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Child CE, Kelly ML, Sizelove H, Garvin M, Guilliams J, Kim P, Cai HD, Luo S, McQuade KJ, Swenson ER, Wise AT, Lynch YT, Ho LA, Brown MB. A remote monitoring-enabled home exercise prescription for patients with interstitial lung disease at risk for exercise-induced desaturation. Respir Med 2023; 218:107397. [PMID: 37640274 DOI: 10.1016/j.rmed.2023.107397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
RATIONALE Alternatives to center-based pulmonary rehabilitation are needed to improve patient access to this important therapy. A critical challenge to overcome is how to maximize safety of unsupervised exercise for at-risk patients. We investigated if a novel remote monitoring-enabled mobile health (mHealth) program is safe, feasible, and effective for patients who experience exercise-induced hemoglobin desaturation. METHODS An interstitial lung disease (ILD) commonly associated with pronounced exercise desaturation was investigated - the rare, female-predominant ILD lymphangioleiomyomatosis (LAM). Over a 12-week program, hemoglobin saturation (SpO2) was continuously recorded during all home exercise sessions. Intervention effects were assessed with 6-min walk test (6MWT), maximal cardiopulmonary exercise test (CPET), lower extremity computerized dynamometry, pulmonary function tests, and health-related quality of life (QoL) surveys. Safety was assessed by blood biomarkers of systemic inflammation and cardiac wall stress, and incidence of adverse events. RESULTS Fifteen LAM patients enrolled and 14 completed the intervention, with high adherence to aerobic (87 ± 15%) and strength (87 ± 12%) training components. An innovative characterization of exercise training SpO2 revealed that while mild-to-moderate desaturation was common during home workouts, participants were able to self-adjust exercise intensity and supplemental oxygen levels to maintain recommended exercise parameters. Significant improvements included 6MWT distance (+36 ± 34 m, p = 0.003), CPET time (p = 0.04), muscular endurance (p = 0.008), QoL (p = 0.009 to 0.03), and fatigue (p = 0.001 to 0.03). Patient acceptability and satisfaction indicators were high, blood biomarkers remained stable (p > 0.05), and no study-related adverse events occurred. CONCLUSION A remote monitoring-enabled home exercise program is a safe, feasible, and effective approach even for patients who experience exercise desaturation.
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Affiliation(s)
- Claire E Child
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Morgan L Kelly
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Haley Sizelove
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Marissa Garvin
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Julia Guilliams
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Paul Kim
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Haotian D Cai
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - SiWei Luo
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Kevin J McQuade
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Erik R Swenson
- Medical Service, VA Puget Sound Health Care System, USA; University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA.
| | - Amanda T Wise
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
| | - Ylinne T Lynch
- University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA.
| | - Lawrence A Ho
- University of Washington, Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, USA.
| | - Mary Beth Brown
- University of Washington, Department of Rehabilitation Medicine, Division of Physical Therapy, USA.
