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Parikh R, O'Sullivan DM, Farber HW. The PH-ILD Detection tool: External validation and use in patients with ILD. Pulm Circ 2023; 13:e12273. [PMID: 37564922 PMCID: PMC10410234 DOI: 10.1002/pul2.12273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023] Open
Abstract
Pulmonary hypertension (PH) results in increased morbidity and mortality in patients with interstitial lung disease (ILD). Early recognition of PH in this population is essential for planning diagnostic testing, initiating therapy, and evaluating for lung transplantation. The previously developed PH-ILD Detection tool has significant potential in the evaluation and treatment of ILD patients; the aim of this study was to validate the tool in an independent, multicenter cohort of patients. We conducted a retrospective review of prospectively collected data from 161 ILD patients. Patients were stratified into low- (n = 78, 48.4%), intermediate- (n = 54, 33.5%), and high-risk (n = 29, 18.0%) groups based on the score obtained with the tool. Intermediate- and high-risk patients underwent follow-up echocardiogram (TTE); 49.4% (n = 41) had an abnormal TTE suggestive of underlying PH. These patients underwent right heart catheterization; PH-ILD was diagnosed in 73.2% (n = 30) of these cases. The PH-ILD Detection tool has a sensitivity of 93.3%, specificity of 90.9%, and area-under-the-curve of 0.921 for diagnosing PH in ILD patients, validating the findings from the original study and establishing the tool as a fundamental resource for early recognition of PH in ILD patients.
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Affiliation(s)
- Raj Parikh
- Division of Pulmonary, Critical Care and Sleep, Hartford HospitalHartfordConnecticutUSA
| | - David M. O'Sullivan
- Department of Research AdministrationHartford HealthCareHartfordConnecticutUSA
| | - Harrison W. Farber
- Division of Pulmonary, Sleep and Critical Care Medicine, Tufts Medical CenterBostonMassachusettsUSA
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Panagiotidou E, Boutou A, Kalamara E, Sourla E, Chatzopoulos E, Stanopoulos I, Pitsiou G. Diagnosis and management of combined post- and precapillary pulmonary hypertension in a patient with multiple comorbidities. Adv Respir Med 2021; 89:444-447. [PMID: 34269398 DOI: 10.5603/arm.a2021.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022]
Abstract
Diagnosis of pulmonary hypertension requires a laborious investigation that must be performed in accordance with international guidelines. Right-heart catheterization is the gold standard examination to assess the degree of hemodynamic impairment of post- or precapillary origin, guiding management. The presence of comorbidities is becoming rather frequent in real-life pulmonary hypertension cases, thus creating diagnostic and therapeutic complexity. We present a case of combined post- and precapillary pulmonary hypertension in a patient with ischemic heart disease and combined pulmonary fibrosis and emphysema, in order to describe the diagnostic algorithm for pulmonary hypertension and elucidate the problematic aspects of managing this debilitating disease in a patient with several comorbidities. Current guidelines do not support the use of specific vasodilator treatment in group II - due to heart disease and group III-due to lung disease pulmonary hypertension, unless the patient presents with severe pulmonary hypertension (mean pulmonary artery pressure > 35 mm Hg or cardiac index < 2.0 L/min) with right ventricular dysfunction and is treated in an expert center and preferably in the context of a randomized control trial. In the case presented, therapeutic management focused, firstly, on treatment of the underlying heart and lung disease and, subsequently, on specific vasoactive therapy, due to severe hemodynamic deterioration.
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Affiliation(s)
- Evangelia Panagiotidou
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Afroditi Boutou
- Department of Respiratory Medicine, General Hospital "G. Papanikolaou", Thessaloniki, Greece
| | - Evgenia Kalamara
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evdokia Sourla
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Chatzopoulos
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Stanopoulos
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Pitsiou
- Respiratory Failure Clinic, General Hospital of Thessaloniki "G. Papanikolaou", Aristotle University of Thessaloniki, Thessaloniki, Greece
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Tsutani Y, Kagimoto A, Handa Y, Mimae T, Miyata Y, Okada M. Prognostic role of interstitial pneumonia with or without emphysema in patients with clinical stage I lung cancer. Jpn J Clin Oncol 2021; 51:1123-1131. [PMID: 34002234 DOI: 10.1093/jjco/hyab073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/30/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The prognostic role of interstitial pneumonia with emphysema in lung cancer is not fully understood. This study aimed to examine the prognostic role of the presence of emphysema in patients with clinical stage I lung cancer and interstitial pneumonia. METHODS The presence of interstitial pneumonia and emphysema was evaluated on preoperative high-resolution computed tomography. In total, 836 consecutive patients with clinical stage I lung cancer who underwent complete resection between April 2007 and March 2016 were retrospectively analyzed using the log-rank test and Cox proportional hazard model to examine survival differences. RESULTS There was a significant difference in 5-year overall survival between patients with interstitial pneumonia and emphysema (n = 65) and those without (n = 771) (62.6% vs. 86.5%; P < 0.001). However, in patients with interstitial pneumonia on high-resolution computed tomography, there was no significant difference in 5-year overall survival between patients with emphysema (n = 65) and those without emphysema (n = 50) (62.6% vs. 59.4%, P = 0.84). Multivariable backward stepwise Cox proportional hazard analysis in patients with interstitial pneumonia showed that histology, %diffusing capacity of the lungs for carbon monoxide, radiologic interstitial pneumonia pattern and surgical procedure were independent prognostic factors for overall survival, but the presence of emphysema was not. CONCLUSIONS The presence of emphysema was not an independent prognostic factor for overall survival in patients with clinical stage I lung cancer with interstitial pneumonia. Poor survival of patients with IP and emphysema may be due to the presence of interstitial pneumonia.
