Publications by authors named "Nishant Gupta"

176 Publications

Tunneled and routine peripherally inserted central catheters placement in adult and pediatric population: review, technical feasibility, and troubleshooting.

Quant Imaging Med Surg 2021 Apr;11(4):1619-1627

Department of Radiology, KU School of Medicine-Wichita, University in Wichita, Wichita, KS, USA.

Vascular access procedures are crucial for the management of various critically ill pediatric and adult patients. Venous access is commonly performed in the form routine as well as tunneled peripherally inserted central catheters (PICC). These venous accesses are commonly used in emergency, surgical as well as ICU settings, for various infusions, total parenteral nutrition, long term intravenous antibiotics, frequent blood draws, etc. PICC insertion is guided using ultrasound and fluoroscopic guidance, which decreases the risk of complications that are otherwise seen with central venous accesses like triple lumen catheters, etc. PICC insertion and care is very simple and can be performed by specially trained PICC nurses and that helps in decreasing the overall cost of healthcare. This review article is written with educational intent for the readers to discuss indications, contraindications, procedure techniques, imaging, care of routine as well as tunneled PICC.
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http://dx.doi.org/10.21037/qims-20-694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930684PMC
April 2021

The Protective Effects of IL-31RA Deficiency During Bleomycin-Induced Pulmonary Fibrosis.

Front Immunol 2021 19;12:645717. Epub 2021 Mar 19.

Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.

Idiopathic Pulmonary Fibrosis (IPF) is a severe fibrotic lung disease characterized by excessive collagen deposition and progressive decline in lung function. Th2 T cell-derived cytokines including IL-4 and IL-13 have been shown to contribute to inflammation and fibrotic remodeling in multiple tissues. Interleukin-31 (IL-31) is a newly identified cytokine that is predominantly produced by CD4 Th2 T cells, but its signaling receptor IL-31RA is primarily expressed by non-hematopoietic cells. However, the potential role of the IL-31-IL31RA axis in pulmonary inflammation and fibrosis has remained largely unknown. To determine the role of IL-31RA deficiency in pulmonary fibrosis, wildtype, and IL-31RA knockout mice were treated with bleomycin and measured changes in collagen deposition and lung function. Notably, the loss of IL-31 signaling attenuated collagen deposition and lung function decline during bleomycin-induced pulmonary fibrosis. The total lung transcriptome analysis showed a significant reduction in fibrosis-associated gene transcripts including extracellular matrix and epithelial cell-associated gene networks. Furthermore, the lungs of human IPF showed an elevated expression of IL-31 when compared to healthy subjects. In support, the percentage of IL-31 producing CD4 T cells was greater in the lungs and PBMCs from IPF patients compared to healthy controls. Our findings suggest a pathogenic role for IL-31/IL-31RA signaling during bleomycin-induced pulmonary fibrosis. Thus, therapeutic targeting the IL-31-IL-31RA axis may prevent collagen deposition, improve lung function, and have therapeutic potential in pulmonary fibrosis.
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http://dx.doi.org/10.3389/fimmu.2021.645717DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017338PMC
March 2021

Developmental Antecedents of Adult Macaque Neurogenesis: Early-Life Adversity, 5-HTTLPR Polymorphisms, and Adolescent Hippocampal Volume.

J Affect Disord 2021 05 27;286:204-212. Epub 2021 Feb 27.

Department of Psychiatry and Behavioral Sciences, State University of New York-Downstate Medical Center, Brooklyn, NY. Electronic address:

Introduction: Attenuated adult hippocampal neurogenesis may manifest in affective symptomatology and/or resistance to antidepressant treatment. While early-life adversity and the short variant ('s') of the serotonin transporter gene's long polymorphic region (5-HTTLPR) are suggested as interacting risk factors for affective disorders, no studies have examined whether their superposed risk effectuates neurogenic changes into adulthood. Similarly, it is not established whether reduced hippocampal volume in adolescence, variously identified as a marker and antecedent of affective disorders, anticipates diminished adult neurogenesis. We investigate these potential developmental precursors of neurogenic alterations using a bonnet macaque model.

Methods: Twenty-five male infant bonnet macaques were randomized to stressed [variable foraging demand (VFD)] or normative [low foraging demand (LFD)] rearing protocols and genotyped for 5-HTTLPR polymorphisms. Adolescent MRI brain scans (mean age 4.2y) were available for 14 subjects. Adult-born neurons were detected post-mortem (mean age 8.6y) via immunohistochemistry targeting the microtubule protein doublecortin (DCX). Models were adjusted for age and weight.