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Raghu G, Hamblin MJ, Brown AW, Golden JA, Ho LA, Wijsenbeek MS, Vasakova M, Pesci A, Antin-Ozerkis DE, Meyer KC, Kreuter M, Burgess T, Kamath N, Donaldson F, Richeldi L. Long-term evaluation of the safety and efficacy of recombinant human pentraxin-2 (rhPTX-2) in patients with idiopathic pulmonary fibrosis (IPF): an open-label extension study. Respir Res 2022; 23:129. [PMID: 35597980 PMCID: PMC9123757 DOI: 10.1186/s12931-022-02047-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Recombinant human pentraxin-2 (rhPTX-2) significantly decreased decline in percent predicted forced vital capacity (FVC) and stabilized 6-min walk distance (6MWD) in patients with idiopathic pulmonary fibrosis (IPF) during the 28-week, placebo-controlled, randomized period of the Phase II PRM-151–202 study. Interim (76-week) data from the open-label extension (OLE) demonstrated sustained safety and efficacy with rhPTX-2 treatment. Here, we present the entire long-term OLE safety and efficacy data to 128 weeks. Methods Patients who completed the randomized PRM-151–202 study period were eligible for the OLE, during which all patients received rhPTX-2, having started rhPTX-2 (i.e., crossed from placebo) or continued rhPTX-2 after Week 28. rhPTX-2 was administered in 28-week cycles, with 10 mg/kg intravenous infusions (60 min) on Days 1, 3, and 5 in the first week of each cycle, then one infusion every 4 weeks up to Week 128. The OLE primary objective was to assess the long-term safety and tolerability of rhPTX-2. Other outcomes included FVC, 6MWD, and patient-reported outcomes (descriptive analysis). Results All 111 patients who completed the randomized period entered the OLE (n = 37 started rhPTX-2; n = 74 continued rhPTX-2); 57 (51.4%) completed to Week 128. The treatment-emergent adverse event (TEAE) profile was consistent with the randomized period, with the majority of TEAEs graded mild or moderate. Serious TEAEs occurred in 47 patients (42.3%), most frequently IPF (n = 11; 9.9%), pneumonia (n = 7; 6.3%), and acute respiratory failure (n = 3; 2.7%). Three patients underwent lung transplantation. Most serious TEAEs (and all 14 fatal events) were considered unrelated to rhPTX-2 treatment. For patients starting vs continuing rhPTX-2, mean (95% confidence interval) changes from baseline to Week 128 were, respectively, − 6.2% (− 7.7; − 4.6) and − 5.7% (− 8.0; − 3.3) for percent predicted FVC and − 36.3 m (− 65.8; − 6.9) and − 28.9 m (− 54.3; − 3.6) for 6MWD; however, conclusions were limited by patient numbers at Week 128. Conclusions Long-term treatment (up to 128 weeks) with rhPTX-2 was well tolerated in patients with IPF, with no new safety signals emerging in the OLE. The limited efficacy data over 128 weeks may suggest a trend towards a treatment effect. Trial registration NCT02550873; EudraCT 2014-004782-24.
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Affiliation(s)
- Ganesh Raghu
- Center for Interstitial Lung Diseases, Department of Medicine and Laboratory Medicine, University of Washington, Seattle, WA, USA.
| | - Mark J Hamblin
- Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - A Whitney Brown
- Inova Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Jeffrey A Golden
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lawrence A Ho
- Center for Interstitial Lung Diseases, Department of Medicine and Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Martina Vasakova
- Department of Respiratory Medicine, First Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Alberto Pesci
- School of Medicine and Surgery, University of Milano-Bicocca, ASST-Monza, Milano, Italy
| | | | - Keith C Meyer
- Department of Medicine, Division of Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | | | | | | | - Luca Richeldi
- Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Hasson AM, Cheeney G, Ho LA, Vary JC. Bullous pemphigoid associated with nintedanib. JAAD Case Rep 2019; 5:821-823. [PMID: 31508475 PMCID: PMC6726861 DOI: 10.1016/j.jdcr.2019.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Amelia M Hasson
- School of Medicine, University of Washington, Seattle, Washington
| | - Gregory Cheeney
- Department of Pathology, University of Washington, Seattle, Washington
| | - Lawrence A Ho
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington
| | - Jay C Vary
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
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Raghu G, van den Blink B, Hamblin MJ, Brown AW, Golden JA, Ho LA, Wijsenbeek MS, Vasakova M, Pesci A, Antin-Ozerkis DE, Meyer KC, Kreuter M, Moran D, Santin-Janin H, Aubin F, Mulder GJ, Gupta R, Richeldi L. Long-term treatment with recombinant human pentraxin 2 protein in patients with idiopathic pulmonary fibrosis: an open-label extension study. The Lancet Respiratory Medicine 2019; 7:657-664. [DOI: 10.1016/s2213-2600(19)30172-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
