ResearchPad - clinical-research https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[<i>In silico</i> analyses identify lncRNAs: WDFY3-AS2, BDNF-AS and AFAP1-AS1 as potential prognostic factors for patients with triple-negative breast tumors]]> https://www.researchpad.co/article/elastic_article_13870 Long non-coding RNAs (lncRNAs) are characterized as having 200 nucleotides or more and not coding any protein, and several been identified as differentially expressed in several human malignancies, including breast cancer.MethodsHere, we evaluated lncRNAs differentially expressed in triple-negative breast cancer (TNBC) from a cDNA microarray data set obtained in a previous study from our group. Using in silico analyses in combination with a review of the current literature, we identify three lncRNAs as potential prognostic factors for TNBC patients.ResultsWe found that the expression of WDFY3-AS2, BDNF-AS, and AFAP1-AS1 was associated with poor survival in patients with TNBCs. WDFY3-AS2 and BDNF-AS are lncRNAs known to play an important role in tumor suppression of different types of cancer, while AFAP1-AS1 exerts oncogenic activity.ConclusionOur findings provided evidence that WDFY3-AS2, BDNF-AS, and AFAP1-AS1 may be potential prognostic factors in TNBC development. ]]> <![CDATA[Quantitative interpretation of FDG PET for cardiac sarcoidosis reclassifies visually interpreted exams and potentially impacts downstream interventions]]> https://www.researchpad.co/article/elastic_article_13786 Background: FDG PET is used in cardiac sarcoidosis (CS) diagnosis and management, including decisions about initiation and titration of immunosuppression. However, optimal methods to identify sarcoidosis-related inflammation on these scans is unknown. Traditional interpretive methods for FDG PET rely on qualitative visual analysis, but quantitative techniques including standardized uptake values (SUVs) may be more specific. This study evaluated the diagnostic reclassification of FDG PET studies using quantitative versus qualitative analysis and evaluated the potential impact of reclassification on downstream management and events. Methods: Cardiac-focused FDG PET examinations performed for the evaluation of CS were analyzed, comparing results from the clinically reported visual analysis to quantitative re-analysis using left ventricular maximal SUV values (SUVmax). Net diagnostic reclassification index (NDI) was calculated and compared to admissions, deaths, ICD placements, immunosuppression initiation/escalation. Of 154 exams, 22 were reclassified from positive to negative using quantitative re-analysis whereas only 2 clinically reported negative exams were quantitatively reclassified to positive, leading to a NDI of -13.0%. In the quantitatively negative/clinically reported positive group, 11 patients had immunosuppression adjusted after 22 exams and 4 ICDs were placed. Conclusions: Quantitative re-analysis of FDG PET for CS led to an overall negative diagnostic reclassification from positive to negative. Studies that were clinically reported as positive by visual analysis but reclassified as negative by quantitative analysis had numerous medical interventions but few clinical events. The low event rate suggests the use of quantitative interpretation of FDG PET for CS may help in providing providers with a more targeted therapeutic framework. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 342-353)

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<![CDATA[Sarcoidosis, inorganic dust exposure and content of bronchoalveolar lavage fluid: the MINASARC pilot study]]> https://www.researchpad.co/article/elastic_article_13785 Inhalation of mineral dust was suggested to contribute to sarcoidosis. We compared the mineral exposome of 20 sarcoidosis and 20 matched healthy subjects. Bronchoalveolar lavage (BAL) samples were treated by digestion-filtration and analyzed by transmission electron microscopy. The chemical composition of inorganic particles was determined by energy-dispersive X-ray (EDX) spectroscopy. Dust exposure was also assessed by a specific questionnaire. Eight sarcoidosis patients and five healthy volunteers had a high dust load in their BAL. No significant difference was observed between the overall inorganic particle load of each group while a significant higher load for steel was observed in sarcoidosis patients (p=0.029). Moreover, the building activity sub-score was significantly higher in sarcoidosis patients (p=0.018). These results suggest that building work could be a risk factor for sarcoidosis which could be considered at least in some cases as a granulomatosis caused by airborne inorganic dust. The questionnaire should be validated in larger studies. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 327-332)

