title: The Left (Germany)

text: The Left is organised into branches in each of the 16 states. The party has smaller branches on a local level, for which the corresponding state branches are responsible. These branches usually organise across a district, city, or (in Berlin), borough. The lowest unit of the party is the grassroots organization, which, depending on the density of membership, can include a residential area, a city or an entire district. The party has a youth wing, Left Youth Solid, and a student wing known as The Left.SDS. The party is also affiliated with a number of left-wing think tanks, education, and policy groups, most prominently the Rosa Luxemburg Foundation.


title: The Left (Germany)

text: The party is formally led by a 26-member Party Executive Committee (PEC), of which seven are members of the party's leadership, the executive board. This includes two federal co-chairpersons, of which at least one is required by statute to be female. Convention also dictates that one leader should come from the Eastern states and one from the west, though this is not an official rule. The PEC is elected by a regular party congress, which also discusses and determines the party platform and rules on basic political and organisational matters. The leadership group of the party's Bundestag faction is considered a second centre of power within the party, and conflicts sometimes arise between the federal leadership and parliamentary group. This most prominently happened in 2015, which resulted in Bundestag co-leaders Sahra Wagenknecht and Dietmar Bartsch being elected as lead candidates for the 2017 federal election, defeating federal co-chairs Katja Kipping and Bernd Riexinger.


title: The Left (Germany)

text: The Left's internal structure underwent a transitional phase after its formation in 2007 in order to integrate the different groups. Western party organisations were initially strongly favoured in party congresses, which strengthened the "fundamental opposition" faction of Oskar Lafontaine. These provisions expired at the 2014 party congress. The dual leadership, initially a temporary measure, was adopted permanently in 2010. This was not initially the case for the parliamentary group leadership, which was co-chaired by both Gregor Gysi and Lafontaine between 2005 and 2009, and solely by Gysi thereafter. After his retirement in 2015, however, the dual chairmanship was reintroduced. The executive committee originally comprised 44 members, but was reduced to 26 at the 2022 party congress. The number of deputy leaders was originally four, increased to six in 2018, and reduced to three in 2022.


title: The Left (Germany)

text: The Left is noted for having an unusually strong and formalised system of internal factions, which are outlined in the party statutes. Factions with sufficiently large membership are entitled to send delegates to party congresses. In addition, there are around 40 working groups within the party.


title: The Left (Germany)

text: The Council of Elders ("Ältestenrat") is an advisory body formed in December 2007. Lothar Bisky stated the council would "focus on the development of the party, allied and international issues, the history of the left and possible consequences for the socialist program." Its current composition is as follows:


title: The Left (Germany)

text: The party has branches in all 16 states. As of 31 December 2021, the membership of the branches is as follows. The increases and decreases are compared to figures from 31 December 2020.


title: The Left (Germany)

text: The Left is noted for having an unusually strong and formalised system of internal factions, which are outlined in the party statutes. Factions with sufficiently large membership are entitled to send delegates to party congresses. The party is traditionally split between reformist factions, such as the Reform Left Network and Forum for Democratic Socialism, and orthodox factions such as the Communist Platform, Anti-Capitalist Left, and Socialist Left. The Emancipatory Left occupies a middle position.


title: The Left (Germany)

text: However, starting from 2015, the party underwent an internal realignment due to the preeminence of Sahra Wagenknecht, who advocated a return to a fundamentally working-class focus and populist positions in the wake of the European refugee crisis and rise of the Alternative for Germany. In response, many eastern reformers and members of radical left factions allied in the broad "Movement Left" ("Bewegungslinke"), committed to social movements, environmentalism, and intersectional progressivism. The Movement Left broadly dominates the party, with no members of the Wagenknecht faction elected to the executive at the 2022 congress.


title: The Left (Germany)

text: In addition to the recognised platforms, a number of smaller groups have aligned with The Left and its predecessors, such as the Trotskyist Socialist Alternative (SAV), though the membership applications of some of its leaders, including Lucy Redler, were initially rejected. "Der Funke", supporters of the International Marxist Tendency (IMT) in Germany, pursue entryist strategies in the party, while the Fourth International-affiliated International Socialist Organisation (ISO) also works inside The Left. Other left-wing groups, such as the German Communist Party (DKP), have formed local alliances with the party, but have not joined. The Association for Solidarity Perspectives (VsP) also supports the party.