Results: A putative vulnerability group (VG) of VFD-reared 's'-carriers (all 's/l') exhibited reduced neurogenesis compared to non-VG subjects. Neurogenesis levels were positively predicted by ipsilateral hippocampal volume normalized for total brain volume, but not by contralateral or raw hippocampal volume.

Limitations: No 's'-carriers were identified in LFD-reared subjects, precluding a 2×2 factorial analysis.

Conclusion: The 's' allele (with adverse rearing) and low adolescent hippocampal volume portend a neurogenic deficit in adult macaques, suggesting persistent alterations in hippocampal plasticity may contribute to these developmental factors' affective risk in humans.
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http://dx.doi.org/10.1016/j.jad.2021.02.052DOI Listing
May 2021

Psychological features of adult patients with langerhans cell histiocytosis.

PLoS One 2021 12;16(2):e0246604. Epub 2021 Feb 12.

Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Paris, France.

Background: The prevalence of psychological symptoms and the co-occurrence of substance abuse disorders in adult patients with Langerhans cell histiocytosis (LCH) has not been previously explored. We aimed to use validated scales to evaluate depression and anxiety symptoms experienced by adult LCH patients.

Methods: In this cross-sectional study, all consecutive adult LCH patients seen at our national reference center between January 2012 and January 2013 were asked to complete the following instruments: the Hospital Anxiety and Depression scale (HADS); Barratt Impulsiveness Scale, Version 10 (BIS-10); and Cannabis Use Disorders Identification Test (CUDIT). Self-reported scores on these scales were used to determine the point prevalence of clinically significant psychological symptoms and substance use disorders in LCH patients. Patient profiles in terms of psychological features were assessed by principal component analysis including the HADS and BIS-10 instruments values, followed by hierarchical clustering. Fisher exact tests and Wilcoxon tests were used to examine the associations between disease-related parameters and high levels of anxiety and impulsivity.

Results: Seventy-one adult LCH patients, mainly with pulmonary LCH (PLCH), completed the evaluations. Clinically significant anxiety and depression symptoms were reported by 22 (31%) and 4 (6%) subjects, respectively. Impulsivity was detected in 14% (10/71) of the patients. Seventeen percent (12/71) of the patients used cannabis on a regular basis, with 50% of these individuals (6/12) exhibiting scores consistent with cannabis use disorder. Three derived clusters of patients were identified in the principal component analysis; these patient clusters differed in successful weaning from tobacco at the time of evaluation (p = 0.03). In univariate analyses, isolated PLCH and the use of psychotropic treatments were statistically associated with clinically significant anxiety symptoms.

Conclusions: High levels of anxiety and impulsivity are common in adult patients with LCH. The consequences of these symptoms for the management of LCH patients warrant further evaluation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246604PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880468PMC
February 2021

Machine learning can predict disease manifestations and outcomes in lymphangioleiomyomatosis.

Eur Respir J 2021 06 4;57(6). Epub 2021 Jun 4.

Nottingham Molecular Pathology Node, Nottingham, UK

Background: Lymphangioleiomyomatosis (LAM) is a rare multisystem disease with variable clinical manifestations and differing rates of progression that make management decisions and giving prognostic advice difficult. We used machine learning to identify clusters of associated features which could be used to stratify patients and predict outcomes in individuals.

Patients And Methods: Using unsupervised machine learning we generated patient clusters using data from 173 women with LAM from the UK and 186 replication subjects from the US National Heart, Lung, and Blood Institute (NHLBI) LAM registry. Prospective outcomes were associated with cluster results.

Results: Two- and three-cluster models were developed. A three-cluster model separated a large group of subjects presenting with dyspnoea or pneumothorax from a second cluster with a high prevalence of angiomyolipoma symptoms (p=0.0001) and tuberous sclerosis complex (TSC) (p=0.041). Patients in the third cluster were older, never presented with dyspnoea or pneumothorax (p=0.0001) and had better lung function. Similar clusters were reproduced in the NHLBI cohort. Assigning patients to clusters predicted prospective outcomes: in a two-cluster model the future risk of pneumothorax was 3.3 (95% CI 1.7-5.6)-fold greater in cluster 1 than cluster 2 (p=0.0002). Using the three-cluster model, the need for intervention for angiomyolipoma was lower in clusters 2 and 3 than cluster 1 (p<0.00001). In the NHLBI cohort, the incidence of death or lung transplant was much lower in clusters 2 and 3 (p=0.0045).