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Collins BF, McClelland RL, Ho LA, Mikacenic CR, Hayes J, Spada C, Raghu G. Sarcoidosis and IPF in the same patient-a coincidence, an association or a phenotype? Respir Med 2018; 144S:S20-S27. [DOI: 10.1016/j.rmed.2018.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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Petek BJ, Rosenthal DG, Patton KK, Behnia S, Keller JM, Collins BF, Cheng RK, Ho LA, Bravo PE, Mikacenic C, Raghu G. Cardiac sarcoidosis: Diagnosis confirmation by bronchoalveolar lavage and lung biopsy. Respir Med 2018; 144S:S13-S19. [PMID: 30249376 DOI: 10.1016/j.rmed.2018.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/21/2018] [Accepted: 09/10/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The diagnosis of cardiac sarcoidosis (CS) is difficult to ascertain due to the insensitivity of endomyocardial biopsy. Current diagnostic criteria require a positive endomyocardial biopsy or extra-cardiac biopsy with clinical features suggestive of CS. Common tests for diagnosis of pulmonary sarcoidosis include bronchoalveolar lavage (BAL), lung and mediastinal lymph node (MLN) biopsies. Our objective was to determine the diagnostic utility of these tests in patients with suspected CS and without prior history of pulmonary involvement. METHODS This retrospective cohort study included 37 patients without history of extra-cardiac sarcoidosis referred for suspected CS. All patients underwent chest computed tomography (CT) staged using the modified Scadding criteria, and had BAL, and/or lung or MLN biopsy. BAL cellular analyses with lymphocytes>15% and/or CD4/CD8 ratio≥ 4 were considered suggestive of sarcoidosis. The number of positive biopsies and BALs were compared between normal CT (Scadding stage 0) and abnormal CT (Scadding stage 1-4) groups. RESULTS A definitive diagnosis of sarcoidosis was ascertained in 18/31 (58%) patients undergoing lung or lymph node biopsy, and a potential diagnosis in 18/27 (67%) patients with BAL CD4/CD8>4 or lymphocytes>15%. Of the 12 patients in the normal CT group, 4/10 (40%) had positive lung biopsies, and 9/12 (75%) patients had either positive biopsy or BAL criteria. CONCLUSIONS In suspected cardiac sarcoidosis, a diagnosis of extra-cardiac sarcoidosis was ascertained in a majority of patients irrespective of degree of lung involvement on chest CT. Our results support referral for pulmonary biopsy/bronchoalveolar lavage in suspected CS to confirm the diagnosis of sarcoidosis.
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Affiliation(s)
- Bradley J Petek
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David G Rosenthal
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
| | - Kristen K Patton
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Sanaz Behnia
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA, USA
| | - Jonathan M Keller
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Bridget F Collins
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Lawrence A Ho
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Paco E Bravo
- Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carmen Mikacenic
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
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7
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Raghu G, Pellegrini CA, Yow E, Flaherty KR, Meyer K, Noth I, Scholand MB, Cello J, Ho LA, Pipavath S, Lee JS, Lin J, Maloney J, Martinez FJ, Morrow E, Patti MG, Rogers S, Wolters PJ, Yates R, Anstrom KJ, Collard HR. Laparoscopic anti-reflux surgery for the treatment of idiopathic pulmonary fibrosis (WRAP-IPF): a multicentre, randomised, controlled phase 2 trial. Lancet Respir Med 2018; 6:707-714. [PMID: 30100404 DOI: 10.1016/s2213-2600(18)30301-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abnormal acid gastro-oesophageal reflux (GER) is hypothesised to play a role in progression of idiopathic pulmonary fibrosis (IPF). We aimed to determine whether treatment of abnormal acid GER with laparoscopic anti-reflux surgery reduces the rate of disease progression. METHODS The WRAP-IPF trial was a randomised controlled trial of laparoscopic anti-reflux surgery in patients with IPF and abnormal acid GER recruited from six academic centres in the USA. We enrolled patients with IPF, abnormal acid GER (DeMeester score of ≥14·7; measured by 24-h pH monitoring) and preserved forced vital capacity (FVC). We excluded patients with a FVC below 50% predicted, a FEV1/FVC ratio of less than 0·65, a history of acute respiratory illness in the past 12 weeks, a body-mass index greater than 35, and known severe pulmonary hypertension. Concomitant therapy with nintedanib and pirfenidone was allowed. The primary endpoint was change in FVC from randomisation to week 48, in the intention-to-treat population with mixed-effects models for repeated measures. This trial is registered with ClinicalTrials.gov, number NCT01982968. FINDINGS Between June 1, 2014, and Sept 30, 2016, we screened 72 patients and randomly assigned 58 patients to receive surgery (n=29) or no surgery (n=29). 27 patients in the surgery group and 20 patients in the no surgery group had an FVC measurement at 48 weeks (p=0·041). Intention-to-treat analysis adjusted for baseline anti-fibrotic use demonstrated the adjusted rate of change in FVC over 48 weeks was -0·05 L (95% CI -0·15 to 0·05) in the surgery group and -0·13 L (-0·23 to -0·02) in the non-surgery group (p=0·28). Acute exacerbation, respiratory-related hospitalisation, and death was less common in the surgery group without statistical significance. Dysphagia (eight [29%] of 28) and abdominal distention (four [14%] of 28) were the most common adverse events after surgery. There was one death in the surgery group and four deaths in the non-surgery group. INTERPRETATION Laparoscopic anti-reflux surgery in patients with IPF and abnormal acid GER is safe and well tolerated. A larger, well powered, randomised controlled study of anti-reflux surgery is needed in this population. FUNDING US National Institutes of Health National Heart, Lung and Blood Institute.