title: The Left (Germany)

text: According to regular studies by the Free University of Berlin, in 2019 The Left's membership comprised 17% blue-collar workers and 32% white-collar workers, similar to the SPD, while 35% were civil servants and 16% self-employed. 51% of party members held an academic degree, and 33% were organized in trade unions. Prior to the merger with WASG, the voting base of PDS was an approximate cross-section of the population, favoured somewhat by more educated voters. Since the merger, The Left has become more favoured among working-class and poorer voters, which made up the core of WASG's support.


title: The Left (Germany)

text: Since the mid-2010s, the party has gained significant popularity among youth. Prior to the merger, PDS had by far the highest proportion of members over 60 years of any party, at 68%, and the lowest proportion of members under 30, at just 4%. By 2019, these numbers had fallen and risen, respectively, to 44% and 19%. The Left now has the highest proportion of members under 30 of any party. Two-thirds of members who joined the party between 2016 and 2018 were under 35 years of age. In the 2021 federal election, The Left was twice as popular among voters under 25 than among voters over 70.


title: The Left (Germany)

text: The PDS inherited 170,000 members from the SED in 1990, but suffered constant decline from that point until the merger with WASG. Upon its formation, The Left had 71,000 members, of which 11,500 had been WASG members. Over the next two years the party grew, reaching a peak of 78,000 in 2009, after which point numbers began to decline. In 2016, the party had 59,000 members. This trend temporarily reversed following the 2017 federal election, and the party gained several thousand new members for a total of 62,300 in 2019; however, membership shrank again to 60,350 in December 2020.


title: The Left (Germany)

text: A large part of The Left's base and membership reside in the new states (the former GDR). The voting base of the PDS was limited almost entirely to the east; upon its formation, the vast majority of The Left's western membership came from WASG. However, the party has grown in the west in the years since: while in 2005, the Left.PDS list won just 45.5% of its votes in the western states, this grew to 57.7% in 2009, and 65.4% in 2017. Between 2016 and 2018, 72% of new party members were from the western states, 15% from the east, and 13% from Berlin. During this period, the party's membership total in the west exceeded that of the east for the first time. As of 2021, 50% of The Left's members are from the west, 37% from the east, and 13% from Berlin.


title: The Left (Germany)

text: Despite this, on the state level, the party has been marginalised in the west since making several breakthroughs in 2007–2010. Since 2010, it has lost representation in the Landtags of Lower Saxony, North Rhine-Westphalia, and Schleswig-Holstein. Generally growing popularity in the west has also been offset by major losses in most of its eastern heartland since 2014.


title: The Left (Germany)

text: The Left's voter demographics are skewed strongly by region. In the east, Left voters and members trend much older: in 2018, 44% of the party's members in Mecklenburg-Vorpommern were 76 years or older. Meanwhile, in the west, the party membership is male-dominated, with two-thirds of western members being men.


title: The Left (Germany)

text: Women have been well-represented amongst elected representatives from The Left. The party's gender quota requires that at least half of the party's ruling bodies and representatives should be female. In 2021, the party elected two women, Janine Wissler and Susanne Hennig-Wellsow, as federal co-chairs for the first time. Amongst the party membership however, the proportion of women has decreased in recent years, contrary to the trend of increasing female membership observed among other parties. Female membership in the PDS was stable at around 45% during the 1990s and 2000s, far higher than any other party, but fell to 39% post-merger in 2007 since the large majority of WASG members were male. Nonetheless, the party had the highest representation of women in its membership until it was overtaken by the Greens in 2012. In 2019, 36.4% of Left members were female, compared to 41% for the Greens and 33% for the SPD. After the 2009 election, the party's Bundestag group was 52.6% female, second only to the Greens (57.4%). In 2013, this increased slightly to 54.7%, which was the highest of any group. After both the 2017 and 2021 federal elections, The Left's group was 54% female, second to the Greens (58%).


title: The Left (Germany)

text: The Federal Office for the Protection of the Constitution ("Bundesamt für Verfassungsschutz", abbreviated as BfV or "Verfassungsschutz") is the German federal domestic security agency, tasked with intelligence-gathering on threats concerning the democratic order, the existence and security of the federation or one of its states. This includes monitoring and reporting on suspected extremist groups and political parties. Members of The Left and groups within the party have been periodically monitored, sometimes leading to controversy. The "Verfassungsschutz" does not consider the party in its entirety extremist, but monitors several of its internal factions and groupings. According to the 2018 report, these are the Communist Platform, Socialist Left, working group "AG Cuba Sí", the Anti-capitalist Left, Marxist Forum, and Gera Dialogue/Socialist Dialogue. The "Verfassungsschutz" also monitors Socialist Alternative and Marx21, which have links with the Anti-Capitalist Left and the Socialist Left, respectively.