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Affiliation(s)
- Yasuhiro Tsutani
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Atsushi Kagimoto
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoshinori Handa
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Yoshihiro Miyata
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan
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Chen Q, Liu P, Zhou H, Kong H, Xie W. An increased risk of lung cancer in combined pulmonary fibrosis and emphysema patients with usual interstitial pneumonia compared with patients with idiopathic pulmonary fibrosis alone: a systematic review and meta-analysis. Ther Adv Respir Dis 2021; 15:17534666211017050. [PMID: 34011211 PMCID: PMC8141990 DOI: 10.1177/17534666211017050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Lung cancer is an important complication of combined pulmonary fibrosis and emphysema (CPFE). Whether the risk of lung cancer is higher in CPFE patients with usual interstitial pneumonia (UIP) than those with idiopathic pulmonary fibrosis (IPF) alone, remains controversial. We conducted this systematic review and meta-analysis to evaluate the prevalence of lung cancer in CPFE patients with UIP compared with IPF patients. Methods: We searched the PubMed, Embase, and Cochrane databases for studies that focused on the incidence of lung cancer in CPFE/UIP and IPF groups. We used a fixed-effects model to analyze the odds ratios (ORs) with 95% confidence intervals (CIs) according to data heterogeneity. The cumulative effects based on the publication year and sample size were assessed by cumulative meta-analysis. Results: A total of nine studies with 933 patients, including 374 CPFE patients with UIP, fulfilled the inclusion criteria. Overall, CPFE patients with UIP have a higher risk of lung cancer than those with IPF alone (OR = 2.69; 95% CI: 1.78–4.05). There were increased risks of lung cancer in CPFE/UIP patients with the presence of emphysema (OR = 2.93; 95% CI: 1.79–4.79) or emphysema in ⩾10% of the lung volume (OR = 2.22; 95% CI: 1.06–4.68). Conclusions: Our systematic review and meta-analysis indicated a significantly higher prevalence of lung cancer in CPFE patients with UIP than in patients with IPF alone. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Qianqian Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ping Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Kong
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province 210029, P. R. China
| | - Weiping Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu Province 210029, P. R. China
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Nathan SD, Cottin V, Behr J, Hoeper MM, Martinez FJ, Corte TJ, Keogh AM, Leuchte H, Mogulkoc N, Ulrich S, Wuyts WA, Yao Z, Ley-Zaporozhan J, Müller-Lisse UG, Scholle FD, Brüggenwerth G, Busse D, Nikkho S, Wells AU. Impact of lung morphology on clinical outcomes with riociguat in patients with pulmonary hypertension and idiopathic interstitial pneumonia: A post hoc subgroup analysis of the RISE-IIP study. J Heart Lung Transplant 2021; 40:494-503. [PMID: 33744088 DOI: 10.1016/j.healun.2021.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Riociguat in Patients with Symptomatic Pulmonary Hypertension associated with Idiopathic Interstitial Pneumonias (RISE-IIP), a randomized, controlled, phase 2b trial of riociguat for pulmonary hypertension associated with idiopathic interstitial pneumonia, was terminated early due to increased mortality in riociguat-treated patients. Baseline characteristics of enrolled patients demonstrated a low diffusing capacity of the lung for carbon monoxide (DLCO) with preserved lung volumes at baseline, suggesting the presence of combined pulmonary fibrosis and emphysema (CPFE) in some patients. This post hoc analysis of RISE-IIP was undertaken to explore lung morphology, assessed by high-resolution computed tomography, and associated clinical outcomes. METHODS Available baseline/pre-baseline high-resolution computed tomography scans were reviewed centrally by 2 radiologists. The extent of emphysema and fibrosis was retrospectively scored and combined to provide the total CPFE score. RESULTS Data were available for 65/147 patients (44%), including 15/27 fatal cases (56%). Of these, 41/65 patients (63%) had CPFE. Mortality was higher in patients with CPFE (12/41; 29%) than those without (3/24; 13%). Fourteen patients with CPFE had emphysema > fibrosis (4 died). No relationship was observed between CPFE score, survival status, and treatment assignment. A low DLCO, short 6-min walking distance, and high forced vital capacity:DLCO ratio at baseline also appeared to be risk factors for mortality. CONCLUSIONS High parenchymal lung disease burden and the presence of more emphysema than fibrosis might have predisposed patients with pulmonary hypertension associated with idiopathic interstitial pneumonia to poor outcomes in RISE-IIP. Future studies of therapy for group 3 pulmonary hypertension should include centrally adjudicated imaging for morphologic phenotyping and disease burden evaluation during screening.
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Affiliation(s)
- Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Falls Church, Virginia.
| | - Vincent Cottin
- National Reference Centre for Rare Pulmonary Diseases, Department of Respiratory Medicine, Louis Pradel Hospital, Lyon, France; Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Juergen Behr
- Department of Internal Medicine V, Ludwig Maximilian University of Munich, Comprehensive Pneumology Center, Helmholtz Zentrum, Munich, Germany
| | - Marius M Hoeper
- Clinic for Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Fernando J Martinez
- Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Tamera J Corte
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Anne M Keogh
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia; St Vincent's Hospital, Sydney, Australia
| | - Hanno Leuchte
- Department of Internal Medicine II, Neuwittelsbach Academic Hospital, Ludwig Maximilian University, Munich, Germany
| | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | - Silvia Ulrich
- Clinic of Pulmonology, University Hospital Zürich, Zürich, Switzerland
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, University Hospitals of Leuven, Leuven, Belgium
| | - Zhen Yao
- Bayer Healthcare Company Ltd., Beijing, China
| | | | | | | | | | | | | | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
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Kagohashi K, Satoh H. Successfully managed combined pulmonary fibrosis and emphysema in a lung large cell neuroendocrine carcinoma patient treated with pembrolizumab. Clin Respir J 2021; 15:574-575. [PMID: 33427390 DOI: 10.1111/crj.13327] [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] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Katsunori Kagohashi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito-city, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito-city, Japan
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Oh JY, Lee YS, Min KH, Hur GY, Lee SY, Kang KH, Shim JJ. Impact and prognosis of lung cancer in patients with combined pulmonary fibrosis and emphysema. Sarcoidosis Vasc Diffuse Lung Dis 2020; 37:e2020020. [PMID: 33597805 PMCID: PMC7883510 DOI: 10.36141/svdld.v37i4.7316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Indexed: 11/25/2022]
Abstract
