Decreased Diffusion Capacity Research Articles

CROSS Versus FLOT Regimens in Esophageal and Esophagogastric Junction Adenocarcinoma

The FLOT protocol and the CROSS trimodality regimen represent current standards in the management of locally advanced esophageal adenocarcinoma. In the absence of published Randomised Controlled Trial data, this propensity-matched comparison evaluated tolerance, toxicity, impact on sarcopenia and pulmonary physiology, operative complications, and oncologic metrics. Two hundred and twenty-two patients, 111 in each arm, were included from 2 high-volume centers. Computed tomography-measured sarcopenia, and pulmonary function (forced expiratory volume in first second/forced vital capacity/diffusion capacity for carbon monoxide) were compared pretherapy and posttherapy. Operative complications were defined as per the Esophageal Complications Consensus Group (ECCG) criteria, and severity per Clavien-Dindo. Tumor regression grade and R status were measured, and survival estimated per Kaplan-Meier. A total of 83% were male, cT3/cN+ was 92%/68% for FLOT, and 86%/60% for CROSS. The full prescribed regimen was tolerated in 40% of FLOT patients versus 92% for CROSS. Sarcopenia increased from 16% to 33% for FLOT, and 14% to 30% in CROSS ( P <0.01 between arms). Median decrease in diffusion capacity for carbon monoxide was -8.25% (-34 to 25) for FLOT, compared with -13.8%(-38 to 29), for CROSS ( P =0.01 between arms). Major pathologic response was 27% versus 44% for FLOT and CROSS, respectively ( P =0.03). In-hospital mortality, respectively, was 1% versus 2% ( P =0.9), and Clavien Dindo >III 22% versus 27% ( P =0.59), however, respiratory failure was increased by CROSS, at 13% versus 3% ( P <0.001). Three-year survival was similar at 63% (FLOT) and 60% (CROSS) ( P =0.42). Both CROSS and FLOT resulted in equivalent survival. Operative outcomes were similar, however, the CROSS regimen increased postoperative respiratory failure and atrial fibrillation. Less than half of patients received the prescribed FLOT regimen, although toxicity rates were acceptable. These data support clinical equipoise, caution, however, may be advised with CROSS in patients with greatest respiratory risk.

Assessment of pulmonary function tests among patients with hypothyroidism

Background: The respiratory system involvement in hypothyroidism varies from mild dyspnea to a more severe respiratory failure. This has been reported as reduction in expiratory and inspiratory muscle strength, alveolar hypoventilation along with reduction of hypoxic and hypercapnic ventilatory drives and decreased maximal breathing capacity and decreased diffusion capacity among hypothyroid patients. Material &amp; Methods: The present prospective study was conducted at department of respiratory medicine of our tertiary care hospital. In present study, we enrolled 50 study participants from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant Results In the present study, majority of patients showed obstructive pattern i.e. 30% which was followed by mixed pattern among 22% patients and 18% of patients showed restrictive pattern. 30% of patients showed normal respiratory pattern on pulmonary function test. On the basis of the Spirometry examination finding among case group, the mean value of FEV1 (L) was 1.38±0.68, the man value of FVC(L) was 2.24±0.71. on assessment the mean value of FEV1/FVC proportion (postbronchodilator) was 61.6 ±11.3.

Fatigue Is a Major Symptom at COVID-19 Hospitalization Follow-Up.

Persistent symptoms after hospitalization with COVID-19 are common, but the frequency and severity of these symptoms are insufficiently understood. We aimed to describe symptoms and pulmonary function after hospitalization with COVID-19. Patients hospitalized with COVID-19 in Central Denmark Region were invited for follow-up 3 months after discharge. Clinical characteristics, patient reported outcomes (Fatigue Assessment Scale (FAS), anxiety and depression (HADS)), symptoms, pulmonary function test and 6-min walk test were collected. We included 218 patients (mean age 59.9 (95% CI: 58.2, 61.7), 59% males). Fatigue, dyspnea and impaired concentration were the most prevalent symptoms at follow-up. Using FAS, 47% reported mild-to-moderate fatigue and 18% severe fatigue. Mean HADS was 7.9 (95% CI: 6.9, 8.9). FAS was correlated to HADS (β = 0.52 (95% CI: 0.44, 0.59, p < 0.001)). Mean DLCO was 80.4% (95% CI: 77.8, 83.0) and 45% had DLCO ˂ 80%. Mean DLCO was significantly reduced in patients treated in the ICU (70.46% (95% CI 65.13, 75.79)). The highest FAS and HADS were seen in patients with the shortest period of hospitalization (2.1 days (95% CI: 1.4, 2.7)) with no need for oxygen. In conclusion, fatigue is a common symptom after hospitalization for COVID-19 and ICU treatment is associated to decreased diffusion capacity.