Conclusions: Machine learning has identified clinically relevant clusters associated with complications and outcome. Assigning individuals to clusters could improve decision making and prognostic information for patients.
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http://dx.doi.org/10.1183/13993003.03036-2020DOI Listing
June 2021

A review of commonly performed bariatric surgeries: Imaging features and its complications.

Clin Imaging 2021 Apr 10;72:122-135. Epub 2020 Nov 10.

Department of Radiology, Bassett Healthcare, 1 Atwell Road, Cooperstown, NY 13326, USA.

Obesity is a disease that has achieved the level that can be considered an epidemic. According to the National Center for Health Statistics data, the prevalence of obesity has increased from 30.5% in 1999-2000 to 42.4% in 2017-2018. During the same period, severe obesity has increased from 4.7% to 9.2%. With the growing prevalence of obesity, related conditions such as coronary artery disease, diabetes, and strokes have also become more prevalent. In the past few years, the need for bariatric surgeries such as laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric banding has increased considerably. With an increasing number of bariatric surgeries, multiple postoperative complications have become common. In this review, we have attempted to describe normal postsurgical anatomical findings after bariatric surgeries and pictorial review of a few common postoperative complications.
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http://dx.doi.org/10.1016/j.clinimag.2020.11.020DOI Listing
April 2021

Lymphangioleiomyomatosis Association with Underlying Genotype in Patients with Tuberous Sclerosis Complex.

Ann Am Thorac Soc 2021 05;18(5):815-819

Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, Ohio; and.

Lymphangioleiomyomatosis (LAM) is a female-predominant lung disease caused by mutations in the tuberous sclerosis complex (TSC) genes and . To examine the association between TSC mutation subtypes and the prevalence of LAM in women with TSC. Adult women seen at the Cincinnati Children's Hospital Medical Center's TSC clinic were stratified into the following three groups: those with mutation, those with mutation, and those with no mutation identified (NMI). Individual TSC manifestations were ascertained by blinded review of chest computed tomographic scans (LAM, multifocal micronodular pneumocyte hyperplasia, and sclerotic bone lesions) and chart review (all other manifestations). The association between mutation status and TSC manifestations was assessed by the Wilcoxon rank-sum test. Our cohort consisted of 55 TSC women, including 30/55 (55%) with , 12/55 (22%) with , and 13/55 (23%) with NMI. Twenty-three women (42%) had characteristic cysts consistent with LAM, of whom 16 had mutations and seven had NMI. The prevalence of LAM was higher in women with mutations compared with women with mutations (16/29 [55%] vs. 0/12;  = 0.003). Similarly, renal angiomyolipomas were more common in women with mutations compared with women with mutations (29/30 [97%] vs. 6/12 [50%];  = 0.01). There was no association between TSC mutation subtype and the presence of multifocal micronodular pneumocyte hyperplasia, sclerotic bone lesions, and skin or brain involvement. Serum VEGF-D (vascular endothelial growth factor-D) concentrations (median [95% confidence interval]) tended to be higher in patients harboring mutations compared with patients with mutations (725 pg/ml [612-1,317] vs. 331 pg/ml [284-406];  = 0.03) and in patients with LAM compared with patients without LAM (725 pg/ml [563-1,609] vs. 429 pg/ml [357-773];  = 0.02). LAM and angiomyolipomas are more common in women with TSC harboring mutations compared with women with mutations. Serum VEGF-D is a useful biomarker to suggest the presence of LAM in women with TSC.
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http://dx.doi.org/10.1513/AnnalsATS.202008-911OCDOI Listing
May 2021

Current role of imaging in COVID-19 infection with recent recommendations of point of care ultrasound in the contagion: a narrative review.

Ann Transl Med 2020 Sep;8(17):1094

Department of Radiology, Bassett Healthcare, Cooperstown, NY, USA.