Background: Combined pulmonary fibrosis and emphysema (CPFE) is frequently associated with lung cancer. However, the impact and outcomes of lung cancer in patients with CPFE are unclear. Objective: We investigated the impact of lung cancer in patients with CPFE in terms of acute exacerbation (AE) and mortality, and identified the mortality predictors of patients with CPFE and lung cancer. Methods: We retrospectively reviewed 12-year medical records of patients at the Korea University Guro Hospital. Based on computed tomography findings, we selected CPFE patients with and without lung cancer, and analyzed age, sex, smoking status and history, body mass index, past medical history, pulmonary function, the gender, age, and physiology (GAP) score, AE, and mortality. Results: Of 227 CPFE patients, 61 were diagnosed with lung cancer. While 10 of the 61 patients experienced AE, 41 died during the observation period. Lung cancer was a significant predictor of AE (hazard ratio [HR] 3.27, 95% confidence interval [CI ]1.44–7.43, P<0.01) and mortality (HR 4.74, 95% CI 2.55–8.81, P<0.01) in CPFE patients. AE, rather than age, GAP score, or lung cancer stage, was the most significant factor associated with mortality in patients with CPFE and lung cancer (HR 9.20, 95% CI 1.13–74.70, P=0.04). Conclusions: Lung cancer has a significant impact on the outcomes of CPFE and is associated with severe complications. AE was the most important mortality predictor in patients with lung cancer combined with CPFE. Therefore, the diagnosis and treatment of lung cancer should be carefully planned in patients with CPFE. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020020)
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Affiliation(s)
- Jee Youn Oh
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Seok Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gyu Young Hur
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Yong Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Ho Kang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Jeong Shim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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He L, Feng QQ, Zhang Q, Zhang B, Wu SS, Gong JH. Protective role of overexpressed MUC5AC against fibrosis in MHV-68-induced combined pulmonary fibrosis and emphysema mouse model. J Med Virol 2020; 92:3726-3735. [PMID: 32557739 DOI: 10.1002/jmv.26094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 11/05/2022]
Abstract
Mucins have long been regarded to play a role as a barrier to prevent mucosal infections; however, some studies report that overexpression of mucins induces obstruction and inflammation of airways. We investigated whether the secretion of overexpressed mucin, mucin5ac (MUC5AC), could improve protection against pathogens. To examine the possible roles of mucin hypersecretion in augmenting host defense against disease-promoting muco-obstructive lung disease, a mouse model that overexpressed MUC5AC was generated. We had previously proved that murine gammaherpesvirus-68 (MHV-68) infection could induce emphysema in mice, which later developed into combined pulmonary fibrosis and emphysema (CPFE). We further explored whether increased MUC5AC secretion could provide benefits against MHV-68 induced fibrosis. We initially developed a pcDNA3.1-MUC5AC mouse model. Next, the experimental mice were randomly divided into five groups: normal control, pcDNA3.1 control, pcDNA3.1-MUC5AC, CPFE, and pcDNA3.1- MUC5AC + CPFE. Morphometric analysis of each group was performed by hematoxylin and eosin staining and Masson trichrome staining. MUC5AC levels in lung tissues were analyzed by immunohistochemical staining, real-time polymerase chain reaction, and Western blot analysis. The airway inflammation was determined by differential cell counts of bronchoalveolar lavage fluid (BALF) and measurement of cytokines and chemokines in BALF by enzyme-linked immunosorbent assay. MUC5AC hypersecretion alone was not sufficient to drive goblet cell metaplasia to induce obvious mucus plugging and airway inflammation. However, MUC5AC overexpression served as a protective barrier against MHV-68 virus infection in vivo. Infectivity of MHV-68 was decreased in the pcDNA3.1-MUC5AC + CPFE group compared with that in CPFE group. Meanwhile, a reduction of MHV-68 virus attenuated the expressions of chemokine (C-C motif) ligand 2 (CCL2), chemokine (C-X-C motif) ligand 5 (CXCL5), interleukin-13 (IL-13), and transforming growth factor-β1 (TGF-β1), and weakened airway inflammation and fibrosis in the pcDNA3.1-MUC5AC + CPFE group. Overexpression of MUC5AC appears to exhibit a protective role against MHV-68 infection in mice with emphysema that subsequently developed into CPFE and to further decrease airway inflammation and fibrosis induced by MHV-68 by decreasing the expressions of CCL2, CXCL5, IL-13, and TGF-β1.
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Affiliation(s)
- Li He
- Department of Respiratory and Critical Care Medicine, Jingzhou Hospital of Tongji Medical College, Huazhong University of Science and Technology, Jingzhou, Hubei, China
- Department of Respiratory and Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian-Qian Feng
- Department of Respiratory and Critical Care Medicine, Jingzhou Hospital of Tongji Medical College, Huazhong University of Science and Technology, Jingzhou, Hubei, China
| | - Qiao Zhang
- Department of Respiratory and Critical Care Medicine, Jingzhou Hospital of Tongji Medical College, Huazhong University of Science and Technology, Jingzhou, Hubei, China
| | - Bo Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of Respiratory and Critical Care Medicine, Wuhan Fourth Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Si-Si Wu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Department of ICU, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian-Hua Gong
- Department of Respiratory and Critical Care Medicine, Jingzhou Hospital of Tongji Medical College, Huazhong University of Science and Technology, Jingzhou, Hubei, China
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Abstract
BACKGROUND Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. However, whether CPFE has a higher or lower mortality than idiopathic pulmonary fibrosis (IPF) alone is still not clear. In this study we conducted a meta-analysis to assess the survival rate (SR) of CPFE versus IPF alone in clinical trials. METHODS We performed a systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials for trials published prior to 31 March 2018. Extracts from the literature were analyzed with Review Manager version 5.3. RESULTS Thirteen eligible trials were included in this analysis (involving 1710 participants). Overall, the pooled results revealed that no statistically significant difference was detected in the 1-year [relative risk (RR) = 0.98, 95% confidence interval (CI): 0.94-1.03, p = 0.47], 3-year (RR = 0.83, 95% CI: 0.68-1.01, p = 0.06), and 5-year (RR = 0.80, 95% CI: 0.59-1.07, p = 0.14) SRs of CPFE versus IPF alone. CONCLUSIONS CPFE exhibits a very poor prognosis, similar to IPF alone. Additional studies are needed to provide more convincing data to investigate the natural history and outcome of patients with CPFE in comparison to IPF. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Chun-Guo Jiang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongti Nanlu, Chaoyang District, Beijing 100020, China
| | - Qiang Fu
- Department of Internal Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chun-Ming Zheng
- Medical Research Center, Beijing Institute of Respiratory Diseases, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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10