Advancing Pulmonary Rehabilitation Approach in Improving Well-being in a Long COVID-19 Syndrome Case

Being a highly contagious disease, Coronavirus Disease-2019 (COVID-19) has shown its impact throughout the world. Clinical manifestations are seen primarily involving the respiratory system. Fever, cough, fatigue, and breathlessness are the commonly seen symptoms. Several cases of COVID-19 manifest as viral pneumonia-induced Acute Respiratory Distress Syndrome (ARDS). COVID19 symptoms appear not only during the course of the illness but also as its after effects. Long COVID-19 is said to be multisystem syndrome, categorised as postacute or chronic depending upon the time frame. It is characterized by the presence of symptoms beyond four weeks of the actual disease. Change in structural components in the lung leads to having a functional consequence on the body, affecting the cognitive, psychosocial, mental and physical well-being of the patients. Studies have shown alveolar damage same as ARDS. The most common pulmonary sequences seen are dyspnoea, cough (dry/with expectoration) and decreased diffusion capacity leading to reduced endurance. The present case report was of a 45-year-old nurse, who presented with the symptoms of postacute long COVID-19. Her previous scan of thorax showed a severity score of 11/25 after being tested COVID-19 positive. In view of the presenting complaints, a tailor-made pulmonary rehabilitation program was administered which showed great improvement in overall health condition. This case had been reported to document the effects of post COVID rehabilitation program on aspects such as functional capacity, quality of life, anxiety and depression using novel measures such as Incremental Shuttle Walk Test (ISWT), World Health Organisation Quality of Life-Brief Version (WHOQOL-BREF), and Depression, Anxiety and Stress Scale - 21 Items (DASS-21). Rehabilitation has been proven to be effective and safe in improving the exercise performance, quality of life affected due to COVID-19 and psychological function of the patients.

Abnormal Pulmonary Function Testing as an Independent Risk Factor for Procedural Complications During Transthoracic Needle Biopsies.

Computed tomography (CT)-guided transthoracic needle biopsy is an important diagnostic tool for pulmonary nodules, offering a less invasive alternative to surgical procedures. This study aims to better risk stratify patients undergoing this procedure by analyzing the pulmonary function testing (PFT), imaging characteristics, and patient demographics most associated with complications. This retrospective study involved 254 patients undergoing transthoracic needle biopsies at 3 hospitals between October 2016 and December 2019. Demographic data, extent of emphysema, and target lesion characteristics were recorded. Complications were defined as minor (small pneumothorax, mild hemoptysis, or pulmonary hemorrhage) and major (pneumothorax requiring chest tube, hemothorax, rapid atrial fibrillation, or postprocedure hypotension or hypoxia). There were 50 minor (20%) and 18 major complications (7%). As seen with prior studies, older age, increased distance to pleura, and smaller nodule size correlated with an increased risk of complications. Uniquely to our study, emphysema severity, seen on CT (P=0.008) and with decreased forced expiratory volume/forced vital capacity ratio, conferred an increased risk (62.94 vs. 68.74, P=0.05) of complications. Decreased Hounsfield unit of surrounding lung (a surrogate measure of emphysema) and decreased diffusion capacity (11.81 vs. 14.93, P=0.05) were associated with increased risk of major complications. Interestingly, body mass index and comorbidities had no correlation with complications. In addition to previous well-described characteristics, we described physiological data (abnormal PFTs), imaging findings, and nodule location as risk factors of procedural complications. Obtaining preprocedural PFT, in addition to reviewing CT imaging and demographic data, may aid clinicians in better risk stratifying patients undergoing transthoracic needle biopsies.

Association of abnormal pulmonary vasculature on CT scan for COVID-19 infection with decreased diffusion capacity in follow up: A retrospective cohort study.

Coronavirus Disease 2019 (COVID-19) is a respiratory viral illness causing pneumonia and systemic disease. Abnormalities in pulmonary function tests (PFT) after COVID-19 infection have been described. The determinants of these abnormalities are unclear. We hypothesized that inflammatory biomarkers and CT scan parameters at the time of infection would be associated with abnormal gas transfer at short term follow-up. We retrospectively studied subjects who were hospitalized for COVID-19 pneumonia and discharged. Serum inflammatory biomarkers, CT scan and clinical characteristics were assessed. CT images were evaluated by Functional Respiratory Imaging with automated tissue segmentation algorithms of the lungs and pulmonary vasculature. Volumes of the pulmonary vessels that were ≤5mm (BV5), 5-10mm (BV5_10), and ≥10mm (BV10) in cross sectional area were analyzed. Also the amount of opacification on CT (ground glass opacities). PFT were performed 2-3 months after discharge. The diffusion capacity of carbon monoxide (DLCO) was obtained. We divided subjects into those with a DLCO <80% predicted (Low DLCO) and those with a DLCO ≥80% predicted (Normal DLCO). 38 subjects were included in our cohort. 31 out of 38 (81.6%) subjects had a DLCO<80% predicted. The groups were similar in terms of demographics, body mass index, comorbidities, and smoking status. Hemoglobin, inflammatory biomarkers, spirometry and lung volumes were similar between groups. CT opacification and BV5 were not different between groups, but both Low and Normal DLCO groups had lower BV5 measures compared to healthy controls. BV5_10 and BV10 measures were higher in the Low DLCO group compared to the normal DLCO group. Both BV5_10 and BV10 in the Low DLCO group were greater compared to healthy controls. BV5_10 was independently associated with DLCO<80% in multivariable logistic regression (OR 1.29, 95% CI 1.01, 1.64). BV10 negatively correlated with DLCO% predicted (r = -0.343, p = 0.035). Abnormalities in pulmonary vascular volumes at the time of hospitalization are independently associated with a low DLCO at follow-up. There was no relationship between inflammatory biomarkers during hospitalization and DLCO. Pulmonary vascular abnormalities during hospitalization for COVID-19 may serve as a biomarker for abnormal gas transfer after COVID-19 pneumonia.