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<![CDATA[A comparison trial of eight weeks versus twelve weeks of exercise program in interstitial lung diseases]]> https://www.researchpad.co/article/elastic_article_13784 Background: Exercise training have been shown to be the effective approach for functional outcomes in interstitial lung diseases (ILD). In many studies, the duration of exercise programs (EPs) varies between 8-12 weeks. However, the optimal duration of EPs is still unknown. Objective: In our prospective non-controlled study, we aimed to compare the results of the 8th week with the results of the 12th week of the PR programs applied to the patients with ILD. Methods: A total of 14 patients [Age; 63(53,70) years, body mass index: 28(25,32) kg/m2, disease duration; 1.5 (1,4) years] with ILD [11 idiopathic pulmonary fibrosis, 2 sarcoidosis (stage 3 and 4) and 1 nonspecific interstitial pneumonia] were included in the study. 6-minute walk test, pulmonary function test, arterial blood gas analysis, mMRC dyspnea scale, quality of life questionnaires and hospital anxiety depression scale were performed at before and 8 and 12 weeks after the program. Results: 6-minute walk distance, dyspnea, anxiety, depression and quality of life improved both at 8th and 12th week after EP when compared the with the initial assessment(P<0.05). When compared with 8th week; mMRC dyspnea score, 6-minute walk distance and quality of life scores significantly improved at 12th weeks (P=0.046, P=0.016, P<0.05, respectively). Conclusions: Prolonging duration of the EPs results in more improvement in functional outcomes in patients with ILD. However, it has no effect on pulmonary functions and arterial blood gas results. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 299-307)

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<![CDATA[A common microbial signature is present in the lower airways of interstitial lung diseases including sarcoidosis]]> https://www.researchpad.co/article/elastic_article_13783 Background: The etiology of pulmonary sarcoidosis is not well established. Although the mechanism triggering pulmonary sarcoidosis remains to be established, inflammatory reactions seem to play an important role in this process. Objectives: The aim of this study was to define the composition of the lower airway microbiota in the bronchoalveolar lavage (BAL) of patients affected by interstitial lung diseases, including sarcoidosis, to determine whether the bacterial signature differs among these diseases. Methods: Ten patients affected by pulmonary sarcoidosis and 9 patients affected by other interstitial lung diseases were enrolled. 16S rRNA next-generation sequencing was used to study BAL microbial composition of these patients, and were also compared with already published microbial content in higher airways of such diseases. Results: Four phyla dominated the lower airway microbiota, Bacteroidetes being the most abundant phylum in both groups (56.9%). Diversity analysis showed no significant differences between the various diseases, particularly between pulmonary sarcoidosis and other interstitial lung diseases affecting lower airways. Conclusions: Our data indicate that the bacterial lower airways microbiota share the same signature and, therefore, cannot be used as a diagnostic tool to discriminate among different interstitial lung diseases, including sarcoidosis, while microbial diversity is present when considering lower or higher respiratory airways. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 354-362)