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Ariani A, Silva M, Bravi E, Parisi S, Saracco M, De Gennaro F, Caimmi C, Girelli F, De Santis M, Volpe A, Lumetti F, Hax V, Bredemeier M, Alfieri V, Santilli D, Bodini FC, Lucchini G, Mozzani F, Seletti V, Bacchini E, Arrigoni E, Giuggioli D, Chakr R, Idolazzi L, Bertorelli G, Imberti D, Michieletti E, Paolazzi G, Fusaro E, Chetta AA, Scirè CA, Sverzellati N. Overall mortality in combined pulmonary fibrosis and emphysema related to systemic sclerosis. RMD Open 2019; 5:e000820. [PMID: 30886735 PMCID: PMC6397433 DOI: 10.1136/rmdopen-2018-000820] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 09/09/2018] [Revised: 11/13/2018] [Accepted: 12/17/2018] [Indexed: 12/02/2022] Open
Abstract
Objectives This multicentre study aimed to investigate the overall mortality of combined pulmonary fibrosis and emphysema (CPFE) in systemic sclerosis (SSc) and to compare CPFE-SSc characteristics with those of other SSc subtypes (with interstitial lung disease—ILD, emphysema or neither). Methods Chest CTs, anamnestic data, immunological profile and pulmonary function tests of patients with SSc were retrospectively collected. Each chest CT underwent a semiquantitative assessment blindly performed by three radiologists. Patients were clustered in four groups: SSc-CPFE, SSc-ILD, SSc-emphysema and other-SSc (without ILD nor emphysema). The overall mortality of these groups was calculated by Kaplan-Meier method and compared with the stratified log-rank test; Kruskal-Wallis test, t-Student test and χ² test assessed the differences between groups. P<0.05 was considered statistically significant. Results We enrolled 470 patients (1959 patient-year); 15.5 % (73/470) died during the follow-up. Compared with the SSc-ILD and other-SSc, in SSc-CPFE there was a higher prevalence of males, lower anticentromere antibodies prevalence and a more reduced pulmonary function (p<0.05). The Kaplan-Meier survival analysis demonstrates a significantly worse survival in patients with SSc-CPFE (HR vs SSc-ILD, vs SSc-emphysema and vs other-SSc, respectively 1.6 (CI 0.5 to 5.2), 1.6 (CI 0.7 to 3.8) and 2.8 (CI 1.2 to 6.6). Conclusions CPFE increases the mortality risk in SSc along with a highly impaired lung function. These findings strengthen the importance to take into account emphysema in patients with SSc with ILD.
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Affiliation(s)
- Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Mario Silva
- Department of Medicine and Surgery (DiMeC), Unit of Surgical Sciences, Section of Radiology, University of Parma, Parma, Italy
| | - Elena Bravi
- Department of Medicine, Internal Medicine and Rheumatology Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | - Simone Parisi
- Rheumatology Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marta Saracco
- Rheumatology Unit, Ospedale Mauriziano - Umberto I di Torino, Torino, Italy
| | - Fabio De Gennaro
- Rheumatology Unit, Azienda Ospedaliera "Istituti Ospitalieri" di Cremona, Cremona, Italy
| | - Cristian Caimmi
- Department of Medicine, Rheumatology Unit, University of Verona, Azienda Ospedaliera di Verona, Verona, Italy
| | - Francesco Girelli
- Department of Medicine, Rheumatology Unit, Ospedale GB Morgagni - L Pierantoni, Forlì, Italy
| | - Maria De Santis
- Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Federica Lumetti
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Vanessa Hax
- Division of Rheumatology, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Markus Bredemeier
- Rheumatology Service, Hospital Nossa Senhora da Conceição - Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Veronica Alfieri
- Department of Medicine and Surgery (DiMeC), Respiratory Disease Unit, University of Parma, Parma, Italy
| | - Daniele Santilli
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Gianluca Lucchini
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Flavio Mozzani
- Department of Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Valeria Seletti
- Department of Medicine and Surgery (DiMeC), Unit of Surgical Sciences, Section of Radiology, University of Parma, Parma, Italy
| | - Emanuele Bacchini
- Department of Medicine and Surgery (DiMeC), Unit of Surgical Sciences, Section of Radiology, University of Parma, Parma, Italy
| | - Eugenio Arrigoni
- Department of Medicine, Internal Medicine and Rheumatology Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | - Dilia Giuggioli
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - Rafael Chakr
- Rheumatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luca Idolazzi
- Department of Medicine, Rheumatology Unit, University of Verona, Azienda Ospedaliera di Verona, Verona, Italy
| | - Giuseppina Bertorelli
- Department of Medicine and Surgery (DiMeC), Respiratory Disease Unit, University of Parma, Parma, Italy
| | - Davide Imberti
- Department of Medicine, Internal Medicine and Rheumatology Unit, Ospedale G. Da Saliceto, Piacenza, Italy
| | | | | | - Enrico Fusaro
- Rheumatology Department, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alfredo Antonio Chetta
- Department of Medicine and Surgery (DiMeC), Respiratory Disease Unit, University of Parma, Parma, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milano, Italy.,Department of Medical Sciences, Section of Rheumatology, AOU Sant'Anna, University of Ferrara, Ferrara, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC), Unit of Surgical Sciences, Section of Radiology, University of Parma, Parma, Italy
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11
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Yoon HY, Kim TH, Seo JB, Lee SM, Lim S, Lee HN, Kim N, Han M, Kim DS, Song JW. Effects of emphysema on physiological and prognostic characteristics of lung function in idiopathic pulmonary fibrosis. Respirology 2018; 24:55-62. [PMID: 30136753 DOI: 10.1111/resp.13387] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 06/11/2018] [Accepted: 07/23/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Combined pulmonary fibrosis and emphysema (CPFE) is characterized by preserved lung volume and slower lung function decline. However, it is unclear at what extent emphysema begins to impact respiratory physiology and prognostic characteristics in idiopathic pulmonary fibrosis (IPF). We estimated the extent of emphysema that could be used to define CPFE in IPF. METHODS The extent of emphysema was observed on high-resolution computed tomography scans and measured by a texture-based automated quantification system in 209 IPF patients. We analysed the impact of differences in the extent of emphysema on the annual decline rate and prognostic significance of lung function parameters. RESULTS The extent of emphysema was ≥5% in 53 patients (25%), ≥10% in 23 patients (11%) and ≥15% in 12 patients (6%). Patients with emphysema to an extent of ≥5% were more frequently men and ever-smokers; they had more preserved lung volume and lower forced vital capacity (FVC) decline rates than those with no or trivial emphysema. The FVC decline rate was a significant predictor of mortality in patients with no or trivial emphysema (hazard ratio (HR): 0.933, P < 0.001) and in patients with an extent of emphysema ≥5% (HR: 0.906, P < 0.001). However, diffusing capacity of the lung for carbon monoxide (DLCO ) was the most significant prognostic factor in those patients with an extent of emphysema ≥10% (HR: 0.972, P = 0.040) and ≥15% (HR: 0.942, P = 0.023). A 10% cut-off value for the extent of emphysema created the most significant difference in the annual FVC decline rate in IPF patients. CONCLUSION In IPF, emphysema to an extent of ≥10% affects both the annual decline rate and the prognostic significance of FVC. This extent could be used to define CPFE.