A RARE CASE OF INTERSTITIAL LUNG DISEASE IN IDIOPATHIC INFLAMMATORY MYOSITIS ASSOCIATED WITH ANTI-MDA5

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Anti-MDA5 (anti-melanoma differentiation-associated gene-5) associated dermatomyositis (DM) is a rare presentation of idiopathic inflammatory myositis, often presenting with treatment refractory rapidly progressing interstitial lung disease (ILD). Diagnosis is difficult as patients can present without symptoms or biochemical evidence of DM. We report a rare adult case of anti-MDA5 ILD with only pulmonary manifestations. CASE PRESENTATION: 74-year-old female with past medical history of atrial fibrillation status post pacemaker, reactive airway disease, and heart failure with preserved ejection fraction, was referred to pulmonary clinic for abnormal CT scan and dyspnea that began 4 months prior while living in India. Initial chest CT was significant for bi-apical consolidations and bronchiectasis. Bronchoscopy with lavage was positive for Aspergillus galactomannan, and she was treated with isavuconazole, prednisone, and Septra (for pneumocystis prophylaxis). Chest CT 4 weeks later showed improvement in consolidations. 3 months later, dyspnea recurred. She was re-started on prednisone 20 mg daily, and dyspnea resolved. She subsequently relocated to the USA. She had serial negative COVID tests. Pulmonary function test showed a restrictive ventilatory defect with decreased diffusion capacity. Follow-up CT chest revealed bi-apical scarring, and multifocal airspace consolidation. ESR 44 (elevated) and CRP 11.2 (elevated). IGE, aldolase, CK, hypersensitivity pneumonitis antibody panel, Aspergillus antibody, nuclear antibody panel, RF, and anti-CCP were negative. Extended myositis panel revealed high positive titer for anti-MDA5 and RNA polymerase 3 antibodies;subsequently confirmed with a different extended myositis assay. She was referred to a rheumatologist who recommended aggressive immune modulating treatment with prednisone, tacrolimus and cyclophosphamide. After discussion, she opted for mycophenolate mofetil and prednisone. DISCUSSION: Anti-MDA5 associated DM can present with rapidly progressive ILD and is associated with poor prognosis. In a small prospective study, a triple therapy regimen consisting of high dose glucocorticoid, Tacrolimus, and intravenous Cyclophosphamide showed 6-month survival benefit compared to a step-up approach (which entailed starting with high dose glucocorticoids and later combining with immunomodulators). Plasmapheresis has been used for patients who have failed combination immunomodulators in multiple small case studies. CONCLUSIONS: Anti-MDA5 associated ILD should be considered in patients with new ILD, since it can present without evidence of DM. Intense multiple drug immune suppression is recommended from the beginning. Plasmapheresis and lung transplant can be considered if patients become refractory to combination immunosuppression. REFERENCE #1: Gupta R, Kumar S, Gow P, Hsien-Cheng Chang L, Yen L. Anti-MDA5-associated dermatomyositis. Intern Med J. 2020 Apr;50(4):484-487. doi: 10.1111/imj.14789. PMID: 32270621. REFERENCE #2: Fiorentino D, Chung L, Zwerner J, Rosen A, Casciola-Rosen L. The mucocutaneous and systemic phenotype of dermatomyositis patients with antibodies to MDA5 (CADM-140): a retrospective study. J Am Acad Dermatol. 2011 Jul;65(1):25-34. doi: 10.1016/j.jaad.2010.09.016. Epub 2011 Apr 29. PMID: 21531040;PMCID: PMC3167687. REFERENCE #3: Hall JC, Casciola-Rosen L, Samedy LA, Werner J, Owoyemi K, Danoff SK, Christopher-Stine L. Anti-melanoma differentiation-associated protein 5-associated dermatomyositis: expanding the clinical spectrum. Arthritis Care Res (Hoboken). 2013 Aug;65(8):1307-15. doi: 10.1002/acr.21992. PMID: 23436757;PMCID: PMC3689861. DISCLOSURES: No relevant relationships by Peter Huh, source=Web Response No relevant relationships by Sudhir Rajan, source=Web Response No relevant relationships by Eduardo Solbes, source=Web Response