title: The Left (Germany)

text: As evidence of extremism in The Left, the 2007 "Verfassungsschutz" report cited a June 2007 statement by Lothar Bisky stating that democratic socialism remains the party's goal: "We also still discuss the change of property and power relations ... . We question the system." However, the report commented that in practice the parliamentary party appears as to act as a "reform-oriented" left force. In the past, The Left was under observation by all western German states. In January 2008, Saarland became the first to cease observation. As of 2008, the authorities of Baden-Württemberg, Bavaria, Hesse, and Lower Saxony considered The Left in its entirety to be extremist. In the five eastern states, The Left is not under surveillance, as state constitutional authorities see no indication of anti-constitutional tendencies in the bulk of the party; however, the Communist Platform is under observation in three eastern states.


title: The Left (Germany)

text: Surveillance of party members has been a point of controversy. Bodo Ramelow, a prominent Left politician in Thuringia, was under surveillance until a court ruling in January 2008 that this was illegal. In January 2012, "Der Spiegel" reported that 27 of the party's 76 Bundestag members were under surveillance, as well as 11 of the party's members of various state parliaments. This included nearly the entirety of the party's Bundestag leadership, federal co-leader Gesine Lötzsch, deputy leader Halina Wawzyniak, and Vice President of the Bundestag Petra Pau. Many of those under surveillance were not associated with acknowledged extremist factions of the party. This surveillance was criticised by the SPD, Greens, and FDP; federal Justice Minister Sabine Leutheusser-Schnarrenberger described it as "intolerable". In October 2013, the Federal Constitutional Court deemed the surveillance of Bundestag members unconstitutional except in extraordinary circumstances, such as if the member was abusing their office to undermine the constitutional order, or otherwise actively fighting against it. Federal Minister of the Interior Thomas de Maizière subsequently announced that none of The Left's Bundestag members would be surveilled, even those affiliated with the factions considered extremist by the "Verfassungsschutz".


title: The Left (Germany)

text: Both media and political scientists have discussed whether The Left should be considered extremist in nature. Outlets including the BBC, "The Guardian", Euronews, and "Der Spiegel" have described the party as far-left. Among academics, there is a general consensus that at least some sections of the party are extremist; however, political scientist Richard Stöss states that they make up less than ten percent of the party membership – 5,000 of 62,000 members according to the BfV – and compete for resources among themselves, and there is little risk of these groups becoming dominant and exerting major influence over the party's leadership and platform. Eckhard Jesse states that, while The Left is far more accepting of the Basic Law than parties like the National Democratic Party of Germany, the presence of its extremist factions means the party overall represents a "soft left-wing extremism". Politcal scientist Karl-Rudolf Korte states that the party is well-integrated within the constitutional order, and "has actually rendered considerable services to German democracy" through the integration of East German protest movement into the parliamentary system. Nonetheless, he criticises the party's continued association with extremist groups.


title: The Left (Germany)

text: The Left has also been characterised as left-wing populist by researchers such as Cas Mudde and Tilman Mayer. Florian Hartleb states that the party is "social-populist". According to Frank Decker, the party during the leadership of Oskar Lafontaine could be described as left-wing populist. In 2011, Bundestag deputy and later party co-leader Katja Kipping stated that she believed The Left needed "a double strategy [of] social-ecological restructuring plus left-wing populism" to become attractive to voters. She elaborated: "Left-wing populism means targeting those who are marginalized in our society in a targeted and pointed manner."


title: The Left (Germany)

text: The Left's position as the successor of the PDS and SED has made it subject to significant controversy and criticism, as well as claims that the party is sympathetic to the former GDR. Prominent member Sahra Wagenknecht, who served as co-leader of the party's Bundestag group from 2015 to 2019, is well known for her controversial statements on this issue. In a 2009 interview, she rejected the characterisation of East Germany as a dictatorship or unconstitutional state ().


title: The Left (Germany)

text: Other incidents include a walkout conducted in 2007 by the Left's delegation in the Landtag of Saxony during a German Unity Day ceremony in protest of the presence of Joachim Gauck, former East German pro-democracy campaigner and later Federal Commissioner for the Stasi Records, who was the keynote speaker at the event. The Left's state leader André Hahn claimed that Gauck did not deliver an "appropriate or balanced speech", arguing he had "an absolutely one-sided view of the GDR."