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Affiliation(s)
- Hee-Young Yoon
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Hoon Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Beom Seo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soyeoun Lim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Na Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Namkug Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minkyu Han
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Soon Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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12
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Oh JY, Lee YS, Min KH, Hur GY, Lee SY, Kang KH, Shim JJ. Presence of lung cancer and high gender, age, and physiology score as predictors of acute exacerbation in combined pulmonary fibrosis and emphysema: A retrospective study. Medicine (Baltimore) 2018; 97:e11683. [PMID: 30075563 PMCID: PMC6081154 DOI: 10.1097/md.0000000000011683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Combined pulmonary fibrosis and emphysema (CPFE) patients visit hospitals frequently due to acute exacerbations (AEs); however, the predictors of CPFE AE have not been comprehensively described in literature. Thus, we investigated the predicting factors of AE in CPFE patients.We retrospectively reviewed medical records from the past 12 years at Korea University Guro Hospital. We selected CPFE patients by computed tomography findings. Rapid deterioration (RD) was defined as acute worsening of dyspnea requiring hospitalization and the presence of newly developed radiologic abnormalities. AE was defined as RD with newly acquired bilateral pulmonary infiltrates without evidence of pulmonary infection or other known causes. We evaluated the following variables in CPFE patients: age, sex, smoking history and amount, body mass index, past medical history, pulmonary function test, gender, age, and physiology (GAP) score, and the presence of lung cancer.Among 227 CPFE patients, 108 had RD and 31 developed AE. The most common cause of RD was infection (n = 60, 55.6%) and 28.7% (n = 31) developed AE. Lung cancer [hazard ratio (HR), 3.274; 95% confidence interval (95% CI) 1.444-7.425; P < .01] and GAP score (HR, 1.434; 95% CI 1.072-1.918; P = .02) were significant predictors of AE. The presence of lung cancer and AE were significant predictors of mortality.In conclusion, CPFE patients with lung cancer and high GAP scores should be carefully observed for AE.
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13
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Salvatore M, Kwon K, Steiner RM. Images in COPD Combined Pulmonary Fibrosis and Emphysema. Chronic Obstr Pulm Dis 2018; 5:154-157. [PMID: 30374454 PMCID: PMC6190518 DOI: 10.15326/jcopdf.5.2.2018.0137] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Mary Salvatore
- Department of Radiology, Mount Sinai Medical Center, New York, New York
| | - Kevin Kwon
- Department of Radiology, Mount Sinai Medical Center, New York, New York
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14
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Kwiatkowska S. IPF and CPFE - the two different entities or two different presentations of the same disease? Adv Respir Med 2017; 86:23-26. [PMID: 29286173 DOI: 10.5603/arm.a2017.0049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/29/2017] [Indexed: 11/25/2022]
Abstract
In this article the co-existence of pulmonary emphysema with lung fibrosis of typical pattern and distribution for usual interstitial pneumonia (UIP) was compared with idiopathic pulmonary fibrosis (IPF) alone. Author discusses the etiopathogenesis of these diseases, differences in signaling pathways and the role of senescent cells. Moreover, clinical course, pulmonary function tests as well as main complications are reviewed. However, the lack of well-established diagnostic criteria for CPFE along with mainly retrospective character of the studies make current knowledge about this entity rather deficient.
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Affiliation(s)
- Sylwia Kwiatkowska
- Pneumonology Ward, Medical University of Lodz, Kopcinskiego 22, 90-153 Lodz, Poland.
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15
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Awano N, Inomata M, Ikushima S, Yamada D, Hotta M, Tsukuda S, Kumasaka T, Takemura T, Eishi Y. Histological analysis of vasculopathy associated with pulmonary hypertension in combined pulmonary fibrosis and emphysema: comparison with idiopathic pulmonary fibrosis or emphysema alone. Histopathology 2017; 70:896-905. [PMID: 27992963 DOI: 10.1111/his.13153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/15/2016] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate pulmonary vasculopathy in an autopsy series of patients with combined pulmonary fibrosis and emphysema (CPFE), and compare these findings with those of patients with idiopathic pulmonary fibrosis (IPF) alone and emphysema alone. METHODS AND RESULTS We retrospectively analysed the clinical, radiological and pathological features of 26 patients with CPFE, 11 with IPF, and 23 with emphysema. We evaluated pulmonary vascular, venous-venular and arteriolar tissue changes in the fibrotic, emphysematous and relatively unaffected (preserved) areas by using the Heath-Edwards scoring system. We found moderate-to-severe vasculopathy in the CPFE group, but no significant differences in the fibrotic and emphysematous areas among the three groups. However, in the preserved area, the grading was significantly different among the three groups (P < 0.001), and vasculopathy in the CPFE group was the most severe. Although venous-venular and arteriolar changes in almost all fibrotic and emphysematous areas in the three groups showed no significant differences, there were significant differences in venous-venular (P = 0.004) and arteriolar (P < 0.001) changes in the preserved area among the three groups, which were most prevalent in the CPFE group. In the CPFE group, venous-venular changes and vasculopathy by Heath-Edwards grading were highest in the fibrotic area and lowest in the preserved area. CONCLUSIONS These results imply that pulmonary vasculopathy in patients with CPFE could occur in the whole lung tissue. This may explain the tendency for it to lead to the development of pulmonary hypertension in CPFE cases.
