Talk:Diffuse panbronchiolitis/GA1

GA Review

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Reviewer: delldot ∇. 04:10, 27 September 2009 (UTC)

Great work overall, but I'm putting this on hold until the following comments are dealt with, mainly involving fleshing out and adding sections:

• Define terms such as bronchiolitis, bronchiectasis, and Microsatellite on first use (for the most part you've done a great job defining difficult terms).

• Lead

• • The lead doesn't mention epidemiology, pathophysiology, signs and symptoms, or genetics.

 Done.-- Rcej (talk) 05:33, 1 October 2009 (UTC)

• • Axl, a pulmonologist, had this to say about that diagram (actually one derived from it), so I'm not sure if you want to use it. Let me know if you do find a better one!

 Done. I replaced the diagram with Image:Respiratory system complete en.svg-- Rcej (talk) 05:33, 1 October 2009 (UTC)

Ooh, excellent. I'll use that one for that article I had the old one in too. delldot ∇. 17:43, 1 October 2009 (UTC)

• Epidemiology
  • Is there anything written about age, sex, etc? The section is kind of skimpy. Good nationality info though. Any info on the rates among people who aren't Japanese? MEDMOS recommends epidemiology at the end of the article (although it seems like most journal articles prefer it at the front the way you have it).

• Signs and symptoms

• • The sentence beginning These include: chronic bronchial and bronchiolar inflammation is too long, and should be split into several sentences. This will give you the opportunity to get rid of some pesky mid-sentence refs and group sentences about similar types of symptoms. Some of this is actually diagnosis (e.g. the presence of the bacteria isn't really a symptom), so it can be separated into its own diagnosis section (preferably) or into a new para with a topic sentence about diagnosis in this section.

 Done.-- Rcej (talk) 08:27, 2 October 2009 (UTC)

• Pathophysiology

• • Not a big deal but: could have resulted in the disease being associated is awkward, better to use wording like could have caused the association or reword entirely. (Little stuff like this is not necessary for GA, just figured I'd mention).

• • This hypothesis was proven accurate... I'd be surprised if the papers use wording as strong as 'proven'; that would be very bold of them. We shouldn't be any more certain than our sources are.

• • I think the part of the third paragraph (about the MHC predispositon) that starts with "This hypothesis was proven... " and goes into detail about a specific study is too detailed. It uses a primary ref, which is not as good as a review article or a textbook. As an encyclopedia, I don't think we should be going into more detail than a review article would. This part is also kind of hard to follow. (But the Candidate genes sentence, the last sentence, is ok).

• • These findings confirm...: again, I think this wording is too strong. If the article says indicate or suggest, we need to avoid wording stronger than theirs. There's also a 'proven' in treatment that should be checked.

• • This part of this sentence is not clear: altering there effectiveness in reducing both known and unknown pathogenic involvement with DPB. What does that mean? Can that be put into plainer, layperson's terms? Maybe split that into two sentences so you can elaborate on the latter part.

• • Consider splitting pathophysiology into two sections: Causes (or Genetics) and Pathophysiology and maybe elaborating a bit on the actual pathophysiological processes that go on in the cells. At this point in the article, it's not really clear what's going on in the body (although the signs and symptoms section covered it a bit).

 Done.-- Rcej (talk) 08:40, 1 October 2009 (UTC)

• Treatment
  • Unclear: an effective long-term treatment for DPB. Are the drugs effective when used over a long term? Or do you get a long-term effect when you use the drugs once?
    • Fixed. (Jeez, does that create problems with drug resistant bugs I wonder?) delldot ∇. 15:00, 27 September 2009 (UTC)
  • Unclear: with the added benefit of low-dose requirements.[27]. Could it be reworded and fleshed out for clarity?

• If there's any information on diagnosis, the article should really include a diagnosis section. If there's really very little, a couple sentences could be added to signs and symptoms (assuming that diagnosis is clinical).