Radiological studies have an important role in the diagnosis and follow up of many infectious diseases. With current pandemic of Coronavirus disease 2019 (COVID-19) though the molecular analysis with reverse transcriptase polymerase chain reaction (RT-PCR) remains the cornerstone of diagnosis, the critical role of chest imaging including CT scan and baseline X-ray became apparent early in the course due to concern for less than optimal sensitivity of PCR testing. Delay in molecular diagnosis due to a shortage of testing kits and laboratory personnel also makes imaging an important modality in early diagnosis for appropriate triage and isolation decisions. CT scan technology is widely available in developed parts of the world but in developing countries, CT scanner is not widely available especially in rural settings. CT imaging usually requires patient movement to the radiology department and the scanner is not easy to disinfect. Point of care ultrasound (POCUS) has been used for many years in the assessment of critically ill patients in emergency departments and intensive care units. It is rapidly gaining popularity across many specialties and part of many general medicine training programs across the United States. It can be learned rapidly and with experienced hands, POCUS can help identify disease patterns in the lung parenchyma, and during the current pandemic has been gaining special attention. In this article, we review the most prominent imaging findings on chest X-ray and CT scan in patients with COVID-19. We also focus on the background and evolution of POCUS with studies showing the promising role of this diagnostic modality in COVID-19 infection. In addition, we describe step by step guidance on the use and disinfection of the portable ultrasound machine.
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http://dx.doi.org/10.21037/atm-20-3043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576001PMC
September 2020

Discovery of isoquinolinone and naphthyridinone-based inhibitors of poly(ADP-ribose) polymerase-1 (PARP1) as anticancer agents: Structure activity relationship and preclinical characterization.

Bioorg Med Chem 2020 12 14;28(24):115819. Epub 2020 Oct 14.

Novel Drug Discovery & Development, Lupin Ltd., Lupin Research Park, Survey No. 46 A/47 A, Village Nande, Taluka Mulshi, Pune 412115, India.

The exploitation of GLU988 and LYS903 residues in PARP1 as targets to design isoquinolinone (I & II) and naphthyridinone (III) analogues is described. Compounds of structure I have good biochemical and cellular potency but suffered from inferior PK. Constraining the linear propylene linker of structure I into a cyclopentene ring (II) offered improved PK parameters, while maintaining potency for PARP1. Finally, to avoid potential issues that may arise from the presence of an anilinic moiety, the nitrogen substituent on the isoquinolinone ring was incorporated as part of the bicyclic ring. This afforded a naphthyridinone scaffold, as shown in structure III. Further optimization of naphthyridinone series led to identification of a novel and highly potent PARP1 inhibitor 34, which was further characterized as preclinical candidate molecule. Compound 34 is orally bioavailable and displayed favorable pharmacokinetic (PK) properties. Compound 34 demonstrated remarkable antitumor efficacy both as a single-agent as well as in combination with chemotherapeutic agents in the BRCA1 mutant MDA-MB-436 breast cancer xenograft model. Additionally, compound 34 also potentiated the effect of agents such as temozolomide in breast cancer, pancreatic cancer and Ewing's sarcoma models.
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http://dx.doi.org/10.1016/j.bmc.2020.115819DOI Listing
December 2020

Consensus Guidelines for Evaluation and Management of Pulmonary Disease in Sjögren's.

Chest 2021 Feb 16;159(2):683-698. Epub 2020 Oct 16.

Division of Rheumatology, University of California, San Francisco, CA; School of Optometry, Sjögren's Clinic, University of California, Berkeley, CA.

Background: Pulmonary disease is a potentially serious yet underdiagnosed complication of Sjögren's syndrome, the second most common autoimmune rheumatic disease. Approximately 16% of patients with Sjögren's demonstrate pulmonary involvement with higher mortality and lower quality of life.

Research Question: Clinical practice guidelines for pulmonary manifestations of Sjögren's were developed by the Sjögren's Foundation after identifying a critical need for early diagnosis and improved quality and consistency of care.

Study Design And Methods: A rigorous and transparent methodology was followed according to American College of Rheumatology guidelines. The Pulmonary Topic Review Group (TRG) developed clinical questions in the PICO (Patient, Intervention, Comparison, Outcome) format and selected literature search parameters. Each article was reviewed by a minimum of two TRG members for eligibility and assessment of quality of evidence and strength of recommendation. Guidelines were then drafted based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale and data extraction tables were submitted to a Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version.