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Affiliation(s)
- Nobuyasu Awano
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.,Department of Respiratory Medicine, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Soichiro Ikushima
- Department of Respiratory Medicine, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Daisuke Yamada
- Department of Radiology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Masatoshi Hotta
- Department of Radiology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Shunji Tsukuda
- Department of Radiology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Centre, Tokyo, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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16
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Otsuka H, Sugino K, Hata Y, Makino T, Koezuka S, Isobe K, Tochigi N, Shibuya K, Homma S, Iyoda A. Clinical features and outcomes of patients with lung cancer as well as combined pulmonary fibrosis and emphysema. Mol Clin Oncol 2016; 5:273-278. [PMID: 27602222 DOI: 10.3892/mco.2016.954] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/20/2016] [Indexed: 01/06/2023] Open
Abstract
The syndrome of combined pulmonary fibrosis and emphysema (CPFE) has been characterized by severely impaired gas exchange and poor survival. However, the clinical features of patients with lung cancer plus CPFE have remained elusive. The present study performed a retrospective analysis to examine the clinical characteristics and outcome of surgically resected patients with lung cancer plus CPFE. Among 831 patients with primary lung cancer who underwent surgical resection, 23 patients (2.8%) were diagnosed with CPFE and 9 patients (1.1%) with solely idiopathic pulmonary fibrosis (IPF). Thirty-five patients were stratified as the solely emphysema group with adjustment of the pathological stage. The clinicopathological characteristics of patients in the CPFE group and their outcomes were evaluated and compared with those with the solely IPF or solely emphysema groups. Within the CPFE group, no significant differences in survival between patients with post-operative acute exacerbation (AE; n=3) and those without AE (n=20) were noted; however, in the solely IPF group, patients with post-operative AE (n=4) had a significantly shorter survival than those without AE (n=5; P=0.022). The 5-year survival rate of patients in the CPFE, solely IPF and solely emphysema groups was 22, 22 and 58%, respectively. Furthermore, the CPFE and solely IPF groups showed a significantly shorter survival than the solely emphysema group (P=0.001 and 0.011, respectively). In conclusion, surgically resected lung cancer patients with CPFE had poor survival, which was, in contrast to that of lung cancer patients with solely IPF, not affected by AE.
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Affiliation(s)
- Hajime Otsuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Keishi Sugino
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Yoshinobu Hata
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Takashi Makino
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Kazutoshi Isobe
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Sakae Homma
- Division of Respiratory Medicine, Toho University School of Medicine, Tokyo 143-8541, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Toho University School of Medicine, Tokyo 143-8541, Japan
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17
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Hata A, Sekine Y, Kota O, Koh E, Yoshino I. Impact of combined pulmonary fibrosis and emphysema on surgical complications and long-term survival in patients undergoing surgery for non-small-cell lung cancer. Int J Chron Obstruct Pulmon Dis 2016; 11:1261-8. [PMID: 27354784 PMCID: PMC4907478 DOI: 10.2147/copd.s94119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Indexed: 02/04/2023] Open
Abstract
Purpose The outcome of radical surgery for lung cancer was investigated in patients with combined pulmonary fibrosis and emphysema (CPFE). Methods A retrospective chart review involved 250 patients with lung cancer who underwent pulmonary resection at Tokyo Women’s Medical University Yachiyo Medical Center between 2008 and 2012. Based on the status of nontumor-bearing lung evaluated by preoperative computed tomography (CT), the patients were divided into normal, emphysema, interstitial pneumonia (IP), and CPFE groups, and their clinical characteristics and surgical outcome were analyzed. Results The normal, emphysema, IP, and CPFE groups comprised 124 (49.6%), 108 (43.2%), seven (2.8%), and eleven (4.4%) patients, respectively. The 5-year survival rate of the CPFE group (18.7%) was significantly lower than that of the normal (77.5%) and emphysema groups (67.1%) (P<0.0001 and P=0.0027, respectively) but equivalent to that of the IP group (44.4%) (P=0.2928). In a subset analysis of cancer stage, the 5-year overall survival rate of the CPFE group in stage I (n=8, 21.4%) was also lower than that of the normal group and emphysema group in stage I (n=91, 84.9% and n=70, 81.1%; P<0.0001 and P<0.0001, respectively). During entire observation period, the CPFE group was more likely to die of respiratory failure (27.2%) compared with the normal and emphysema groups (P<0.0001). Multivariate analysis of prognostic factors using Cox proportional hazard model identified CPFE as an independent risk factor (P=0.009). Conclusion CPFE patients have a poorer prognosis than those with emphysema alone or with normal lung on CT finding. The intensive evaluation of preoperative CT images is important, and radical surgery for lung cancer should be decided carefully when patients concomitantly harbor CPFE, because of unfavorable prognosis.
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Affiliation(s)
- Atsushi Hata
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Centre, Yachiyo, Japan; Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Yasuo Sekine
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Centre, Yachiyo, Japan
| | - Ohashi Kota
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Centre, Yachiyo, Japan
| | - Eitetsu Koh
- Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Centre, Yachiyo, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
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18
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Sugino K, Gocho K, Kikuchi N, Shibuya K, Uekusa T, Homma S. Acute exacerbation of combined pulmonary fibrosis and emphysema associated with Hermansky-Pudlak syndrome. Respirol Case Rep 2016; 4:13-5. [PMID: 26839694 PMCID: PMC4722101 DOI: 10.1002/rcr2.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/18/2015] [Revised: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 11/18/2022] Open
Abstract
A 30‐year‐old male smoker with congenital amblyopia and oculocutaneous albinism was admitted to our hospital complaining of progressive dyspnea on exertion. Chest computed tomography images revealed diffuse reticular opacities and honeycombing in the bilateral lower lobes with sparing of the subpleural region along with emphysema predominantly in the upper lobes. Lung biopsy specimens showed a mixture of usual interstitial pneumonia and a non‐specific interstitial pneumonia pattern with emphysema. Of note, cuboidal epithelial cells with foamy cytoplasm on the alveolar walls and phagocytic macrophages with ceroid pigments in the fibrotic lesions were observed. The patient was diagnosed with Hermansky–Pudlak syndrome (HPS) associated with combined pulmonary fibrosis and emphysema (CPFE). Six years following the patient's initial admission to our hospital, he died from acute exacerbation (AE) of CPFE associated with HPS. This is one of only few reports available on the clinicopathological characteristics of AE in CPFE associated with HPS.