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<![CDATA[Comparison of serum interleukin-10 level of fungal exposure among patients with pulmonary sarcoidosis and healthy people]]> https://www.researchpad.co/article/elastic_article_13780 Introduction: Sarcoidosis is a chronic systemic inflammatory disease with unknown etiology. Fungal exposure has been assumed as one of many possible causes of the disease. The prevalence of sarcoidosis is likely to be higher in the Northern Iran compared with other regions. Environmental studies have shown higher levels of fungal spores in the air of this area. Some studies have shown that fungal exposure in patients with sarcoidosis is associated with decreased levels of interleukin-10 (IL-10) serum levels. The aim of present study was comparison of the serum levels of IL-10 in patients with pulmonary sarcoidosis and healthy people. Objectives and Methods: In this current analytical, cross-sectional study, 40 patients with pulmonary sarcoidosis compared with 34 healthy individuals as a control group, who had been visited in a pulmonary referral clinic in Rasht (Guilan-Iran). Demographic data were collected by a questionnaire. Serum IL-10 levels were measured by ELISA kit. The data were analyzed by using the SPSS software (version 19). Results: The mean concentration of IL-10 serum levels were reported 10.96±9.48 pg/ml-1 and 3.77±1.47 pg/ml-1 among the patients with pulmonary sarcoidosis and healthy individuals, respectively. The significance difference was demonstrated between patients with pulmonary sarcoidosis and control group (p<0.0001). The IL-10 showed a significant difference between the patients older than 40 and those younger than 40. In statistical analysis, 4.75 pg.ml-1 was considered the cutoff point to separate patients and control group. Conclusion: The results showed that IL-10 was greater among patients who diagnosed as pulmonary sarcoidosis. There was a contrary opinion of the expectations for the role of fungal exposure as a possible cause of greater prevalence of sarcoidosis in Northern Iran. Age and stage of disease showed a significant relationship with the IL-10 serum level and requires further investigation. IL-10 might be a possible predictor of sarcoidosis along with other factors. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 294-298)

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<![CDATA[Predictive value of pulmonary function testing in the evaluation of pulmonary hypertension in sarcoidosis]]> https://www.researchpad.co/article/elastic_article_13778 Background: In sarcoidosis patients, pulmonary hypertension (PH) is associated with significant morbidity and mortality. Early identification of sarcoidosis-associated pulmonary hypertension (SAPH) has substantial clinical implications. While a number of pulmonary function testing (PFT) variables have been associated with SAPH, the optimal use of PFT’s in screening for SAPH is unknown. Objectives: To examine the predictive value of PFT’s for echocardiographic PH in a cohort of sarcoidosis patients. Methods: We conducted a retrospective cohort study of patients with sarcoidosis from a single center over a period of five years. All consecutive adult patients with a diagnosis of biopsy-proven sarcoidosis (determined by review of the medical chart) who underwent PFT and echocardiographic testing were included. Echocardiographic risk of PH (either intermediate or high) was determined by the presence of echocardiographic PH signs and tricuspid regurgitant jet velocity. Data analysis was performed using multivariate logistic regression analysis with least absolute shrinkage and selection operator. Results: Of the 156 patients included in the study, 42 (27%) met the criteria for echocardiographic PH. Roughly equal proportions met the criteria for intermediate risk (45%) as did for high risk of PH (55%). The percent predicted of diffusion capacity for carbon monoxide (%DLCO) and forced vital capacity (%FVC) were predictive of echocardiographic PH. No other PFT variables outperformed these two markers, and the incorporation of additional PFT variables failed to significantly enhance the model. Conclusions: The %FVC and %DLCO emerged as being predictive of echocardiographic PH in this cohort of biopsy-proven sarcoidosis patients. Potentially reflecting the multifactorial pathogenesis of PH in sarcoidosis, incorporation of other PFT variables failed to enhance screening for PH in this population. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 308-316)

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<![CDATA[Acute respiratory failure due to diffuse parenchymal lung diseases in a respiratory intensive care unit of North India]]> https://www.researchpad.co/article/elastic_article_13776 Background: Acute respiratory failure (ARF) due to diffuse parenchymal lung diseases (DPLDs) is associated with high mortality. Whether ARF due to acute interstitial pneumonia (AIP), idiopathic pulmonary fibrosis (IPF) and non-IPF DPLDs behaves differently remains unclear. Methods: A retrospective analysis of consecutive DPLD subjects with ARF admitted to respiratory intensive care unit (RICU). The baseline clinical, demographic characteristics, cause of ARF and mortality were compared between the groups. Results: 145 (5.8% of RICU admission) subjects (mean [SD] age, 51.6 [14.7] years, 406% males) with DPLD-related ARF (17 AIP; 32 IPF; 96 non-IPF DPLD) were admitted. Common causes of ARF were acute exacerbation of the underlying DPLD (n=59, 40.4%) followed by infections (n=48, 37.5%). There was no difference in the peak, plateau and driving pressures across groups. The mortality rate was 45.5% (66/145) and was highest in AIP (82%) followed by IPF (59%) and non-IPF DPLD (34%). On multivariate logistic regression analysis, baseline APACHE II score, PaO2:FiO2 ratio, delta SOFA, and the use of invasive mechanical ventilation were independent predictors of mortality. The type of underlying DPLD however, did not affect survival. Conclusions: DPLD-related ARF is an uncommon cause of admission even in a RICU, and is associated with a high mortality. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 363-370)