A CALCIFIED CARCINOID TUMOR

TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: Pulmonary carcinoid tumor is a neuroendocrine tumor of enterochromaffin cells representing about 1–5% of all lung malignancies. It usually presents in never smokers typically in proximal airways. Patients present with chronic cough, hemoptysis, and bronchial obstruction. These tumors show a low to moderate activity on PET scan. We present a case of a calcified carcinoid tumor. CASE PRESENTATION: A 49-year-old never-smoker male with medical history known for obesity, diabetes mellitus, hypothyroidism and exposure to welding presented complaining from progressive dyspnea with cough, wheezing and a history of mild hemoptysis. A Pulmonary function test (PFT) was performed which showed a FEV1/FVC ratio of 73% (post-bronchodilator), FEV1 77%, TLC 112%, RV 152% and DLCO of 77%. Findings were suggestive of a moderate obstructive lung defect and no significant bronchodilator response associated with decreased diffusion capacity and air trapping. The patient was started on umeclidium-vilanterol and a Chest X-ray was performed that showed atelectasis with prominence of the right hilum suggestive of pulmonary artery enlargement or potentially underlying lymphadenopathy/nodule. Thus, a Chest computer topography (CT) was scheduled. However, the patient developed an episode of hemoptysis and presented to the emergency department (ED) acutely prior to performing the chest CT. Chest CT was performed upon presentation to the ED which showed a calcified right hilar mass. Upon presentation the patient denied having any other complaints. He was started on antibiotics and steroids. A bronchoscopy with endobronchial ultrasound was performed that showed an endobronchial mass at the level of the secondary carina between the right upper lobe and bronchus intermedius bulging into the bronchus intermedius with about 85% obstruction of the bronchus intermedius not allowing the bronchoscope to pass distally with cobblestone mucosa. A transbronchial needle aspiration from the right hilar mass was performed as well as an endobronchial biopsy from right lung mass and lateral wall of the bronchus intermedius. Brushing from the right lung mass in the bronchus intermedius and bronchioalveolar lavage from bronchus intermedius was done. Pathology from the right upper lobe biopsy was positive for a neuroendocrine tumor (carcinoid). BAL, brushing, and lymph nodes were negative. A PET CT scan was done which confirmed the presence of a partially calcified right posterior hilar soft tissue mass with low FDG uptake and no definite metastatic disease. Patient underwent a right pneumonectomy. DISCUSSION: Calcifications has been reported in mesenteric carcinoid tumors, however, no prior cases of pulmonary carcinoid calcification were reported in the literature. This case describes an unusual presentation of pulmonary carcinoid tumor. CONCLUSIONS: This presentation highlights the importance of proper evaluation of a calcified mass. REFERENCE #1: https://pubmed.ncbi.nlm.nih.gov/7839976/ DISCLOSURES: No relevant relationships by Ahmad Albalbissi, source=Web Response No relevant relationships by Girendra Hoskere, source=Web Response No relevant relationships by AYA MASADEH, source=Web Response

Coronavirus Pneumonia: Outcomes and Characteristics of Patients in an Inner-City Area after 3 Months of Infection.

Background: The morbidity and long term pulmonary consequences of COVID-19 infection continue to unfold as we learn and follow survivors of this disease. We report radiological evolution and pulmonary function findings in those patients. Methods: This was a retrospective cohort study of adult patients referred to the post-acute COVID-19 pulmonary clinic after a diagnosis of COVID-19 pneumonia. The study period was after the initial peak of the pandemic in New York City, from June to December 2020. Results: 111 patients were included. The average interval time between COVID-19 pneumonia and initial clinic evaluation was 12 weeks. 48.2% of patients had moderate and 22.3% had severe infection. Dyspnea and cough was the most common respiratory symptoms post infection. Radiographic abnormalities improved in majority of patients with ground glass opacities been the common residual abnormal finding. Restrictive airway disease and decreased diffusion capacity were the most common findings in pulmonary function test. Conclusion: Our study suggests the needs for close and serial monitoring of functional and radiological abnormalities during the post COVID-19 period. Considering that many of the clinical-radiological and functional abnormalities are reversible, we suggest a “wait and watch“approach to avoid unnecessary invasive work up.

Six-Month Pulmonary Function After Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 Patients.