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Affiliation(s)
- Keishi Sugino
- Department of Respiratory Medicine Toho University Omori Medical Center Tokyo Japan
| | - Kyoko Gocho
- Department of Respiratory Medicine Toho University Omori Medical Center Tokyo Japan
| | - Naoshi Kikuchi
- Department of Respiratory Medicine Toho University Omori Medical Center Tokyo Japan
| | - Kazutoshi Shibuya
- Department of Diagnostic Pathology Toho University Omori Medical Center Tokyo Japan
| | - Toshimasa Uekusa
- Department of Pathology Labor Health and Welfare Organization Kanto Rosai Hospital Kanagawa Japan
| | - Sakae Homma
- Department of Respiratory Medicine Toho University Omori Medical Center Tokyo Japan
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19
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Sanchez MEV, Steiner R. Images in COPD: Combined Pulmonary Fibrosis and Emphysema. Chronic Obstr Pulm Dis 2015; 2:367-369. [PMID: 28848856 DOI: 10.15326/jcopdf.2.4.2015.0162] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Maria Elena Vega Sanchez
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Robert Steiner
- Department of Radiology, Temple University School of Medicine, Philadelphia, Pennsylvania
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20
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De Simone G, Aquino G, Di Gioia C, Mazzarella G, Bianco A, Calcagno G. Efficacy of aerobic physical retraining in a case of combined pulmonary fibrosis and emphysema syndrome: a case report. J Med Case Rep 2015; 9:85. [PMID: 25928714 PMCID: PMC4422471 DOI: 10.1186/s13256-015-0570-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/09/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Combined pulmonary fibrosis and emphysema has recently been recognized as a syndrome but remains under-diagnosed. Neither clinical management nor therapeutic approaches have been clearly defined. Pulmonary rehabilitation has not been considered within the therapeutic options for combined pulmonary fibrosis and emphysema. In this case we explored the potential benefits of a specific aerobic physical retraining program in the management of combined pulmonary fibrosis and emphysema. CASE PRESENTATION We describe the case of a 65-year-old Caucasian man with combined pulmonary fibrosis and emphysema and respiratory failure who was receiving long-term oxygen therapy. Our patient underwent physical retraining with moderate intensity aerobic and breathing exercises for four weeks. Clinical and motor tests, as well as questionnaires assessing quality of life and depression levels, were performed prior to and following the retraining. At the end of the retraining program a relevant reduction of long-term oxygen therapy requirement was registered; improvements in terms of physical performance, quality of life, and mood were observed in our patient but no change in respiratory parameters. CONCLUSIONS A program of aerobic physical retraining appears to be beneficial to patients with combined pulmonary fibrosis and emphysema and may be considered as an additional therapeutic option.
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Affiliation(s)
- Giuseppe De Simone
- Institute of Rehabilitation "Villa Margherita Benevento", Unit of Cardiology and Pneumology, Benevento, Italy.
| | - Giovanna Aquino
- Department of Medicine and Health Sciences, "V Tiberio" University of Molise, Campobasso, Italy.
| | - Claudio Di Gioia
- Institute of Rehabilitation "Villa Margherita Benevento", Unit of Cardiology and Pneumology, Benevento, Italy.
| | - Gennaro Mazzarella
- Department of Cardio-Thoracic and Respiratory Sciences, Second University of Napoli, Napoli, Italy.
| | - Andrea Bianco
- Department of Medicine and Health Sciences, "V Tiberio" University of Molise, Campobasso, Italy.
| | - Giuseppe Calcagno
- Department of Medicine and Health Sciences, "V Tiberio" University of Molise, Campobasso, Italy.
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21
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Sugino K, Ota H, Fukasawa Y, Uekusa T, Homma S. Pathological characteristics in idiopathic nonspecific interstitial pneumonia with emphysema and pulmonary hypertension. Respirol Case Rep 2014; 1:39-42. [PMID: 25473539 PMCID: PMC4184524 DOI: 10.1002/rcr2.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 07/31/2013] [Revised: 08/08/2013] [Accepted: 08/20/2013] [Indexed: 11/08/2022] Open
Abstract
A 75-year-old man was admitted to our hospital complaining of a 4-year history of persistent dry cough and progressive dyspnea on exertion. Chest computed tomography images revealed diffuse reticular opacities and traction bronchiectasis in the bilateral lower lobes and emphysema predominantly in the upper lobes. He was treated with inhaled N-acetylcystein therapy, oral corticosteroids, and pirfenidone in addition to oxygen administration. However, his symptoms and oxygenation gradually deteriorated. In addition, echocardiography showed that estimated pulmonary arterial pressure was 109 mm Hg, sildenafil was started. Twenty months later, he suddenly died of decompensated right heart failure. The autopsied lungs demonstrated a diffuse fibrotic nonspecific interstitial pneumonia (NSIP) pattern with emphysema (combined pulmonary fibrosis and emphysema) and widespread severe intimal and medial thickening ranging from proximal elastic to distal muscular pulmonary arteries. To our knowledge, little has been reported on clinicopathological characteristics of idiopathic NSIP associated with emphysema and severe pulmonary hypertension.