title: Peru national football team

text: The Peru national football team represents Peru in men's international football. The national team has been organised, since 1927, by the Peruvian Football Federation (FPF). The FPF constitutes one of the ten members of FIFA's South American Football Confederation (CONMEBOL). Peru has won the Copa América twice, and has qualified for the FIFA World Cup finals five times (last appearing in 2018); the team also participated in the 1936 Olympic football competition and has reached the semi-finals of the CONCACAF Gold Cup. The team plays most of its home matches at the Estadio Nacional in Lima, the country's capital.


title: Peru national football team

text: The team is well known for its white shirts adorned with a diagonal red stripe, which combine Peru's national colours. This basic design has been used continuously since 1936, and gives rise to the team's common Spanish nickname, "la Blanquirroja" ("the white-and-red"). Peruvian football fans are known for their distinctive cheer "¡Arriba Perú!" ("Onward Peru!"). Peru has longstanding rivalries with Chile and Ecuador.


title: Peru national football team

text: The Peru national team enjoyed its most successful periods thanks to footballing generations from the 1930s and the 1970s. The 1930s generation led Peru at the inaugural FIFA World Cup in 1930 and won the 1938 Bolivarian Games and the 1939 Copa América, with goalkeeper Juan Valdivieso and forwards Teodoro Fernández and Alejandro Villanueva playing important roles. The 1970s generation qualified Peru for three World Cups and won the Copa América in 1975; the team then notably included defender Héctor Chumpitaz and the forward partnership of Hugo Sotil and Teófilo Cubillas, often regarded as Peru's greatest player.


title: Peru national football team

text: The national team's all-time top goalscorer is Paolo Guerrero, with 38 goals, and its most-capped player is Roberto Palacios, with 128 appearances. Since August 2022, Peru is managed by former team captain Juan Reynoso.


title: Peru national football team

text: During the 19th century, British immigrants and Peruvians returning from England introduced football to Peru. In 1859, members of the British community in the country's capital founded the Lima Cricket Club, Peru's first organisation dedicated to the practice of cricket, rugby, and football. These new sports became popular among the local upper-class over the following decades, but early developments stopped due to the War of the Pacific that Peru fought against Chile from 1879 to 1883. After the war, Peru's coastal society embraced football as a modern innovation. In Lima's "barrios", football became a popular daily activity, encouraged by bosses who wanted it to inspire solidarity and productivity among their workers. In the adjacent port of Callao and other commercial areas, British civilian workers and sailors played the sport among themselves and with locals. Sports rivalries between locals and foreigners arose in Callao, and between elites and workers in Lima—as foreigners departed, this became a rivalry between Callao and Lima. These factors, coupled with the sport's rapid growth among the urban poor of Lima's La Victoria district (where, in 1901, the Alianza Lima club formed), led to Peru developing the Andean region's strongest footballing culture, and, according to historian Andreas Campomar, "some of the most elegant and accomplished football on the continent".


title: Peru national football team

text: The Peruvian Football League, founded in 1912, held annual competitions until it disbanded in 1921 amid disputes amongst its clubs. The Peruvian Football Federation (FPF), formed in 1922, reorganised the annual tournament in 1926. The FPF joined the South American Football Confederation (CONMEBOL) in 1925 and, after restructuring its finances, formed the Peru national football team in 1927. The team debuted in the 1927 South American Championship, hosted by the FPF at Lima's Estadio Nacional. Peru lost 0–4 against Uruguay in its first match, and won 3–2 over Bolivia in its second. Peru did not advance beyond the first stage of the inaugural FIFA World Cup in 1930.


title: Peru national football team

text: The 1930s were the team's first golden era, when they improved their game through play with more experienced teams. The "Combinado del Pacífico" (a squad composed of Chilean and Peruvian footballers) toured Europe from 1933 to 1934. Starting with Ciclista Lima in 1926, Peru's football clubs toured Latin America with much success. During one of these tours—Alianza Lima's undefeated journey through Chile in 1935—emerged the "Rodillo Negro" ("Black Roller"), a skillful group led by forwards Alejandro Villanueva, Teodoro Fernández and goalkeeper Juan Valdivieso. Sports historian Richard Witzig described these three as "a soccer triumvirate unsurpassed in the world at that time", citing their combined innovation and effectiveness at both ends of the field. Peru and the "Rodillo Negro" impressed at the 1936 Summer Olympics, won the inaugural Bolivarian Games in 1938, and finished the decade as South American champions.