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Affiliation(s)
- Ganesh Raghu
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | | | - Eric Yow
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kevin R Flaherty
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Keith Meyer
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Imre Noth
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - John Cello
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lawrence A Ho
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Joyce S Lee
- Department of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Jules Lin
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James Maloney
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | | | - Ellen Morrow
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Marco G Patti
- Departments of Medicine and Surgery, University of North Carolina, Chapel Hill, NC
| | - Stan Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Paul J Wolters
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Robert Yates
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Harold R Collard
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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8
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Raghu G, van den Blink B, Hamblin MJ, Brown AW, Golden JA, Ho LA, Wijsenbeek MS, Vasakova M, Pesci A, Antin-Ozerkis DE, Meyer KC, Kreuter M, Santin-Janin H, Mulder GJ, Bartholmai B, Gupta R, Richeldi L. Effect of Recombinant Human Pentraxin 2 vs Placebo on Change in Forced Vital Capacity in Patients With Idiopathic Pulmonary Fibrosis: A Randomized Clinical Trial. JAMA 2018; 319:2299-2307. [PMID: 29800034 PMCID: PMC6134440 DOI: 10.1001/jama.2018.6129] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with poor prognosis. Approved therapies do not halt disease progression. OBJECTIVE To determine the effect of recombinant human pentraxin 2 vs placebo on change from baseline to week 28 in mean forced vital capacity (FVC) percentage of predicted value. DESIGN, SETTING, AND PARTICIPANTS Phase 2, randomized, double-blind, placebo-controlled trial conducted at 18 sites in 7 countries of eligible patients with IPF (N = 117; aged 40-80 years; FVC ≥50% and ≤90% predicted; ratio of forced expiratory volume in the first second/FVC >0.70; diffusing capacity for carbon monoxide [Dlco] ≥25% and ≤90% predicted; and distance of ≥150 m on the 6-minute walk test). Study period was August 2015-May 2017. INTERVENTIONS Patients were randomized to receive either recombinant human pentraxin 2 (10 mg/kg intravenous every 4 weeks, n = 77) or placebo (n = 39) for 24 weeks, and stratified by concurrent IPF treatment status. MAIN OUTCOMES AND MEASURES The primary end point was the least-squares mean change in FVC percentage of predicted value from baseline to week 28 (minimal clinically important difference, decline of 2%-6%). Secondary end points included mean change in lung volumes (total, normal, and interstitial lung abnormalities) on high-resolution computed tomography (HRCT) and 6-minute walk distance (minimal clinically important difference, 24-45 m). RESULTS Of 117 randomized patients, 116 received at least 1 dose of study drug (mean age, 68.6 years; 81.0% men; mean time since IPF diagnosis, 3.8 years), and 111 (95.7%) completed the study. The least-squares mean change in FVC percentage of predicted value from baseline to week 28 in patients treated with recombinant human pentraxin 2 was -2.5 vs -4.8 for those in the placebo group (difference, +2.3 [90% CI, 1.1 to 3.5]; P = .001). No significant treatment differences were observed in total lung volume (difference, 93.5 mL [90% CI, -27.7 to 214.7]), quantitative parenchymal features on HRCT (normal lung volume difference, -1.2% [90% CI, -4.4 to 1.9]; interstitial lung abnormalities difference, 1.1% [90% CI, -2.2 to 4.3]), or measurement of Dlco (difference, -0.4 [90% CI, -2.6 to 1.7]). The change in 6-minute walk distance was -0.5 m for patients treated with recombinant human pentraxin 2 vs -31.8 m for those in the placebo group (difference, +31.3 m [90% CI, 17.4 to 45.1]; P < .001). The most common adverse events in the recombinant human pentraxin 2 vs placebo group were cough (18% vs 5%), fatigue (17% vs 10%), and nasopharyngitis (16% vs 23%). CONCLUSIONS AND RELEVANCE In this preliminary study, recombinant human pentraxin 2 vs placebo resulted in a slower decline in lung function over 28 weeks for patients with idiopathic pulmonary fibrosis. Further research should more fully assess efficacy and safety. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02550873.