Results: The literature search revealed 1,192 articles, of which 150 qualified for consideration in guideline development. Of the original 85 PICO questions posed by the TRG, 52 recommendations were generated. These were then reviewed by the Consensus Expert Panel and 52 recommendations were finalized, with a mean agreement of 97.71% (range, 79%-100%). The recommendations span topics of evaluating Sjögren's patients for pulmonary manifestations and assessing, managing, and treating upper and lower airway disease, interstitial lung disease, and lymphoproliferative disease.

Interpretation: Clinical practice guidelines for pulmonary manifestations in Sjögren's will improve early identification, evaluation, and uniformity of care by primary care physicians, rheumatologists, and pulmonologists. Additionally, opportunities for future research are identified.
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http://dx.doi.org/10.1016/j.chest.2020.10.011DOI Listing
February 2021

Review of X-ray and computed tomography scan findings with a promising role of point of care ultrasound in COVID-19 pandemic.

World J Radiol 2020 Sep;12(9):195-203

Division of Hospital Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN 55407, United States.

As healthcare professionals continue to combat the coronavirus disease 2019 (COVID-19) infection worldwide, there is an increasing interest in the role of imaging and the relevance of various modalities. Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management, it is critical to examine the role of different modalities currently in use, such as baseline X-rays and computed tomography scans carefully. In this article, we will draw attention to the critical findings for the radiologist. Further, we will look at point of care ultrasound, an increasingly a popular tool in diagnostic medicine, as a component of COVID-19 management.
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http://dx.doi.org/10.4329/wjr.v12.i9.195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523085PMC
September 2020

Successful Response to Treatment with Sirolimus in Pulmonary Sarcoidosis.

Am J Respir Crit Care Med 2020 11;202(9):e119-e120

Division of Pulmonary, Critical Care and Sleep Medicine and.

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http://dx.doi.org/10.1164/rccm.202004-0914IMDOI Listing
November 2020

Clinical and imaging features of idiopathic granulomatous mastitis - The diagnostic challenges and a brief review.

Clin Imaging 2021 Jan 15;69:126-132. Epub 2020 Jun 15.

Department of Radiology, Columbia University at Bassett Healthcare, Cooperstown, NY, USA.

Idiopathic granulomatous mastitis (IGM), or granulomatous lobular mastitis is a rare, benign, inflammatory condition of the breast, without an identifiable underlying etiology. The clinical and imaging diagnosis of this entity is challenging with the presentation frequently mimicking inflammatory breast carcinoma (IBC). Mammography and breast ultrasound (US) have an important role in its detection, however, biopsy is imperative for histopathological confirmation. We present three cases of biopsy proven IGM, highlighting the variability of the clinical and imaging features,brieflyreview the relevant literature and discuss the challenges associated with its diagnosis and management.
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http://dx.doi.org/10.1016/j.clinimag.2020.06.022DOI Listing
January 2021

Roca disease: An osteochondrosis of the inferior pole of the scapula with review of the literature.

Radiol Case Rep 2020 Sep 4;15(9):1523-1527. Epub 2020 Jul 4.

Department of Diagnostic Radiology, St. Vincent's Medical Center at Hartford Healthcare, 2800 Main Street, Bridgeport, CT 06606, USA.

Osteochondrosis is a developmental condition affecting the endochondral ossification. It is commonly idiopathic however can be due to vascular anomalies, dietary conditions, hormonal irregularity, or overuse trauma. Osteochondrosis occurring in the inferior pole of the scapula is an extremely rare condition and is referred to as roca disease. A higher degree of suspicion is required especially in a young patient with atraumatic shoulder pain and additional unconventional MRI sequences focusing on the inferior pole of scapula can be taken to rule out such conditions. We report a case of Roca disease in a 16-year male who presented with right shoulder pain. This is the third case report of roca disease in the English literature according to our knowledge and the first case report to demonstrate extensive MRI imaging features with a normal radiograph. Imaging, particularly MRI, plays a pivotal role in the diagnosis of this extremely rare entity. Also, the inferior pole of the scapula is usually not included in routine shoulder MRI imaging thus close scrutiny with additional MRI sequences should be done to diagnose such a rare entity.
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http://dx.doi.org/10.1016/j.radcr.2020.06.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339011PMC
September 2020

Osteochondroses of the bilateral metacarpal heads: Dieterich disease. A case report with review of the literature.

Clin Imaging 2020 Nov 29;67:7-10. Epub 2020 May 29.