title: Peru national football team

text: Historian David Goldblatt assessed the decline of its previous success: "despite all the apparent preconditions for footballing growth and success, Peruvian football disappeared". He attributes this sudden decline to Peruvian authorities' repression of "social, sporting and political organisations among the urban and rural poor" during the 1940s and 1950s. Nevertheless, Peru performed creditably at the South American Championships, placing third in Brazil 1949 and Chile 1955, and missed qualification for the Sweden 1958 World Cup finals, over two legs to eventual champions Brazil.


title: Peru national football team

text: Successes during the late 1960s, including qualification for the Mexico 1970 World Cup finals, ushered in a second golden period for Peruvian football. The formidable forward partnership between Teófilo Cubillas and Hugo Sotil was a key factor in Peru's triumphs during the 1970s. Peru reached the quarter-finals in 1970, losing to the tournament winners Brazil, and earned the first FIFA Fair Play Trophy; historian Richard Henshaw describes Peru as "the surprise of the 1970 competition, showing flair and a high level of skill". Five years later, Peru became South American champions for the second time when it won the 1975 Copa América (the then-rechristened South American Championship). The team next qualified for two consecutive World Cup finals, reaching the second round in Argentina 1978 and the first group stage in Spain 1982. Peru's early elimination in 1982 marked the end of the side's globally-admired "flowing football". Peru, nonetheless, barely missed the Mexico 1986 World Cup finals after placing second in a qualification group to eventual champions Argentina.


title: Peru national football team

text: By the late 1980s, renewed expectations for Peru were centred on a young generation of Alianza Lima players known colloquially as "Los Potrillos" ("The Colts"). Sociologists Aldo Panfichi and Victor Vich write that "Los Potrillos" "became the hope of the entire country"—fans expected them to qualify for the Italy 1990 World Cup finals. These hopes were dashed when the national team entered a hiatus after its manager and several of its players died in a plane crash carrying most of Alianza's team and staff in 1987. Peru subsequently only came close to reaching the France 1998 World Cup finals, missing qualification on goal difference, but would go on to win the 1999 Kirin Cup tournament in Japan (sharing the title with Belgium) and reached the semi-finals at the 2000 CONCACAF Gold Cup (contested as an invitee).


title: Peru national football team

text: Qualification for the FIFA World Cup finals continued being an elusive objective for Peru during the early 21st century. According to historian Charles F. Walker, player indiscipline problems marred Peru's national team and football league. Troubles in the FPF, particularly with its then-president Manuel Burga, deepened the crisis in Peruvian football—FIFA temporarily suspended the country from international competition, in late 2008, because the Peruvian government investigated alleged corruption within the FPF. Burga's twelve-year tenure as FPF president, deemed by journalists and the public as disastrous for the national team despite a third place at the 2011 Copa América, ended in 2014. The FPF's new leadership appointed Juan Carlos Oblitas as the federation's new director and Ricardo Gareca as Peru's manager in March 2015. Gareca is credited by sports journalists as revitalizing Peru's football prowess by improving the players' training and professional sports conduct. Under Gareca, Peru achieved third place in the 2015 Copa América, reached the quarter-finals of the Copa América Centenario, participated in the group stage of the Russia 2018 World Cup finals, and finished runners-up at the 2019 Copa América.


title: Peru national football team

text: The Peru national football team plays in red and white, Peru's national colours. Its first-choice kit has been, since 1936, white shorts, white socks, and white shirts with a distinctive red "sash" crossing their front diagonally from the proper left shoulder to the right hip and returning on the back from the right hip to the proper left shoulder. This basic scheme has been only slightly altered over the years.


title: Peru national football team

text: Peru's kit has won praise as one of world football's most attractive designs. Christopher Turpin, the executive producer of NPR's "All Things Considered" news show, lauded the 1970 iteration as "the beautiful game's most beautiful shirt", also describing it as "retro even in 1970". Miles Kohrman, football reporter for "The New Republic", commended Peru's kit as "one of soccer's best-kept secrets". Rory Smith, Chief Soccer Correspondent for "The New York Times", referred to Peru's 2018 version of the jersey as "a classic" with a nostalgic, fan-pleasing "blood-red sash". The version worn in 1978 came first in a 2010 ESPN list of the "Best World Cup jerseys of all time", described therein as "simple yet strikingly effective".