 Done delldot ∇. 01:19, 10 October 2009 (UTC)

• How about a prognosis section after treatment? Or if there's not enough info, maybe a couple sentences in treatment about outcomes? There's prognosis info in PMID 16088577 (and a little history info too, maybe you could tuck something about history and discovery into the article too).

 Done. Added a prognosis section.-- Rcej (talk) 07:01, 10 October 2009 (UTC)

Amazing work. I'm so impressed with what you've done for this article. I think the hybrid prognosis and history section works well here, although in the future if you find a lot more on either you may want to pull them apart. Minor question: The original prognosis of the disease was poor, and even more discouraging in cases where superinfection... Is this referring to in the past, before modern treatments were available? If so, you many want to add something at the beginning of the sentence, like "Prior to the 1980s, " or something so the reader is transitioned into reading about the past. delldot ∇. 01:47, 11 October 2009 (UTC)

• I think the confusion that I had (and still have) about what the disease actually is and what happens in it would be really diminished by a classification section. You could define the disease more specifically than in the lead, differentiate it from other types of bronchiolitis and COPD, and explain how it's related to similar disorders. Check out for example PMID 16493150 and PMID 16456385.

 Done. Added a classification section; will still expand it further, though.-- Rcej (talk) 08:24, 28 September 2009 (UTC)

• Looks awesome so far. Can we get a quick definition of COPD in the first sentence? (I would have ripped one off from the lead of the COPD article but wasn't sure if I'd get the definition right. I'm thinking of something like "(COPD), a condition in which airways become narrowed, ..." I think also if there are other types of bronchiolitis other than, uh, 'pan', it would be good to distinguish those. delldot ∇. 20:40, 28 September 2009 (UTC)

 Done.Rcej (talk) 08:08, 29 September 2009 (UTC)

Looks awesome. Very impressive job. delldot ∇. 01:41, 30 September 2009 (UTC)

• The whole article is written in very technical language. It would be good if you could copy edit it with a view toward making it more readable for the lay person who's not informed about medicine (e.g. defining unusual terms, using simple words when they're available).

• As I mentioned above, I think this article still needs fleshing out (e.g. info on prognosis, classification, diagnosis, more on pathophysiology). You've got a tough job writing an article when there's not that much to go on, but a pubmed showed 100+ hits for Diffuse panbronchiolitis, so it looks like there is at least some more to go on.

Overall very high quality work, and the referencing is great! Let me know if you have any questions of if I can help with the work. I'm not trying to ask you to do the impossible here; if the info's really not out there then that's just the way it has to be. I'll look over the changes you make in response to this and see if there's anything else to comment on. delldot ∇. 04:10, 27 September 2009 (UTC)

Thank you for reviewing. I am going to make the improvements over the next several days, and it might even take over a week. The Pathophysiology section is what I'd really appreciate the help with; especially with separating it out between cause and pathophysiology. And I'm not quite sure about how the wording of a classification section should go; so if someone could lend a hand there it would be great too. About that diagram, it only has numbered pointers without names; if we fix the caption so that each number is labelled correctly as to what part of the lung it's pointing to, I'm thinking we could keep it- unless the illustration is incorrect.-- Rcej (talk) 07:29, 27 September 2009 (UTC)

No problem if you need longer than a week, there's no hurry. For direction on classification sections, you could check out medical FA's like oxygen toxicity or pulmonary contusion (probably any medical FA will do, whether it's about the lung or not). But with classification you basically want to say how it's defined and how it's different from similar stuff, if I understand it correctly. I can help pull apart genetics and pathophysiology if you like. I think Axl was criticizing the diagram itself (except for the thing that I had actually mislabeled; there were several problems with it). delldot ∇. 07:47, 27 September 2009 (UTC)