Department of Diagnostic Radiology, St. Vincent's Medical Center at Hartford Healthcare, 2800 Main Street, Bridgeport, CT 06606, USA.

Osteochondroses is a well-known entity and typically affecting immature skeleton with few common locations involved are femoral head epiphysis, tibial tubercle apophysis, calcaneal apophysis, humeral capitellum and anterior vertebral end plates. We report a rare case of osteochondroses showing avascular necrosis involving metacarpal heads known as Dieterich disease, involving the head of the third metacarpal and probably the first case with a history of rock climbing as an etiology. Chronic repetitive microtrauma plays a significant role in the disease, as is seen in our patient. Imaging plays a crucial role in diagnosing, as well as monitoring progress, with MRI being a critical modality. The fact that this entity is rare does not necessarily make it difficult to detect. It may be clinical underdiagnosed due to lack of familiarity with this entity and radiographic findings may be subtle or inapparent. Bone scan is likely sensitive but not specific. MRI also likely has a role for early detection. This article is written with educational intent for the reader for the benefit of the patients with this rare disease.
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http://dx.doi.org/10.1016/j.clinimag.2020.05.020DOI Listing
November 2020

Pulmonary Langerhans Cell Histiocytosis.

Semin Respir Crit Care Med 2020 Apr 12;41(2):269-279. Epub 2020 Apr 12.

Medical Service, Veterans Affairs Medical Center, Cincinnati, Ohio.

Pulmonary Langerhans cell histiocytosis (PLCH) is a diffuse cystic lung disease that is strongly associated with exposure to cigarette smoke. Recently, activating pathogenic mutations in the mitogen-activated protein kinase pathway have been described in the dendritic cells in patients with PLCH and have firmly established PLCH to be an inflammatory myeloid neoplasm. Disease course and prognosis in PLCH are highly variable among individual patients, ranging from spontaneous resolution to development of pulmonary hypertension and progression to terminal respiratory failure. A subset of patients with PLCH may have extrapulmonary involvement, typically involving the skeletal system in the form of lytic lesions, skin lesions, or the central nervous system most commonly manifesting in the form of diabetes insipidus. Smoking cessation is the cornerstone of treatment in patients with PLCH and can lead to disease regression or stabilization in a substantial proportion of patients. Further insight into the underlying molecular pathogenesis of PLCH has paved the way for the future development of disease-specific biomarkers and targeted treatment options directed against the central disease-driving mutations.
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http://dx.doi.org/10.1055/s-0039-1700996DOI Listing
April 2020

Controversies and Evolving Concepts in Orphan Lung Diseases.

Semin Respir Crit Care Med 2020 04 12;41(2):175-176. Epub 2020 Apr 12.

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.

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http://dx.doi.org/10.1055/s-0040-1708057DOI Listing
April 2020

Comparative Assessment of Clinical and Predicted Treatment Outcomes of Clear Aligner Treatment: An in Vivo Study.

Turk J Orthod 2019 Dec 1;32(4):229-235. Epub 2019 Dec 1.

Department of Orthodontics, Division of Dentofacial Orthopedics, Sudha Rustagi College of Dental Science and Research, Faridabad, India.

Objective: The objective of this clinical study was to assess the predicted software models and clinical models and to compare the stage models of both the groups so as to evaluate the efficacy of tooth movement with clear aligner.

Methods: The sample size included 10 cases with mild anterior crowding treated with aligner therapy. The predicted software models were superimposed on the clinical stereolithography (STL) models at various stages by using the MeshLab software. The predicted software models showing orthodontic tooth movement were compared with the actual movement achieved clinically.

Results: The results of the present study have shown that when a comparison was made on the basis of irregularity scores in both the groups, it was seen that the irregularity score was higher at 2.55 at T4, 1.65 at T6, and 1.0 at T8 in the clinical STL group at each stage, whereas it was 2.0 at T4, 0.90 at T6, and 0.25 at T8 in the software model group. In addition, in comparing the mean accuracy of these three stages, the analysis of data showed that the mean accuracy is 62.5% at T4, 68.8% at T6, and 78.1% at T8.