title: Peru national football team

text: Peru's first kit, made for the 1927 South American Championship, comprised a white-and-red striped shirt, white shorts and black socks. At the 1930 World Cup, Peru used an alternate design because Paraguay had already registered a similar kit with white-and-red striped shirts. The Peruvians instead wore white shirts with a red collar, white shorts and black socks. The team added a horizontal red stripe to the shirt for the 1935 South American Championship. The following year, at the 1936 Berlin Olympics, the team adopted the iconic diagonal red sash design it has retained ever since. According to historian Jaime Pulgar-Vidal Otálora, the idea for the design came from school football matches in which coloured sashes worn over the shoulder would allow two teams wearing white shirts to play against each other.


title: Peru national football team

text: Peru wears as its badge the emblem of the Peruvian Football Federation. The first badge, presented in 1927, had a heater shield design with the country's name and the federation's acronym (FPF). Eight different emblems followed, with the longest-lasting design being the modern French escutcheon form emblazoned in the team's jersey from 1953 until 2014. This design had the Peruvian flag at its base, and either the country's name or the federation's acronym at its chief. Since 2014, the badge has a retro-inspired heater shield design, with the entire field comprised by Peru's flag and the federation's acronym, surrounded by a gold-colored frame.


title: Peru national football team

text: Eight sportswear manufacturers have supplied Peru's national team. The first, the German company Adidas, supplied the team's kit in 1978 and 1983–1985. The FPF has signed contracts with manufacturers from Brazil (Penalty, 1981–82), Canada (Power, 1989–1991), Italy (Diadora, 1991–1992), England (Umbro, 1996–1997, 2010–2018), and another from Germany (Puma, 1987–1989). The team has also been supplied by three local firms: Calvo Sporwear (1986–1987), Polmer (1993–1995), and Walon Sport (1998–2010). Since August 2018, the Ecuadorian Marathon Sports produce Peru's kit.


title: Peru national football team

text: The traditional home of Peruvian football is the country's national stadium, the Estadio Nacional in Lima, which seats 45,000 spectators. The present ground is the Estadio Nacional's third incarnation, renovated under the Alan García administration. Its official re-inauguration, 24 July 2011, marked 88 years to the day after the original ground opened on the same site in 1923.


title: Peru national football team

text: To celebrate the centenary of Peru's independence from Spain, Lima's British community donated the original Estadio Nacional, a wooden structure with a capacity of 6,000. Construction began on 28 July 1921, overseen by President Augusto B. Leguía. The stadium's re-inauguration on 27 October 1952, under the Manuel A. Odría administration, followed an onerous campaign for its renovation led by Miguel Dasso, president of the "Sociedad de Beneficencia de Lima". The renovated stadium boasted a cement structure and larger spectator capacity of 53,000. Its last redevelopment, in 2011, included the construction of a plaque-covered exterior, an internal multicoloured illumination system, two giant LED screens, and 375 private suites.


title: Peru national football team

text: A distinctive feature of the ground is the Miguel Dasso Tower on its north side, which contains luxury boxes (renovated in 2004). The Estadio Nacional currently has a natural bermudagrass pitch, reinstalled as part of redevelopments completed in 2011. Previously, the FPF had installed artificial turf in the stadium for the 2005 FIFA U-17 World Championship, making it the only national stadium in CONMEBOL with such a turf. Despite the synthetic ground's rating of "FIFA Star II", the highest certification granted to artificial pitches, players accused the turf of causing them injuries, such as burns and bruises.


title: Peru national football team

text: Peru sometimes play home matches at other venues. Outside the desert-like coast region of Lima, the thin atmosphere at the high-altitude Estadio Garcilaso de la Vega in Cusco has been described as providing strategic advantages for Peru against certain visiting teams. Other common alternate venues for the national team include two other grounds in the Peruvian capital—Alianza's Estadio Alejandro Villanueva and Universitario's Estadio Monumental.


title: Peru national football team

text: The national team's training grounds are located within the "Villa Deportiva Nacional" (VIDENA) sports complex in Lima's San Luis district. Since 1981, the complex is managed by the Peruvian Institute of Sport (IPD). In 2017, following Peru's qualification for the Russia 2018 World Cup finals, the Peruvian Football Federation announced the creation of a new complex, the Center of National Teams, in Lima's Chaclacayo district. The new complex will contain six training grounds for both the male and the female squads, including the senior and the youth sides.