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Affiliation(s)
| | | | | | | | | | | | - Marlies S. Wijsenbeek
- Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martina Vasakova
- First Medical Faculty Charles University and Thomayer Hospital, Prague, Czech Republic
| | | | | | | | - Michael Kreuter
- Center for Rare and Interstitial Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Luca Richeldi
- Unità Operativa Complessa di Pneumologia, IRCCS Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
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Abstract
Comprehensive, up-to-date review of RA-associated lung diseases including pathogenesis and managementhttp://ow.ly/FBaNZ
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Affiliation(s)
- Megan Shaw
- Division of Rheumatology, UW Medical Centre, University of Washington, Seattle, WA, USA
| | - Bridget F Collins
- Division of Pulmonary and Critical Care Medicine, UW Medical Centre, University of Washington, Seattle, WA, USA
| | - Lawrence A Ho
- Division of Pulmonary and Critical Care Medicine, UW Medical Centre, University of Washington, Seattle, WA, USA
| | - Ganesh Raghu
- Division of Pulmonary and Critical Care Medicine, UW Medical Centre, University of Washington, Seattle, WA, USA
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10
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Mohanasundaram U, Ho LA, Kuschner WG, Chitkara RK, Canfield J, Canfield LM, Krishna G. The Diagnostic Yield of Navigational Bronchoscopy Performed with Propofol Deep Sedation. ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/824693] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective. To describe the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) utilizing propofol for procedural deep sedation. Methods. We conducted a structured retrospective analysis of the medical records of patients who underwent ENB with propofol for the evaluation of pulmonary nodules and masses. We analyzed the relationships between lesion size and location, variance (CT-to-body divergence), and positron emission tomography findings on diagnostic yield. Diagnoses were established by histopathological evaluation and clinical-radiographic followup. Results. 41 patients underwent ENB during the study period. The overall diagnostic yield was 89% (42 of 47 target lesions). Among the 42 positive specimens, the diagnoses were squamous cell carcinoma (n=10), adenocarcinoma (n=14), small cell carcinoma (n=2), adenocarcinoma in situ (n=2), coccidioidomycosis (n=1), and inflammatory processes (n=13). Average lesion size was 3.01±0.21 cm and variance 3.6±0.15 mm. The diagnostic yield was greater when the lesion size was >4 cm (100%) and when variance was ≤4 mm (91% versus 87%, P=0.003). Conclusion. The diagnostic yield of ENB utilizing propofol for procedural deep sedation at our center was excellent. ENB with deep sedation may result in superior diagnostic yield compared with ENB performed with moderate sedation.