Venovenous extracorporeal membrane oxygenation has been largely used in patients with refractory acute respiratory distress syndrome due to coronavirus disease 2019. Few data on long-term pulmonary function among venovenous extracorporeal membrane oxygenation survivors are available. Retrospective, observational cohort. Two mixed medical-surgical tertiary (30 beds) and secondary (22 beds) ICUs. All critically ill adult coronavirus disease 2019 survivors treated with venovenous extracorporeal membrane oxygenation between March 10, and April 30, 2020. The last available lung function and 6-minute walking tests, performed after a median of 178 days (ranges, 72-232 d) from ICU admission, were analyzed. Among the 32 coronavirus disease 2019 patients treated by venovenous extracorporeal membrane oxygenation during the study period, 11 (34%; median age 56 yr; median duration of mechanical ventilation and extracorporeal membrane oxygenation therapy of 26 and 15 d, respectively) were successfully weaned and discharged home. Spirometry was performed in nine patients; the volumetric lung function was preserved, that is, median forced vital capacity was 83% of predicted value (51-99% of predicted value), and median forced expiratory volume in 1 second was 82% of predicted value (60-99% of predicted value). Also, the median residual volume and the lung capacity were 100% of predicted value (50-140% of predicted value) and 90% of predicted value (50-100% of predicted value); only the diffusion capacity of the lung for carbon monoxide and 6-minute walking test were decreased (58% of predicted value [37-95% of predicted value] and 468 meters (365-625 meters), corresponding to [63-90% of predicted value], respectively). Among survivors from severe coronavirus disease 2019 pneumonia treated with venovenous extracorporeal membrane oxygenation, preserved long-term volumetric lung function with decreased diffusion capacity of lung carbon monoxide was observed.

Fatigue and its relationship with disease-related factors in patients with systemic sclerosis: A cross-sectional study

Background/aimFatigue is very common symptom in patients with systemic sclerosis (SSc) and adversely affects health-related quality of life and the ability to perform daily living activities. This study aimed to determine the severity of fatigue, and its related factors, in patients with SSc.Materials and methodsA total of 35 patients with SSc (6 males and 29 females, mean age of 50.71 ± 10.09 years) and 35 healthy control subjects (8 males and 27 females, mean age of 54.14 ± 9.51 years) were included in this study. The Fatigue Impact Scale for fatigue, Modified Medical Research Council Scale for dyspnea severity, 6-Minute Walking Test for functional capacity, Health Assessment Questionnaire Disability Index, Scleroderma Health Assessment Questionnaire and Short Form-36 Quality of Life Questionnaire for health-related quality of life were used in the evaluation of the subjects. Furthermore, pulmonary functions, diffusion capacity, and respiratory and peripheral muscle strength were evaluated.Results Of the SSc patients, 80% experienced fatigue and presented with higher total and cognitive, physical, and psychosocial subscale fatigue scores than the healthy control subjects (P < 0.05). Moreover, the SSc patients exhibited significantly increased dyspnea severity, impaired pulmonary function-diffusion capacity, decreased respiratory-peripheral muscle strength, reduced functional capacity, and worsened health-related quality of life when compared to the control group (P < 0.05). Fatigue in the SSc group was significantly associated with age, dyspnea severity, diffusion capacity, respiratory and peripheral muscle strength, functional capacity, and health-related quality of life (P < 0.05).ConclusionsAlong with the decrease in diffusion capacity, increase dyspnea, a decrease in both peripheral and respiratory muscle strength, and worsening functional capacity may have an effect on increased fatigue in SSc patients. Increased fatigue can also affect the life quality and daily life activities of a patient. Therefore, multidisciplinary approaches are recommended to evaluate and improve these parameters in the treatment of fatigue from the early period in SSc patients.

Severe SARS-CoV-2 pneumonia: Clinical, functional and imaging outcomes at 4 months

IntroductionGiven the pathophysiology of coronavirus disease 19 (COVID-19), persistent pulmonary abnormalities are likely. MethodsWe conducted a prospective cohort study in severe COVID-19 patients who had oxygen saturation<94% and were primarily admitted to hospital. We aimed to describe persistent gas exchange abnormalities at 4 months, defined as decreased diffusing capacity of the lungs for carbon monoxide (DLco) and/or desaturation on the 6-minute walk test (6MWT), along with associated mechanisms and risk factors. ResultsOf the 72 patients included, 76.1% required admission to an intensive care unit (ICU), while 68.5% required invasive mechanical ventilation (MV). A total of 39.1% developed venous thromboembolism (VTE). After 4 months, 61.4% were still symptomatic. Functionally, 39.1% had abnormal carbon monoxide test results and/or desaturation on 6MWT; high-flow oxygen, MV, and VTE during the acute phase were significantly associated. Restrictive lung disease was observed in 23.6% of cases, obstructive lung disease in 16.7%, and respiratory muscle dysfunction in 18.1%. A severe initial presentation with admission to ICU (P=0.0181), and VTE occurrence during the acute phase (P=0.0089) were associated with these abnormalities. 41% had interstitial lung disease in computed tomography (CT) of the chest. Four patients (5.5%) displayed residual defects on lung scintigraphy, only one of whom had developed VTE during the acute phase (5.5%). The main functional respiratory abnormality (31.9%) was reduced capillary volume (Vc<70%). ConclusionAmong patients with severe COVID-19 pneumonia who were admitted to hospital, 61% were still symptomatic, 39% of patients had persistent functional abnormalities and 41% radiological abnormalities after 4 months. Embolic sequelae were rare but the main functional respiratory abnormality was reduced capillary volume. A respiratory check-up after severe COVID-19 pneumonia may be relevant to improve future management of these patients.