title: Peru national football team

text: Football has been the most popular sport in Peru since the early 20th century. Originally largely exclusive to Lima's Anglophile elite and expatriates, and secluded from the rest of the city, football became an integral part of wider popular culture during the 1900s and 1910s. Over the following decades, Augusto Leguía's government institutionalised the sport into a national pastime by promoting and organising its development. Consequently, the national football team became an important element of Peru's national identity. According to the historian Carlos Aguirre, nationalist fervor spiked during the qualification phase for the 1970 World Cup finals, because the revolutionary government of General Juan Velasco Alvarado tied the national team's success with the alleged cultural, social, and psychological changes spurred by the country's new political project.


title: Peru national football team

text: Peruvian football fans are known for their distinctive cheer "¡Arriba Perú!" ("Onward Peru!"), unabating popular chant "¡Vamos peruanos!" (Let's go Peruvians!), as well as for their use of traditional Peruvian "música criolla" to express support, both at national team games and at club matches. "Música criolla" attained national and international recognition with the advent of mass media during the 1930s, becoming a recognised symbol of Peru and its culture. The national team's most popular anthems are "Peru Campeón", a "polca criolla" (Peruvian polka) glorifying Peru's qualification for the Mexico 1970 World Cup, and "Contigo Perú", a "vals criollo" (Peruvian waltz) that newspaper "El Comercio" calls "the hymn of Peruvian national football teams". In 2018, a FIFA-sanctioned worldwide online poll honoured the "fervent and dedicated group" of Peruvian supporters at that year's World Cup tournament with the FIFA Fan Award.


title: Peru national football team

text: The Estadio Nacional disaster of 24 May 1964, involving Peruvian supporters, is cited as one of the worst tragedies in football history. During a qualifying match for the 1964 Olympics between Peru's under-20 team and its counterpart from Argentina, the Uruguayan referee Angel Payos disallowed a would-be Peruvian equaliser, alleging rough play. Spectators threw missiles from the stands while two fans invaded the pitch and attacked the referee. Police threw tear gas into the crowd, causing a stampede; trying to escape, fans were crushed against the stadium's locked gates. A total of 315 people died in the chaos, with more than 500 others injured.


title: Peru national football team

text: The Peru national football team maintains prominent rivalries with its counterparts from neighbouring Chile and Ecuador. The Peruvians have a favourable record against Ecuador and a negative record against Chile. Peru faced both rivals in the 1939 South American Championship in Lima, which also marked the first time that Peru faced Ecuador in an official tournament; Peru won both games. Peru also defeated its rivals during qualifying for the Argentina 1978 World Cup, directly eliminating both teams.


title: Peru national football team

text: The Chile–Peru football rivalry is known in Spanish as the "Clásico del Pacífico" ("Pacific Derby"). CNN World Sport editor Greg Duke ranks it among the top ten football rivalries in the world. Peru first faced Chile in the 1935 South American Championship, defeating it 1–0. The football rivalry between Peru and Chile, partly a reflection of the geopolitical conflict between both neighboring states, is primarily a result of both football squads vying for recognition as the better team in South America's Pacific coast—as their football confederation is historically dominated by countries in South America's Atlantic coast. The two countries traditionally compete with each other over the rank of fourth-best national team in South America (after Argentina, Brazil, and Uruguay). They also both claim to have invented the bicycle kick; Peruvians call it the "chalaca", while it is the "chilena" in Chile.


title: Peru national football team

text: The rivalry between the Ecuador and Peru football teams is rooted in the historical border conflict between the two nations dating back to the 19th century. In 1995, after the brief Cenepa War, CONMEBOL contemplated altering that year's Copa América group stage to prevent a match between the two sides, but ultimately did not. According to cultural historian Michael Handelsman, Ecuadorian fans consider losses to Colombia or Peru "an excuse to lament Ecuador's inability to establish itself as an international soccer power". Handelsman adds that "[t]he rivalries are intense, and the games always carry an element of national pride and honor".


title: Peru national football team

text: The following is a list of match results in the last 12 months, as well as any future matches that have been scheduled.


