four of seven MDTMs. INTERPRETATION Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF, as validated by the non-significant greater prognostic separation of an IPF diagnosis made by MDTMs than the separation of a diagnosis made by individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than did clinicians or radiologists. This difference is of particular importance, because accurate and consistent diagnoses of IPF are needed if clinical outcomes are to be optimised. Inter-multidisciplinary team agreement for a diagnosis of hypersensitivity pneumonitis is low, highlighting an urgent need for standardised diagnostic guidelines for this disease. FUNDING National Institute of Health Research, Imperial College London.
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Affiliation(s)
| | | | - Sujal R Desai
- King's College Hospital NHS Foundation Trust, London, UK
| | - Venerino Poletti
- Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Sara Piciucchi
- Department of Radiology, GB Morgagni Hospital, Forlì, Italy
| | - Alessandra Dubini
- Department of Surgical Pathology, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Hilario Nunes
- Université Paris, Sorbonne Paris Cité, EA2363 Réponses cellulaires et fonctionnelles à l'hypoxie, Bobigny, France; Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France
| | - Dominique Valeyre
- Université Paris, Sorbonne Paris Cité, EA2363 Réponses cellulaires et fonctionnelles à l'hypoxie, Bobigny, France; Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France
| | - Pierre Y Brillet
- Université Paris, Sorbonne Paris Cité, EA2363 Réponses cellulaires et fonctionnelles à l'hypoxie, Bobigny, France; Service de Radiologie, Hôpital Avicenne, Bobigny, France
| | | | - António Morais
- Serviço de Pneumologia, Porto, Portugal; Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | | | - Jan C Grutters
- ILD Center of Excellence St Antonius Hospital, Division Heart and Lungs, University, Medical Centre Utrecht, Netherlands
| | | | - Hendrik W van Es
- Department of Radiology, St Antonius Hospital, Nieuwegein, Netherlands
| | | | | | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Line B Madsen
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Bibek Gooptu
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Sabine Pomplun
- Department of Cellular Pathology, University College Hospital London, London, UK
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Japan
| | | | - Charlie Sayer
- Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - Lilian Edmunds
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Joseph Jacob
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Jeffrey L Myers
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Kevin R Flaherty
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
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Ravaglia C, Bonifazi M, Wells AU, Tomassetti S, Gurioli C, Piciucchi S, Dubini A, Tantalocco P, Sanna S, Negri E, Tramacere I, Ventura VA, Cavazza A, Rossi A, Chilosi M, La Vecchia C, Gasparini S, Poletti V. Safety and Diagnostic Yield of Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases: A Comparative Study versus Video-Assisted Thoracoscopic Lung Biopsy and a Systematic Review of the Literature. Respiration 2016; 91:215-27. [PMID: 26926876 DOI: 10.1159/000444089] [Citation(s) in RCA: 244] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A diagnosis of interstitial lung diseases (ILDs) may include surgical lung biopsy (SLB), which is associated with significant morbidity and mortality and also appreciable costs. Transbronchial lung cryobiopsy (TBLC) is adopting an important role. OBJECTIVES The aim of this study was to compare the diagnostic yield (DY) and safety of TBLC and SLB in a large cohort of patients and to perform a systematic review of the literature as well as a meta-analysis. METHODS We performed a retrospective analysis of 447 cases with ILD undergoing TBLC and/or SLB and a systematic review of the literature (MEDLINE and Embase for all original articles on the DY and safety of TBLC in ILDs up to July 2015). RESULTS A total of 150 patients underwent SLB and 297 underwent TBLC. The median time of hospitalization was 6.1 days (SLB) and 2.6 days (TBLC; p < 0.0001). Mortality due to adverse events was observed for 2.7% (SLB) and 0.3% (TBLC) of the patients. Pneumothorax was the most common complication after TBLC (20.2%). No severe bleeding was observed. TBLC was diagnostic for 246 patients (82.8%), SLB for 148 patients (98.7%, p = 0.013). A meta-analysis of 15 investigations including 781 patients revealed an overall DY of 0.81 (0.75-0.87); the overall pooled probability of developing a pneumothorax, as retrieved from 15 studies including 994 patients, was 0.06 (95% CI 0.02-0.11). CONCLUSION Cryobiopsy is safe and has lower complication and mortality rates compared to SLB. TBLC might, therefore, be considered the first diagnostic approach for obtaining tissue in ILDs, reserving the surgical approach for cases in which TBLC is not diagnostic.