Study for the Effect of Temperature on Methane Desorption Based on Thermodynamics and Kinetics.

Desorption hysteresis is important for primary gas production. Temperature may cause serious changes in the methane adsorption/desorption behaviors. In order to study the mechanism of methane desorption and desorption hysteresis, three sets of samples of long-flame coal, coking coal, and anthracite were collected, and experiments such as microscopic composition determination, liquid nitrogen adsorption, and isothermal adsorption/desorption were performed. From the perspectives of desorption kinetics, desorption thermodynamics, and methane occurrence state, the differences in methane and methane desorption characteristics and the desorption hysteresis mechanism are discussed. The results show that at the same temperature, anthracite (SH3#) has the largest saturated adsorption capacity and residual adsorption capacity, followed by coking coal (SGZ11#), and long-flame coal (DFS4#) has the smallest. As the temperature increases, the theoretical desorption rate and residual adsorption capacity of anthracite (SH3#) and coking coal (SGZ11#) will increase first and then decrease. Temperature and methane desorption do have positive effects, but temperature may have a threshold for promoting methane desorption. It is necessary to comprehensively consider the influence of temperature on the activation of gas molecules and the pore structure of coal. Under the premise of a certain temperature, as the pressure increases, the desorption hysteresis rate changes in a logarithmic downward trend, the methane desorption hysteresis rate in the low-pressure stage (P < 4 MPa) is large, and the methane desorption hysteresis rate in the high-pressure stage (P > 4 MPa) is lower; during the isobaric adsorption process, the adsorption capacity of anthracite (SH3#) increases the fastest, followed by SGZ11#, and that of DFS4# is the smallest. In the low-pressure stage (P < 4 MPa), the adsorption capacity increases significantly with the increase in pressure, but in the high-pressure stage (P > 4 MPa), the adsorption capacity does not change significantly with pressure, instead gradually stabilizes. Under the same pressure, the molecular free path of methane increases with temperature. Under the premise of constant temperature, in the low-pressure stage (0 < P < 4 MPa), when the pressure continues to decrease, the free path of methane molecules increases significantly, resulting in a decrease in diffusion capacity. In the high-pressure stage (4 < P < 8 MPa), when the pressure continues to decrease, the free path of methane molecules does not change significantly; the sample desorption process of three sets of samples DFS4#, SGZ11#, and SH3# occurs, and the intermediate adsorption heat is greater than the isometric adsorption heat during the adsorption process, indicating that the desorption process needs to continuously absorb heat from outside the system. The energy difference produced in the process of adsorption and desorption causes the desorption hysteresis effect. The greater the difference in the isometric heat value of adsorption, the more significant the hysteresis is.

Clinical characteristics of connective tissue disease associated interstitial lung disease in children

Objective: To elucidate the clinical features of connective tissue disease associated interstitial lung disease (CTD-ILD) in children. Methods: A total of 24 children diagnosed with CTD-ILD and treated in Department of Rheumatology and Immunology, Shanghai Children's Medical Center from January 2010 to December 2019 were included in the study. Their medical data including clinical features, lab test, imaging, pulmonary function test, treatment and outcome were analyzed statistically. Results: In these 24 patients, 4 were males and 20 females. Their main clinical presentations were cough (10/24, 42%), shortness of breath (10/24, 42%), tachycardia in quiet state (8/24, 33%), fatigue with activity (7/24, 29%), and fever (6/24, 25%). The main abnormal physical examination findings were moist rales (4/24, 17%) and acropachy (2/24, 8%). There were various abnormal findings in the patients' lab test. All the patients (100%) had pulmonary interstitial changes on chest CT. Eight patients had spirometry test, and all (100%) showed decreased diffusion capacity. After immunosuppressive treatment, 15 cases (63%) improved, 4 cases (17%) gave up or died, while 5 cases (21%) had no significant improvement on the imaging examination. Conclusions: The onset of pediatric CTD-ILD could be insidious. Early diagnosis and aggressive treatment may change the prognosis, but are both difficult and need further studies.

Possible association of idiopathic pulmonary hemosiderosis with rheumatoid arthritis: A case report.