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<![CDATA[Determination of the smallest detectable change (SDC) and the minimal important difference (MID) for the Small Fiber Neuropathy Screening List (SFNSL) in sarcoidosis]]> https://www.researchpad.co/article/elastic_article_13775 Background: Previous studies found that 40-60% of the sarcoidosis patients suffer from small fiber neuropathy (SFN), substantially affecting quality of life. SFN is difficult to diagnose, as a gold standard is still lacking. The need for an easily administered screening instrument to identify sarcoidosis-associated SFN symptoms led to the development of the SFN Screening List (SFNSL). The usefulness of any questionnaire in clinical management and research trials depends on its interpretability. Obtaining a clinically relevant change score on a questionnaire requires that the smallest detectable change (SDC) and minimal important difference (MID) are known. Objectives: The aim of this study was to determine the SDC and MID for the SFNSL in patients with sarcoidosis. Methods: Patients with neurosarcoidosis and/or sarcoidosis-associated SFN symptoms (N=138) included in the online Dutch Neurosarcoidosis Registry participated in a prospective, longitudinal study. Anchor-based and distribution-based methods were used to estimate the MID and SDC, respectively. Results: The SFNSL was completed both at baseline and at 6-months’ follow-up by 89/138 patients. A marginal ROC curve (0.6) indicated cut-off values of 3.5 points, with 73% sensitivity and 49% specificity for change. The SDC was 11.8 points. Conclusions: The MID on the SFNSL is 3.5 points for a clinically relevant change over a 6-month period. The MID can be used in the follow-up and management of SFN-associated symptoms in patients with sarcoidosis, though with some caution as the SDC was found to be higher. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 333-341)

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<![CDATA[Validation of 4-meter-gait-speed test and 5-repetitions-sit-to-stand test in patients with pulmonary fibrosis: a clinimetric validation study]]> https://www.researchpad.co/article/elastic_article_13773 Background and objective: Patients with pulmonary fibrosis (PF) have a clear exercise intolerance. The 4-meter-gait-speed (4MGS) test and the 5-repetitions-sit-to-stand (5STS) test are easy, inexpensive and reliable measures of functional performance. Both tests have been validated in healthy adults and patients with chronic obstructive pulmonary disease. 4MGS test and 5STS test have not been studied in patients with PF. Methods: In this cross-sectional clinimetric validation study 51 PF patients conducted in random order the 4MGS test, 5STS test and the 6-min walk test (6MWT) on a single day. Additionally, body weight, height, lean body mass, health-related quality of life, disease severity, handgrip strength, dyspnoea and leg fatigue were assessed. The setting was a tertiary referral center for Interstitial Lung Diseases. Results: Patients had a diagnosis of idiopathic pulmonary fibrosis (IPF, 37%), PF other than IPF (47%), or unclassified (16%). Patients walked 453±111m in six minutes. Moreover, it took the patients 2.0±0.5s to walk 4 m, and 12.0±3.8s for the 5STS test. The 4MGS test (r = 0.77; p<0.01) and the 5STS test (r = -0.41; p<0.01) correlated significantly with the distance walked in 6MWT. Indeed, 4MGS combined with handgrip strength and Medical Research Council dyspnoea grade could explain 75% of the variance in 6MWD. Conclusions: 4-meter-gait-speed and 5-repetitions sit-to-stand are significantly and independently correlated with the 6-minute walk distance in patients with pulmonary fibrosis. Indeed, 4-meter-gait-speed test may serve as a simple initial field test to assess exercise performance in patients with pulmonary fibrosis. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 317-326)