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Affiliation(s)
- Keishi Sugino
- Department of Respiratory Medicine, Toho University Omori Medical Center Tokyo, Japan
| | - Hiroki Ota
- Department of Respiratory Medicine, Toho University Omori Medical Center Tokyo, Japan
| | - Yuri Fukasawa
- Department of Diagnostic Pathology, Toho University Omori Medical Center Tokyo, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Labor Health and Welfare Organization Kanto Rosai Hospital Kanagawa, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center Tokyo, Japan
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22
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Seeger W, Adir Y, Barberà JA, Champion H, Coghlan JG, Cottin V, De Marco T, Galiè N, Ghio S, Gibbs S, Martinez FJ, Semigran MJ, Simonneau G, Wells AU, Vachiéry JL. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol 2013; 62:D109-16. [PMID: 24355635 DOI: 10.1016/j.jacc.2013.10.036] [Citation(s) in RCA: 389] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 10/22/2013] [Indexed: 12/22/2022]
Abstract
Chronic obstructive lung disease (COPD) and diffuse parenchymal lung diseases (DPLD), including idiopathic pulmonary fibrosis (IPF) and sarcoidosis, are associated with a high incidence of pulmonary hypertension (PH), which is linked with exercise limitation and a worse prognosis. Patients with combined pulmonary fibrosis and emphysema (CPFE) are particularly prone to the development of PH. Echocardiography and right heart catheterization are the principal modalities for the diagnosis of COPD and DPLD. For discrimination between group 1 PH patients with concomitant respiratory abnormalities and group 3 PH patients (PH caused by lung disease), patients should be transferred to a center with expertise in both PH and lung diseases for comprehensive evaluation. The task force encompassing the authors of this article provided criteria for this discrimination and suggested using the following definitions for group 3 patients, as exemplified for COPD, IPF, and CPFE: COPD/IPF/CPFE without PH (mean pulmonary artery pressure [mPAP] <25 mm Hg); COPD/IPF/CPFE with PH (mPAP ≥25 mm Hg); PH-COPD, PH-IPF, and PH-CPFE); COPD/IPF/CPFE with severe PH (mPAP ≥35 mm Hg or mPAP ≥25 mm Hg with low cardiac index [CI <2.0 l/min/m(2)]; severe PH-COPD, severe PH-IPF, and severe PH-CPFE). The "severe PH group" includes only a minority of chronic lung disease patients who are suspected of having strong general vascular abnormalities (remodeling) accompanying the parenchymal disease and with evidence of an exhausted circulatory reserve rather than an exhausted ventilatory reserve underlying the limitation of exercise capacity. Exertional dyspnea disproportionate to pulmonary function tests, low carbon monoxide diffusion capacity, and rapid decline of arterial oxygenation upon exercise are typical clinical features of this subgroup with poor prognosis. Studies evaluating the effect of pulmonary arterial hypertension drugs currently not approved for group 3 PH patients should focus on this severe PH group, and for the time being, these patients should be transferred to expert centers for individualized patient care.
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Fujiwara A, Tsushima K, Sugiyama S, Yamaguchi K, Soeda S, Togashi Y, Kono Y, Kasagi S, Setoguchi Y. Histological types and localizations of lung cancers in patients with combined pulmonary fibrosis and emphysema. Thorac Cancer 2013; 4:354-360. [PMID: 28920226 DOI: 10.1111/1759-7714.12023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/13/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Most patients with combined pulmonary fibrosis and emphysema (CPFE) are males, and heavy smokers. CPFE is more prevalent than fibrosis in patients with lung cancer, and patients with CPFE usually have a poor prognosis. This study reviewed the differences in the prevalence of lung cancer among patients with normal, fibrosis, emphysema and CPFE via chest computed tomography (CT), and the relationship between histopathology and the localizations of lung cancer. METHODS Patients that were diagnosed with lung cancer confirmed by pathological examinations between 2003 and 2011 were retrospectively reviewed to obtain clinical, pathological, and radiological data. These patients were categorized into four groups based on chest CT findings: normal, fibrosis, emphysema and CPFE. RESULTS Two hundred and seventy-four patients with lung cancer were classified into 146 normal, 14 fibrosis, 78 emphysema, and 36 CPFE groups. Combined centriacinar and paraseptal emphysema was common in the CPFE group. The prevalence of squamous cell carcinoma in the CPFE group was significantly higher in comparison to the normal group. The rate of peripheral localization of lung cancer in the CPFE group was significantly higher in comparison to the normal, fibrosis, and emphysema groups. The prevalence of squamous cell carcinoma of peripheral areas in the CPFE group was significantly higher in the normal and emphysema groups. CONCLUSIONS CPFE patients demonstrated histopathological and radiological differences concerning the histological types and localization of lung cancers.
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Affiliation(s)
- Akahito Fujiwara
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Shinya Sugiyama
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Koichi Yamaguchi
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Seiko Soeda
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yuki Togashi
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yuta Kono
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Satoshi Kasagi
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yasuhiro Setoguchi
- Department of Pulmonary Medicine, Tokyo Medical University, Tokyo, Japan
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Chilosi M, Carloni A, Rossi A, Poletti V. Premature lung aging and cellular senescence in the pathogenesis of idiopathic pulmonary fibrosis and COPD/emphysema. Transl Res 2013; 162:156-73. [PMID: 23831269 DOI: 10.1016/j.trsl.2013.06.004] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [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: 05/17/2013] [Accepted: 06/11/2013] [Indexed: 02/06/2023]
Abstract
Different anatomic and physiological changes occur in the lung of aging people that can affect pulmonary functions, and different pulmonary diseases, including deadly diseases such as chronic obstructive pulmonary disease (COPD)/emphysema and idiopathic pulmonary fibrosis (IPF), can be related to an acceleration of the aging process. The individual genetic background, as well as exposure to a variety of toxic substances (cigarette smoke in primis) can contribute significantly to accelerating pulmonary senescence. Premature aging can impair lung function by different ways: by interfering specifically with tissue repair mechanisms after damage, thus perturbing the correct crosstalk between mesenchymal and epithelial components; by inducing systemic and/or local alteration of the immune system, thus impairing the complex mechanisms of lung defense against infections; and by stimulating a local and/or systemic inflammatory condition (inflammaging). According to recently proposed pathogenic models in COPD and IPF, premature cellular senescence likely affects distinct progenitors cells (mesenchymal stem cells in COPD, alveolar epithelial precursors in IPF), leading to stem cell exhaustion. In this review, the large amount of data supporting this pathogenic view are discussed, with emphasis on the possible molecular and cellular mechanisms leading to the severe parenchymal remodeling that characterizes, in different ways, these deadly diseases.
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Affiliation(s)
- Marco Chilosi
- Department of Pathology, University of Verona, Verona, Italy.
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