Conclusion: The predicted software models do not accurately reflect the patient's tooth position. There is an overestimation by predicted software as compared with actual clinically achieved tooth position. There is a need of overcorrection to be built in the treatment planning stage itself and execution of the anticipated end result.
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http://dx.doi.org/10.5152/TurkJOrthod.2019.19019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018496PMC
December 2019

MAPK mutations and cigarette smoke promote the pathogenesis of pulmonary Langerhans cell histiocytosis.

JCI Insight 2020 02 27;5(4). Epub 2020 Feb 27.

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA.

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare smoking-related lung disease characterized by dendritic cell (DC) accumulation, bronchiolocentric nodule formation, and cystic lung remodeling. Approximately 50% of patients with PLCH harbor somatic BRAF-V600E mutations in cells of the myeloid/monocyte lineage. However, the rarity of the disease and lack of animal models have impeded the study of PLCH pathogenesis. Here, we establish a cigarette smoke-exposed (CS-exposed) BRAF-V600E-mutant mouse model that recapitulates many hallmark characteristics of PLCH. We show that CD11c-targeted expression of BRAF-V600E increases DC responsiveness to stimuli, including the chemokine CCL20, and that mutant cell accumulation in the lungs of CS-exposed mice is due to both increased cellular viability and enhanced recruitment. Moreover, we report that the chemokine CCL7 is secreted from DCs and human peripheral blood monocytes in a BRAF-V600E-dependent manner, suggesting a possible mechanism for recruitment of cells known to dominate PLCH lesions. Inflammatory lesions and airspace dilation in BRAF-V600E mice in response to CS are attenuated by transitioning animals to filtered air and treatment with a BRAF-V600E inhibitor, PLX4720. Collectively, this model provides mechanistic insights into the role of myelomonocytic cells and the BRAF-V600E mutation and CS exposure in PLCH pathogenesis and provides a platform to develop biomarkers and therapeutic targets.
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http://dx.doi.org/10.1172/jci.insight.132048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101136PMC
February 2020

Lung MRI as a Potential Complementary Diagnostic Tool for Early COPD.

Am J Med 2020 06 16;133(6):757-760. Epub 2020 Jan 16.

Center for Pulmonary Imaging Research, Pulmonary Medicine & Radiology, Cincinnati Children's Hospital, Ohio; Department of Pediatrics, University of Cincinnati, Ohio.

Introduction: Many knowledge gaps in the nature of early chronic obstructive pulmonary disease (COPD) still exist, mainly because COPD has always been considered a disease of the elderly. Little attention has been paid to the pathologic changes in the lungs of young adults with risk factors for COPD, such as bronchopulmonary dysplasia. One major limitation is the current lack of noninvasive ways to sensitively measure or image functional declines from subjects who are at risk for COPD but haven't yet developed more significant clinical symptoms of the disease.

Methods: We report the use of lung magnetic resonance imaging with hyperpolarized gas in the diagnostic workup for bronchopulmonary dysplasia with underlying chronic airflow limitation in presence of spirometry criteria that meet the diagnosis of early-onset COPD.

Conclusions: In the postsurfactant era, where more young adults will be spirometrically diagnosed with COPD, patients should be classified not only on the basis of their airflow limitation, but also on lung abnormalities identified with safe, comprehensive imaging technologies that allow regular, longitudinal follow-up.
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http://dx.doi.org/10.1016/j.amjmed.2019.12.009DOI Listing
June 2020

A pictorial review of gall stones and its associated complications.

Clin Imaging 2020 Apr 28;60(2):228-236. Epub 2019 Nov 28.

Department of Diagnostic Radiology, Bridgeport Hospital at Yale New Haven Health, 167 Grant St, Bridgeport, CT 06610, USA.

Gallstone disease is the term commonly used to refer to gallstones that cause symptoms. There is a myriad of complications that can arise from gallstones: acute cholecystitis, xanthogranulomatous cholecystitis, emphysematous cholecystitis, gallbladder wall perforations, pericholecystic abscesses, Mirizzi syndrome, cholecystoenteric fistulas, choledocholithiasis, gallstone pancreatitis, porcelain gallbladder, gallbladder malignancies, and many more. The aim of this pictorial review is to revisit how multimodality imaging can help with the diagnosis of gallstone disease. We review the classic imaging findings on different imaging modalities for gallstone disease and its associated complications and how it is useful in early diagnosis for timely management of complications as well as surgical planning.
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http://dx.doi.org/10.1016/j.clinimag.2019.11.015DOI Listing
April 2020
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