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<![CDATA[The presence of mycobacterial antigens in sarcoidosis associated granulomas]]> https://www.researchpad.co/article/elastic_article_13772 Background: Sarcoidosis is a multi-organ disorder with unknown etiology. The role of bacteria in pathogenesis of sarcoidosis is still controversial. This study analyses new aspects of Mycobacterium Tuberculosis (MTB) presence in sarcoidosis diseases. Objectives: To find MTB in paraffin embedded tissues of sarcoidosis patients, samples of 10 sarcoidosis, 12 confirmed pulmonary tuberculosis (PTB) and 5 controls associated with granulomatous tissues were analysed. Methods: The paraffin embedded tissue specimens of the selected patients from the pathology archive of a subspecialty pulmonary hospital in IRAN were evaluated by Real Time PCR for MTB DNA using IS6110. Immunohistochemistry (IHC) method using MTB purified protein derivative (PPD) antibody was used to detect mycobacterial antigens. Results: All sarcoidosis patients had negative MTB DNA results in Real time PCR analysis. This analysis resulted in 10 (83.3%) positive cases for TB patients. The IHC analysis for MTB anti-PPD antibody showed positive diffused cytoplasmic staining for all TB patients whereas this staining was positive for 3 sarcoidosis patients (30%). Conclusion: Amplification of the IS6110 DNA sequence that is the most common target used for MTB diagnosis is not sensitive method to detect MTB in sarcoidosis granuloma. However, tissue IHC for anti-PPD antibody shows higher performance to detect MTB in sarcoidal granulomas reveals a mycobacterial signature in sarcoidosis tissue with negative IS6110 assay. This finding supports Mycobacterium tuberculosis may have an etiologic role in sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 236-241)

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<![CDATA[Relationship of pectoralis muscle area and skeletal muscle strength with exercise tolerance and dyspnea in interstitial lung disease]]> https://www.researchpad.co/article/elastic_article_13770 Background: Pectoralis muscle area (PMA) is an easily derived computed tomography-based assessment that can provide insight into clinical features of other skeletal muscles. Respiratory and locomotor muscle dysfunction has been increasingly recognized in patients with interstitial lung disease (ILD). Its contribution to exercise performance has been controversial. Objective: We aimed to investigate if PMA is related with respiratory and locomotor skeletal muscle strength in ILD patients, and if skeletal muscle function is compromised and independently related with exercise capacity and dyspnea. Methods: Cross-sectional study where subjects performed incremental cycling cardiopulmonary exercise testing with maximal inspiratory (MIP) and expiratory (MEP) pressure measurements, and quadriceps maximal voluntary contraction (MVC) before and after exercise. Results: Thirty ILD patients (forced vital capacity [FVC] and lung diffusing capacity [DLCO] of 60±15% and 38±10% of predicted, respectively) and 15 healthy control subjects were studied. Patients presented significantly lower MIP and qMVC compared to controls. PMA was significantly associated with qMVC only (r=0.506; p<0.01). Only expiratory muscles showed a significant strength decline after exercise, both in patients and controls. In multivariate regression analysis, only FVC remained as independent predictor of peak aerobic capacity and MEP post exercise remained as independent predictor of peak exercise dyspnea even adjusting for FVC. Conclusion: ILD patients exhibited reduced inspiratory and quadriceps strength, but PMA was associated with the later only. Muscle strength was not associated with exercise capacity while expiratory muscle fatigue might underlie exertional dyspnea. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 200-208)