Idiopathic pulmonary hemosiderosis (IPH) is a rare interstitial lung disease, usually occurring in children or young adults. Although several studies reported on the coexistence of IPH and immune system diseases, the association between these conditions has not been well described. The present study reports on the case of a 21-year-old female patient who presented with bilateral lung abnormalities. The patient was admitted due to a 2-year history of progressive exertional dyspnea, as well as arthralgia and joint swelling in the recent 2 months. During the past 15 years, the patient had been diagnosed with anemia and received repeated blood transfusions. Serial chest CT scans indicated an interstitial pattern. On physical examination, the patient had pale skin with a hemoglobin level of 65 g/l and exhibited finger-clubbing. Arterial blood gas analysis revealed hypoxia. Anticyclic-citrullinated protein antibody and rheumatoid factor were highly positive. Pulmonary function tests revealed restrictive ventilation dysfunction and decreased diffusion capacity. Bronchoscopy and biopsy confirmed diffuse alveolar hemorrhage. Following assessment of the etiology, the diagnosis of IPH was made by exclusion. The patient's symptoms and laboratory findings combined also confirmed the diagnosis of rheumatoid arthritis (RA). After receiving corticosteroid treatment, the patient's condition improved, and she was discharged and followed up. Based on this patient and a review of the literature, the present study demonstrated for the first time that IPH may mediate the development of an RA pathology. Therefore, early diagnosis is important for the timely management of IPH, which may also delay or even prevent the development of immune system diseases, e.g. RA, in patients with IPH. Further attention should be paid to determine the association between IPH and immune system diseases in the clinical setting.

Desquamative interstitial pneumonia: a systematic review of its features and outcomes

Desquamative Interstitial Pneumonia (DIP) is a rare form of idiopathic interstitial pneumonia (IIP). Data on clinical features, aetiology, prognosis and effect of treatment strategies are limited. We aimed to collect all published cases to better characterise DIP. A systematic literature search was performed for all original cases of adult patients with histopathologically-confirmed DIP. Individual patient data were extracted and summarised. We included 68 individual cases and 13 case series reporting on 294 cases. Most common presenting symptoms were dyspnoea and cough. Pulmonary function showed a restrictive pattern (71%) with decreased diffusion capacity. We found a high incidence (81%) of ever smoking in patients with DIP and 22% of patients had other (occupational) exposures. Characteristic features on high-resolution computed tomography (HRCT) scan were bilateral ground-glass opacities with lower lobe predominance (92%). Treatment and duration of treatment widely varied. Initial response to treatment was generally good, but definitely not uniformly so. A significant proportion of patients died (25% of individual cases) or experienced a relapse (18% of individual cases). DIP remains an uncommon disease, frequently but not always related to smoking or other exposures. Furthermore, DIP behaves as a progressive disease more often than generally thought, possibly associated with different underlying aetiology.

Lung Function of Adults Born at Very Low Birth Weight.

Much remains unknown about the consequences of very low birth weight (VLBW) and bronchopulmonary dysplasia (BPD) on adult lungs. We hypothesized that VLBW adults would have impaired lung function compared with controls, and those with a history of BPD would have worse lung function than those without. At age 26 to 30 years, 226 VLBW survivors of the New Zealand VLBW cohort and 100 term controls born in 1986 underwent lung function tests including spirometry, plethysmographic lung volumes, diffusing capacity of the lung for carbon monoxide, and single-breath nitrogen washout (SBN2). An obstructive spirometry pattern was identified in 35% VLBW subjects versus 14% controls, with the majority showing mild obstruction. Compared with controls, VLBW survivors demonstrated significantly lower forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity (FVC) ratio (FEV1/FVC), forced expiratory flow at 25% to 75% of FVC and higher residual volume (RV), RV/total lung capacity (TLC) ratio (RV/TLC), decreased diffusing capacity of the lung for carbon monoxide, and increased phase III slope for SBN2. The differences persisted after adjustment for sex and smoking status. Within the VLBW group, subjects with BPD showed significant reduction in FEV1, FEV1/FVC, and forced expiratory flow at 25% to 75% of FVC, and increase in RV, RV/TLC, and phase III slope for SBN2, versus subjects without. The differences remained after adjustment for confounders. Adult VLBW survivors showed a higher incidence of airflow obstruction, gas trapping, reduced gas exchange, and increased ventilatory inhomogeneity versus controls. The findings suggest pulmonary effects due to VLBW persist into adulthood, and BPD is a further insult on small airway function.

Respiratory Diseases in Post-9/11 Military Personnel Following Southwest Asia Deployment.

Persistent respiratory symptoms following post-9/11 military deployment to Iraq and Afghanistan are well-recognized, but the spectrum of respiratory diseases remains poorly characterized. This study describes deployment-related respiratory diseases and the diagnostic utility of resting and exercise pulmonary function testing. Between 2009 and 2017, 127 consecutive military workers ("deployers") with new-onset respiratory symptoms underwent clinical evaluation. Deployment-related respiratory diseases were classified as proximal and/or distal. Using descriptive statistics and logistic regression, we analyzed lung function parameters associated with deployment-related distal lung disease (DDLD). Common deployment-related respiratory diseases included asthma (31.5%), intermittent laryngeal obstruction (14.2%), rhinosinusitis (15%), and DDLD (68.5%). Decreased diffusion capacity (odds ratio [OR] = 4.6, 95% confidence interval [CI]: 1.4 to 15.1, P = 0.01) was significantly associated with DDLD. A comprehensive diagnostic approach may identify a spectrum of proximal and distal respiratory diseases that can occur in symptomatic post-9/11 deployers, requiring a personalized approach to care.