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Affiliation(s)
- Claudia Ravaglia
- Pulmonology Unit, Department of Thoracic Diseases, G.B. Morgagni - L. Pierantoni Hospital, Forlx00EC;, Italy
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Consensus document for the diagnosis and treatment of idiopathic pulmonary fibrosis: Joint Consensus of Sociedade Portuguesa de Pneumologia, Sociedade Portuguesa de Radiologia e Medicina Nuclear e Sociedade Portuguesa de Anatomia Patológica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2016; 22:112-22. [PMID: 26906287 DOI: 10.1016/j.rppnen.2016.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Indexed: 12/15/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a rare interstitial lung disease included in the Idiopathic Interstitial Pneumonias group. Although several potential risk factors have been described, it is a progressive fibrosing disease of unknown cause affecting mainly adults over 50 years and associated with a poor prognosis, reflected in a median survival of 2-3 years after diagnosis. The concept of a multidisciplinary working group for the diagnosis of idiopathic pulmonary fibrosis is based on the need to have experienced pulmonologists, radiologists and pathologists in the evaluation and correct treatment of the disease, and requires the use of all available data about individual patients, standardized (largely through High Resolution Computed Tomography and pathology when needed) as well as non-standardized data (laboratory, serology and biomarkers). This approach helps to increase diagnostic accuracy and is an internationally accepted recommendation. In regard to therapy, the situation has changed radically since the publication of the ATS/ERS/JRS/ALAT 2011 guidelines on the diagnosis and management of idiopathic pulmonary fibrosis where it was stressed that no proven therapy exists for this disease. Currently besides non-pharmacological treatment, therapy of complications and comorbidities and palliative care, nintedanib and pirfenidone, two compounds with pleiotropic mechanisms of action, are to date, the two drugs with confirmed efficacy in slowing functional decline and disease progression in idiopathic pulmonary fibrosis patients.
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Bonella F, Wijsenbeek M, Molina-Molina M, Duck A, Mele R, Geissler K, Wuyts W. European IPF Patient Charter: unmet needs and a call to action for healthcare policymakers. Eur Respir J 2015; 47:597-606. [DOI: 10.1183/13993003.01204-2015] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 09/20/2015] [Indexed: 11/05/2022]
Abstract
Patient advocacy groups play an important role in supporting patients with chronic diseases and promoting better care. The aim of this patient–physician initiative was to gather perceptions from European idiopathic pulmonary fibrosis (IPF) patient advocacy groups regarding inequalities and unmet needs in IPF care, in order to develop a Patient Charter to advocate for better care.In total, 11 European patient advocacy groups were interviewed regarding the care of patients with IPF in their countries. Interview feedback was presented to a Working Group including patient advocacy group representatives and IPF specialists; key areas of agreement were developed into the European IPF Patient Charter.The interviews identified five key themes that fed into the final Charter: the need for improved diagnosis, treatment access, holistic care, disease awareness and palliative care. The final Charter was endorsed by patient advocacy groups and presented to 26 Members of the European Parliament in September 2014. It has received >8900 signatures to date.This patient–physician initiative highlights the inequalities and unmet needs in IPF care across Europe, and demonstrates how this insight can inform the development of a Patient Charter, designed as a call to action for healthcare policymakers to drive improvement in European IPF care.
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Abstract
Medicinal plants have been the main remedy to treat various ailments for a long time and nowadays, many drugs have been developed from traditional medicine. This paper reviews some medicinal plants and their main constituents which possess anti-inflammatory activities useful for curing joint inflammation, inflammatory skin disorders, cardiovascular inflammation and other inflammatory diseases. Here, we provide a brief overview of quick and easy reading on the role of medicinal plants and their main constituents in these inflammatory diseases. We hope that this overview will shed some light on the function of these natural anti-inflammatory compounds and attract the interest of investigators aiming at the design of novel therapeutic approaches for the treatment of various inflammatory conditions.
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Affiliation(s)
- Francesco Maione
- a Department of Pharmacy , University of Naples, Federico II , Naples , Italy
| | - Rosa Russo
- a Department of Pharmacy , University of Naples, Federico II , Naples , Italy
| | - Haroon Khan
- b Department of Pharmacy , Abdul Wali Khan University of Mardan , Mardan , Pakistan
| | - Nicola Mascolo
- a Department of Pharmacy , University of Naples, Federico II , Naples , Italy
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