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<![CDATA[The importance of PET/CT findings and hematological parameters in prediction of progression in sarcoidosis cases]]> https://www.researchpad.co/article/elastic_article_13768 Aim: We aimed to reveal the correlation of NLR rate, RDW and MPV values and with the findings of PET/CT regarding the prediction of disease progression and the clinical characteristics. Materials and methods: The treatment naive sarcoidosis cases, of whose PET/CT have been taken due to mediastinal lymphadenopathy of whose diagnosis have been confirmed by biopsy, were included in the study. Hematological parameters, clinical, radiological and PET/CT findings are evaluated. Results: 40 sarcoidosis and 40 healthy control cases were included in the study. NLR, RDW, MPV and the sedimentation values in the sarcoidosis group were determined statistically significantly higher. In patients having parenchymal involvement in PET/CT, the values of FVC%, DLCO, DLCO%, DLCO/VA and DLCO/VA% were determined significantly lower. High NLR and PET/CT LAP SUVmax values and low DLCO% values are statistically significantly correlated with one-year disease progression. For predicting the progression, for the NLR cut-off value 3.20, the area under the curve was determined as 0.79 (CI 62.2-96.5), sensitivity as 80.0%, specificity as 76.7% and for the PET/CT SUVmax cut-off value 9.5, the area under the curve was determined as 0.71 (CI 46.6-95.9), sensitivity as 70.0%, specificity as 82.1%. Conclusion: We determined that the values observed in routine hematologic examinations such as NLR, RDW and MPV, were high in sarcoidosis cases. In addition, the values of NLR, DLCO% and PET/CT SUVmax might be used in predicting the progression. At the same, once again we showed that the lung parenchyma involvement in PET/CT correlates with many pulmonary function parameters. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 242-250)

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<![CDATA[Prevalence of interstitial and other lung diseases on Aruba]]> https://www.researchpad.co/article/elastic_article_13766 Background: Health care management has to be based on the local prevalence of diseases and the local diagnostic and therapeutic needs. So far, no systematic registration system for various lung diseases exists on Aruba. Questions that need to be answered are: what specific lung disorders occur on Aruba, and what are the specific needs there? The aim of this study was to assess the prevalence of lung disorders and the diversity of the patient population. Methods: Retrospectively, all records (n=2352) of patients of the Department of Respiratory Diseases of the Dr. Horatio E. Oduber Hospital, Aruba, who were seen at the clinic at least once in the period between January 2010 and October 2014 were reviewed. Results: Asthma (22%) and sleeping disorders (20%) were the most prevalent diagnoses. The mean body mass index (BMI) of the overall lung patient population was 31.6 kg/m2. Obstructive sleep apnea syndrome (OSAS) was the most frequently diagnosed sleeping disorder (78.4%). A diagnosis of interstitial lung diseases (ILD) was established in 4.4% of the cases. Among the ILDs, non-specific interstitial pneumonia (NSIP: 28%), sarcoidosis (18%) and idiopathic pulmonary fibrosis (IPF: 16%) were the most frequent. Conclusion: Obesity and OSAS appeared to be major problems on Aruba. Increased awareness, education, and diagnostic facilities are required to prevent and diagnose obesity and OSAS in an early stage. NSIP, sarcoidosis and IPF are the most frequently diagnosed ILDs on Aruba, and optimization of ILD management is warranted, considering new treatment options available for ILD, especially for IPF.(Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 217-225)