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Affiliation(s)
- Uma Mohanasundaram
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
- Pulmonary Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Lawrence A. Ho
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
- Pulmonary Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Ware G. Kuschner
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
- Pulmonary Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Rajinder K. Chitkara
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
- Pulmonary Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - James Canfield
- Pulmonary Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Lourdes M. Canfield
- Pulmonary Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Ganesh Krishna
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, CA 94305, USA
- Pulmonary Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
- Palo Alto Medical Foundation, Palo Alto, 701 E. El Camino Real, Mountain View, CA 94040, USA
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11
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Abstract
Many home-based and leisure activities can generate hazardous respirable exposures. Routine domestic activities and a variety of hobbies, avocations, and leisure pursuits have been associated with a spectrum of respiratory tract disorders. Indoor environments present a special risk for high-intensity exposures and adverse health effects. There are important knowledge gaps regarding the prevalence of specific health hazards within and across communities, exposure-response effects, population and individual susceptibilities, best management strategies, the adverse health effects of mixed exposures, and long-term clinical outcomes following exposures. The home environment presents special health risks that should be part of the health assessment.
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Affiliation(s)
- Lawrence A Ho
- Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Division of Pulmonary and Critical Care Medicine, 3801 Miranda Avenue, MC 111P, Palo Alto, CA 94304, USA.
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12
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Abstract
Simulation is a versatile technique used in a variety of health care settings for a variety of purposes, but the extent to which simulation may improve patient safety remains unknown. This systematic review examined evidence on the effects of simulation techniques on patient safety outcomes. PubMed and the Cochrane Library were searched from their beginning to 31 October 2012 to identify relevant studies. A single reviewer screened 913 abstracts and selected and abstracted data from 38 studies that reported outcomes during care of real patients after patient-, team-, or system-level simulation interventions. Studies varied widely in the quality of methodological design and description of simulation activities, but in general, simulation interventions improved the technical performance of individual clinicians and teams during critical events and complex procedures. Limited evidence suggested improvements in patient outcomes attributable to simulation exercises at the health system level. Future studies would benefit from standardized reporting of simulation components and identification of robust patient safety targets.
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Affiliation(s)
- Eric Schmidt
- Stanford Center for Health Policy/Center for Primary Care and Outcomes Research and Stanford University School of Medicine, Stanford University Hospital and Clinics, Stanford, California, USA
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Roberts DK, Ho LA, Beedle NL, Flynn FM, Gable EM. Heritage characteristics reported by a group of African-Americans who exhibit the pigment dispersion syndrome: a case-control study. Doc Ophthalmol 2000; 101:179-93. [PMID: 11291948 DOI: 10.1023/a:1002768428257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To investigate the racial heritage of a group of African-Americans who exhibit the pigment dispersion syndrome (PDS). SUBJECTS AND METHODS Ten unrelated African-American PDS patients (age range 13-59) from a primary eye care population in Chicago, Illinois, USA, were interviewed to determine their racial heritage. Since Caucasian and Native American heritage were commonly reported, 101 unaffected African-American control subjects (age range 18-55) were also interviewed to determine the reported frequency of these specific racial heritage characteristics. RESULTS Some degree of Caucasian heritage was reported by 100% of the PDS subjects and by 46.5% of controls. Native American heritage was reported by 90% of the PDS subjects and by 71.3% of controls. Based on these data, the PDS subjects were significantly more likely to report Caucasian heritage (Fisher's exact test, P=0.001) but they were not significantly more likely to report Native American heritage (P=0.282). In addition, the PDS subjects were significantly more likely to report Caucasian heritage from both parents (P=0.024) and more likely to report a combination of both Caucasian and Native American heritage (P=0.0006) than corresponding controls. In general, the PDS subjects had 'light' or 'medium' complexions. CONCLUSION Results from this analysis are consistent with the hypothesis that non-African heritage, particularly Caucasian, is likely to be prevalent in the background of African-Americans who exhibit PDS. It is suggested that non-African heritage may not only be important for the transference of PDS causing genes, but it may also influence factors such as degree of iris pigmentation and rigidity which could influence iris contour and the subsequent expression of PDS in those who are genetically predisposed. Further investigation is needed to study the factors that influence the expression and severity of PDS among African-Americans, a population which traditionally has been considered to be rarely affected by this condition.
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Affiliation(s)
- D K Roberts
- Illinois Eye Institute, Illinois College of Optometry, Chicago 60616, USA
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