There are 3 interesting journal abstracts about DPB I found sort of under the radar. The mechanism of macrolides on p. aerugenosa, with a mention of DPB and some contemporaries is at PMID 16086598. Also, specific differences between findings in DPB and bronchiolitis obliterans from PMID 19543504; possibly some differential diagnosis content could be added. Then, there is a possible DPB/Rheumatoid arthritis association, which isn't a surprise. That's PMID 9727799. Anyway, more good stuff... it just takes time to write. It's sometimes hard to juggle between relevant/technical/boring, aye? heh.-- Rcej (talk) 07:34, 5 October 2009 (UTC)

I hear that, I have this disease where I want to add everything I read to the article! But with something this obscure you can probably get away with adding some of this stuff. Great job so far! delldot ∇. 21:04, 5 October 2009 (UTC)

Litte update. There is quite a bit more on the DPB/RA/Obliterans association than I thought, so it might take a while to sift through the additional journal 'shinola'. heh. Anyway, that's where I am, presently.-- Rcej (talk) 06:17, 14 October 2009 (UTC)

Take your time. I'm very impressed with your work. If you're ready for me to have another look and I'm not around, give me a nudge on my talk page. delldot ∇. 02:37, 16 October 2009 (UTC)

Still at it...will probably be ready for the gar-white glove in another weekish. Thx for the patience. I'm going to have to revise some of the 'long-term treatment' and prognosis info. in light of PMID 9455056. Anyway; we're almost there.-- Rcej (talk) 07:26, 29 October 2009 (UTC)

That we are! No worries, take your time. It doesn't require patience on my part, I just hang out. ;) delldot ∇. 12:54, 29 October 2009 (UTC)

I am going to stop here, with that latest expansion to prognosis. Everything else that could be added is primarily uber-technical schmeel about the innerworkings of p. aeruginosa or macrolides, which doesn't necessarily belong. Anyway, take another read thru whenever, and I can fix or fiddle with anything you think needs it... if it isn't GACkable yet. heh.-- Rcej (talk) 08:17, 10 November 2009 (UTC)

Second pass

Great work making improvements, I'm very impressed. I do think that the article covers the topic in sufficient depth, which had been my primary concern before. I gave the article another pass and had a few more comments, but these are pretty minor and should be easy to fix.

• This sentence is too long and complicated: It was suggested that a mutation associated with the founder effect, of a putative disease-susceptibility gene located somewhere between HLA-B[22] and HLA-A[23] had occurred on an ancestral chromosome carrying both HLA-B54 and HLA-A11, and it was possible that a number of genetic recombination events around the disease locus (location on a chromosome) could have resulted in the disease being associated with HLA-B54 in Japanese and HLA-A11 in Koreans.[17][21] I would have split it myself but wasn't sure if the refs both applied to the whole sentence.

 Done. Rcej (talk) 07:41, 14 November 2009 (UTC)

• It's not clear how the para on Microsatellites relates to the subject of the article.

 Done. I reduced it as a defintion incorp'd into main paragraph. Rcej (talk) 07:41, 14 November 2009 (UTC)

• the immune system causes inflammatory cells such as neutrophil granulocytes, lymphocytes and chemokines - chemokines aren't cells

 Done. Rcej (talk) 07:41, 14 November 2009 (UTC)

• the life-cycle of pathogens like bacteria and viruses, -- do viruses have a life-cycle, being not alive?

 Done. Eww, not my finest literary moment there... LOL Rcej (talk) 07:41, 14 November 2009 (UTC)

• You've done a great job defining difficult terms throughout the article, and the technical language is very much improved. Could you define bronchiectasia quickly the way you have been doing with other words?

 Done.Rcej (talk) 07:41, 14 November 2009 (UTC)

• The disease is statistically more common in males, though the difference above females is negligible. If the difference was negligible, wouldn't this mean it was not statistically significant? Maybe just the 'difference is small'?

 Done.Rcej (talk) 07:41, 14 November 2009 (UTC)

I'll give you a chance to address these before passing it. Overall very impressive work bringing this article up to par! delldot ∇. 20:34, 13 November 2009 (UTC)

Great work! Thanks for taking all this time to make this article so good. Here it is: delldot ∇. 02:27, 15 November 2009 (UTC)