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<![CDATA[Clinical characteristics of sarcoidosis patients in the United States versus China]]> https://www.researchpad.co/article/elastic_article_13762 Objective: To characterize and compare the disease manifestations between patients with sarcoidosis in China versus the United States using the World Association of Sarcoidosis and Other Granulomatous disease (WASOG) instrument. Methods: Clinical data and disease manifestations were reviewed from sarcoidosis patients from the Shanghai Pulmonary Hospital (China) and University of Cincinnati Medical Center (US). Results: 481 Chinese patients and 522 US patients with sarcoidosis were studied. Extra-pulmonary sarcoidosis was observed more frequently in US patients than Chinese patients. Chinese patients were more likely to develop hypercalcemia or hypercalcuria (23%) compared to US patients (14%) (χ2=18.342, P<0.001), and US White patients were more likely to experience hypercalcemia or hypercalcuria (20%) compared to US Black patients (7.6%) (χ2=16.230, P<0.001). However, Black patients were more likely to have eye involvement (39%) than White patients (26%) (χ2=10.986, P=0.001). Additionally, US patients witnessed more advanced Stage 3 or 4 chest x-ray patterns and lower predicted FVC% and DLCO% compared to Chinese patients (both P<0.001). Conclusion: Compared to US sarcoidosis patients, Chinese patients were older at diagnosis and experienced a lower frequency of extra thoracic involvement, higher incidence of hypercalcemia or hypercalcuria, and less severe lung involvement. These differences were mostly due to the African American patients seen in the US sarcoidosis clinic. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 209-216)

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<![CDATA[The association between health-related quality of life and disease progression in idiopathic pulmonary fibrosis: a prospective cohort study]]> https://www.researchpad.co/article/elastic_article_13761 Background and objective: Generally, a disease-specific health-related quality of life (HRQOL) measurement is more useful than generic measures in assessing perceived physical and mental health characteristic of a particular disease. The idiopathic pulmonary fibrosis (IPF)-specific version of St. George’s Respiratory Questionnaire (SGRQ-I) has been recently developed for patients with IPF. We proposed to evaluate associations between the SGRQ-I and other clinical indices, as well as its prognostic value in patients with IPF. Methods: Fifty-two patients with IPF were recruited in this prospective cohort study. HRQOL was assessed using the SGRQ-I and the Medical Outcomes Study 36-item Short Form, dyspnea using the modified Medical Research Council (mMRC) dyspnea scale, and psychological status using the Hospital Anxiety and Depression Scale (HADS). We then evaluated the relationship between the SGRQ-I and other clinical measures, as well as one-year clinical deterioration defined as a hospital admission due to respiratory exacerbation or all-cause death. Results: Stepwise multiple-regression analyses revealed that the mMRC dyspnea scale, the HADS anxiety or depression, and minimum oxygen saturation during a six-minute walk test significantly contributed to the Total and three components of the SGRQ-I. In multivariate Cox proportional-hazards analyses, the Total score of SGRQ-I predicted clinical deterioration independent of forced vital capacity, the six-minute walk distance, or partial pressure of arterial oxygen on room air. Conclusions: The SGRQ-I is a multidisciplinary instrument representing physical, functional and psychological impairments in patients with IPF. The SGRQ-I is a significant predictor of short-term disease progression independent of physiological measurements. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 226-235)

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<![CDATA[Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy]]> https://www.researchpad.co/article/elastic_article_12431 To compare demographic characteristics, clinical presentation, and outcomes of patients with and without concomitant cardiac disease, hospitalized for COVID-19 in Brescia, Lombardy, Italy.Methods and resultsThe study population includes 99 consecutive patients with COVID-19 pneumonia admitted to our hospital between 4 March and 25 March 2020. Fifty-three patients with a history of cardiac disease were compared with 46 without cardiac disease. Among cardiac patients, 40% had a history of heart failure, 36% had atrial fibrillation, and 30% had coronary artery disease. Mean age was 67 ± 12 years, and 80 (81%) patients were males. No differences were found between cardiac and non-cardiac patients except for higher values of serum creatinine, N-terminal probrain natriuretic peptide, and high sensitivity troponin T in cardiac patients. During hospitalization, 26% patients died, 15% developed thrombo-embolic events, 19% had acute respiratory distress syndrome, and 6% had septic shock. Mortality was higher in patients with cardiac disease compared with the others (36% vs. 15%, log-rank P = 0.019; relative risk 2.35; 95% confidence interval 1.08–5.09). The rate of thrombo-embolic events and septic shock during the hospitalization was also higher in cardiac patients (23% vs. 6% and 11% vs. 0%, respectively).ConclusionsHospitalized patients with concomitant cardiac disease and COVID-19 have an extremely poor prognosis compared with subjects without a history of cardiac disease, with higher mortality, thrombo-embolic events, and septic shock rates. ]]> <![CDATA[At the heart of COVID-19]]> https://www.researchpad.co/article/elastic_article_12422