HEADACHE OF A DIAGNOSIS: A CASE OF METASTATIC PULMONARY CALCIFICATION IN A YOUNG END-STAGE RENAL DISEASE PATIENT

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Inadequate renal replacement therapy may lead to metastatic pulmonary calcification (MPC) in end stage renal disease (ESRD) patients. MPC is seldom recognized as it is usually asymptomatic. Cough and shortness of breath are uncommon manifestations of MPC. We present a case of symptomatic MPC in a young female diagnosed on CT scan. CASE PRESENTATION: 32 year old non-alcoholic, non-smoker, past history of ESRD (secondary to hypertension) and no previous drug abuse on hemodialysis (HD) for 12 years was referred for a Chest X-ray suggestive of military tuberculosis. She was started on Cefepime before transfer. She reported non-productive cough and dyspnea for 2 months. No previous history of night sweats, fever, chills, weight loss, travel, hemoptysis, exposure to tuberculous contacts, chronic infections, cancer or intake of immunosuppressive medications. She was not compliant with HD. Vitals were within normal limits except for sinus tachycardia. A left upper extremity functional AV fistula was noted and there was a firm non-tender mass in the left infraclavicular region. Her lungs were clear to auscultation with symmetric expansion. Labs showed a white cell count of 12 k/cmm, hemoglobin of 8.5 g/dl, BUN of 65 mg/dl, Cr of 12 mg/dl, phosphorus of 8 mg/dl, Ca of 9.1 mg/dl, albumin of 2.4 g/dl and an elevated PTH of 1318 pg/ml. HRCT of the chest showed multiple bilateral pulmonary micro nodules with heavy and extensive calcifications throughout upper lobes and a big soft tissue calcification in the left infraclavicular region. A 2D ECHO revealed mitral valve calcification. Vancomycin was added to cefepime. Blood cultures and TB quantiferon test were negative. HD and phosphate binders were continued throughout the hospital stay. Bronchoalveolar lavage was negative for mycobacterial, bacterial and fungal infection. During her stay the patient remained afebrile. Considering her history of ESRD and an elevated calcium phosphorus product; diagnosis of MPC was made. Antibiotics were stopped and the patient was counselled on compliance with HD and medications. Pulmonary function tests (PFTs) revealed restrictive defect with decreased diffusion capacity. DISCUSSION: MPC is most likely to develop when calcium phosphorus product exceeds 70. Mean onset of MPC from diagnosis of ESRD is 22.6 +/- 3.1 years. Most patients are asymptomatic with normal PFTs. Rarely they may have restrictive defect on PFTs. HRCT is highly sensitive. The differential diagnosis includes granulomatous infections, viral infections, pneumocystis jiroveci, silicosis, metastatic malignancy and alveolar microlithiasis. No definitive treatment is available. CONCLUSIONS: MPC is relatively common at autopsy (60-70%) in patients with ESRD, but clinical manifestations are infrequent. ESRD patients on HD who are inadequately treated and present with cough, dyspnea and lung calcification, MPC should be considered in the differential diagnosis. Reference #1: Jost, R. Gilbert, and Stuart S. Sagel. "Metastatic calcification in the lung apex.” American Journal of Roentgenology 133.6 (1979): 1188-1190. Reference #2: Belém, Luciana Camara, et al. "Metastatic pulmonary calcification: state-of-the-art review focused on imaging findings.” Respiratory medicine 108.5 (2014): 668-676. DISCLOSURES: No relevant relationships by Ghulam Aftab, source=Web Response

Advanced interstitial lung fibrosis with emphysema and pulmonary hypertension with no evidence for interstitial lung disease on high resolution CT.

The diagnosis of idiopathic pulmonary arterial hypertension (iPAH) is complex and, besides invasive hemodynamic evaluation, includes several diagnostic steps to exclude any underlying diseases. The role of a decreased diffusion capacity of the lung for carbon monoxide (DLCO) is a matter of discussion. Here, we present a 76-year-old man with a smoking history of 30 pack-years who was diagnosed with iPAH after chronic thromboembolic pulmonary hypertension was excluded based on a negative perfusion scan, an underlying heart disease was excluded based on echocardiography and right heart catheterization, and a significant lung disease was excluded based on lung function test (FVC = 101% predicted, FEV1 = 104% predicted, FEV1/FVC = 77, TLC = 97% predicted) and thin-slice computed tomography (CT) scan. Just DLCO was reduced to 40% predicted, suggesting a possible structural lung disease. Postmortem examination demonstrated severe interstitial lung fibrosis combined with microscopic emphysema. This indicates that both CT imaging and pulmonary function test may be insensitive to a diffuse peripheral combined pattern of fibrosis and emphysema and that DLCO may be the only sensitive marker of this significant lung pathology.