Reports of rapamycin-covered stents

Searching for treatment alternatives, we hypothesized that the basic pathogenesis of our patient’s condition might just be equivalent to that suggested for the coronary arteries restenosis; we suspected that in both conditions a similar mechanism of response to injury, manifested by exaggerated proliferation of either neoin-tima or granulation tissue around the disrupted epithelium. Encouraged by the seemingly effective endovascular procedure, we offered the patient endobronchial HDR brachytherapy. Early reports of rapamycin-covered stents used in coronary revascularization are promising in preventing neointimal growth, and it will be most interesting to examine their use in endobronchial stents.


The first report on the use of endobronchial HDR brachytherapy for nonmalignant causes, still in press at the time the treatment of our first patient was tailored, was done by Kennedy. In this report, a similar approach was chosen in two patients with lung transplantation, in whom hyperplastic bronchial obstruction developed at the site of the anastomosis, and in whom balloon dilatation, laser application, and stent placement failed to restore protracted patency. This group used a lower dose (3 Gy) than we did, although in one patient two sessions were required. The authors described a significant clinical improvement and patent airways, 6 months and 7 months after the procedure, in both patients.

Both reports, that of Kennedy and the present study, demonstrate the effectiveness of endobronchial HDR brachytherapy in preventing granulation tissue formation reactive to a bronchial stent. In spite of the impressive clinical results, data regarding the potential mechanism underlying these phenomena are still scarce. This is even more surprising considering the enthusiasm surrounding the congruent endovascular brachytherapy field, which has resulted in various clinical and laboratory studies. Indeed, clues regarding the biological effects of irradiation on the injured epithelium covering the bronchial wall emerge almost exclusively from the vascular model.

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Health and Care: Respiratory research

Respiratory research
Respiratory research

We found that neither SGRQ total nor dimensional score were affected by sex. There was no statistically significant correlation between age and SGRQ dimensions and total scores. SGRQ total and activity dimension scores were slightly skewed and therefore presented as median and interquartile ranges (IQRs); moreover, the median, IQR, and minimum and maximum ranges of SGRQ dimensions and total scores are also illustrated.

Using Cronbach a for measuring internal consistency for the total score and each dimension (symptom, activity, and impact), we found a values of 0.94, 0.77, 0.91, 0.86, respectively. Total SGRQ had a highly statistically significant correlation with SGRQ symptoms, activity, and impact domains (0.64, 0.82, and 0.96, respectively). Symptoms domain had mild correlation with activity domain (0.41) and a moderate correlation with impact domain (0.61).

However, a better correlation was seen between activity and impact domains (0.7) (P < . 0001 for all these correlations). For test-retest reliability, the intraclass correlation coefficients for the total SGRQ and its dimensions (symptom, activity, and impact) were 0.97, 0.92, 0.94 and 0.95, respectively. There were small and statistically insignificant mean differences between scores at both completions, and the 95% limits of agreement of repeatability as shown in Bland-Altman plot.

The SGRQ total and dimensional scores showed high convergent validity correlating with different objective and subjective measures in respiratory research. The MRC dyspnea score, SF-36 PCS score, and SF-36 PCM score had the highest correlation with total and dimensional SGRQ scores. The maximum correlation was with both SF-36 scores and greater than the MRC dyspnea score (R2 = 0.5), suggesting that other important elements of ill health in these patients are being captured by the SGRQ.

Worse health status was associated with increasing severity of CPA; patients with severe CPA had worse health status than patients with mild or moderate disease. Moreover, the SGRQ showed significant discriminating ability in differentiating between all grades of shortness of breath. In addition, patients with more disease severity as justified by the respiratory physician scored consistently higher total and dimensional SGRQ scores.