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<![CDATA[Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin–angiotensin–aldosterone inhibitors]]> https://www.researchpad.co/article/elastic_article_12417 The current pandemic coronavirus SARS-CoV-2 infects a wide age group but predominantly elderly individuals, especially men and those with cardiovascular disease. Recent reports suggest an association with use of renin–angiotensin–aldosterone system (RAAS) inhibitors. Angiotensin-converting enzyme 2 (ACE2) is a functional receptor for coronaviruses. Higher ACE2 concentrations might lead to increased vulnerability to SARS-CoV-2 in patients on RAAS inhibitors.Methods and resultsWe measured ACE2 concentrations in 1485 men and 537 women with heart failure (index cohort). Results were validated in 1123 men and 575 women (validation cohort).The median age was 69 years for men and 75 years for women. The strongest predictor of elevated concentrations of ACE2 in both cohorts was male sex (estimate = 0.26, P < 0.001; and 0.19, P < 0.001, respectively). In the index cohort, use of ACE inhibitors, angiotensin receptor blockers (ARBs), or mineralocorticoid receptor antagonists (MRAs) was not an independent predictor of plasma ACE2. In the validation cohort, ACE inhibitor (estimate = –0.17, P = 0.002) and ARB use (estimate = –0.15, P = 0.03) were independent predictors of lower plasma ACE2, while use of an MRA (estimate = 0.11, P = 0.04) was an independent predictor of higher plasma ACE2 concentrations.ConclusionIn two independent cohorts of patients with heart failure, plasma concentrations of ACE2 were higher in men than in women, but use of neither an ACE inhibitor nor an ARB was associated with higher plasma ACE2 concentrations. These data might explain the higher incidence and fatality rate of COVID-19 in men, but do not support previous reports suggesting that ACE inhibitors or ARBs increase the vulnerability for COVID-19 through increased plasma ACE2 concentrations. ]]> <![CDATA[Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era]]> https://www.researchpad.co/article/elastic_article_12345 To evaluate the impact of the COVID-19 pandemic on patient admissions to Italian cardiac care units (CCUs).Methods and ResultsWe conducted a multicentre, observational, nationwide survey to collect data on admissions for acute myocardial infarction (AMI) at Italian CCUs throughout a 1 week period during the COVID-19 outbreak, compared with the equivalent week in 2019. We observed a 48.4% reduction in admissions for AMI compared with the equivalent week in 2019 (P < 0.001). The reduction was significant for both ST-segment elevation myocardial infarction [STEMI; 26.5%, 95% confidence interval (CI) 21.7–32.3; P = 0.009] and non-STEMI (NSTEMI; 65.1%, 95% CI 60.3–70.3; P < 0.001). Among STEMIs, the reduction was higher for women (41.2%; P = 0.011) than men (17.8%; P = 0.191). A similar reduction in AMI admissions was registered in North Italy (52.1%), Central Italy (59.3%), and South Italy (52.1%). The STEMI case fatality rate during the pandemic was substantially increased compared with 2019 [risk ratio (RR) = 3.3, 95% CI 1.7–6.6; P < 0.001]. A parallel increase in complications was also registered (RR = 1.8, 95% CI 1.1–2.8; P = 0.009).ConclusionAdmissions for AMI were significantly reduced during the COVID-19 pandemic across Italy, with a parallel increase in fatality and complication rates. This constitutes a serious social issue, demanding attention by the scientific and healthcare communities and public regulatory agencies. ]]>