title: Peru national football team

text: A total of 43 managers have led the Peru national football team since 1927 (including multiple spells separately); of these, 36 have been from Peru and 23 have been from abroad. Sports analysts and historians generally consider Peru's most successful managers to have been the Englishman Jack Greenwell and the Peruvian Marcos Calderón. The former managed Peru to triumph in the 1938 Bolivarian Games and the 1939 South American Championship, and the latter led Peru to victory in the 1975 Copa América tournament and coached it at the 1978 FIFA World Cup. Three other managers have led Peru to tournament victories—Juan Carlos Oblitas, Freddy Ternero, and Sergio Markarián each oversaw Peru's victory in the Kirin Cup in Japan, in 1999, 2005 and 2011, respectively.


title: Peru national football team

text: Soon after forming Peru's national football team, the FPF invited Uruguayan coaches Pedro Olivieri and Julio Borelli to manage the squad. Olivieri received the FPF's first appointment, for the 1927 South American Championship, due to his prior experience managing Uruguay. Borelli became the national team's second manager, for the 1929 South American Championship, after some years of refereeing football matches in Peru. The Spaniard Francisco Bru, Peru's third manager and first World Cup coach at the inaugural tournament in 1930, previously had been Spain's first manager. The FPF next appointed the national team's first Peruvian coach, Telmo Carbajo, for the 1935 South American Championship. The team's manager since August 2022 is the Peruvian Juan Reynoso.


title: Peru national football team

text: Managers that brought outstanding changes to the Peru national team's style of play include the Hungarian György Orth and the Brazilians Didi and Tim. Orth coached Peru from 1957 to 1959; sports historian Andreas Campomar cites Peru's "4–1 thrashing of England in Lima" as evidence of Orth's positive influence over the national team's offensive game. Víctor Benítez, Peru's defensive midfielder under Orth, attributes the Hungarian with maximizing the team's potential by accurately placing each player in their optimal positions. Didi coached Peru from 1968 to 1970 and managed it at the 1970 FIFA World Cup; Campomar attributes Didi's tactics as the reason for Peru's development of a "free-flowing football" style. "Placar", a Brazilian sports journal, attributed Tim, who managed Peru at the 1982 FIFA World Cup, with making Peru "a team that plays beautiful, combining efficiency with that swagger that people thought only existed in Brazil".


title: Peru national football team

text: The following players were called up for the friendly matches against Paraguay and Bolivia on 16 and 19 November 2022.


title: Peru national football team

text: The players listed below were not included in the current squad, but have been called up by Peru in the last twelve months.


title: Peru national football team

text: A report published by CONMEBOL in 2008 described Peru as traditionally exhibiting an "elegant, technical and fine football style", and praised it as "one of the most loyal exponents of South American football talent". In 2017, Argentine manager Ricardo Gareca described Peruvian footballers as "technically sound, [physically] strong and adaptable", adding that their adaptability resulted from Peru's diverse geography.


title: Peru national football team

text: Peruvian players noted in the CONMEBOL report as "true artists of the ball" include forwards Teófilo Cubillas, Pedro Pablo León and Hugo Sotil, defender Héctor Chumpitaz and midfielders Roberto Challe, César Cueto, José del Solar, and Roberto Palacios. Cubillas, an attacking midfielder and forward popularly known as "El Nene" ("The Kid"), is widely regarded as Peru's greatest ever player. Chumpitaz is often cited as the team's best defender; Witzig lists him among his "Best Players of the Modern Era", and praises him as "a strong reader of the game with excellent ball skills and distribution, [who] marshalled a capable defence to support Peru's attack". "El Gráfico", an Argentine sports journal, described Cueto, Cubillas, and José Velásquez as, collectively, "the best [midfield] in the world" in 1978.


title: Peru national football team

text: Before Cubillas' appearance, Teodoro "Lolo" Fernández, a forward nicknamed "El Cañonero" ("The Cannoneer"), held the status of Peru's greatest player—due to his powerful shots, marksmanship, and club loyalty to Universitario. Fernández participated as a key member of the "Rodillo Negro" team of the 1930s, along with Alejandro Villanueva and Juan Valdivieso. Fernández scored most of the team's goals; his partner in attack, the gifted playmaker Villanueva, awed audiences with his acrobatic skills. Goalkeeper Valdivieso had a reputation as a penalty stopper with exceptional athleticism.


title: Peru national football team

text: In 1972, teams representing Europe and South America played a commemorative match in Basel, Switzerland, for the benefit of homeless children. Cubillas, Chumpitaz, Sotil, and Julio Baylón played in the South American team, which won the game 2–0; Cubillas scored the first goal. The teams held another match the following year, at Barcelona's Camp Nou, with the declared intent of fighting global poverty. Cubillas, Chumpitaz, and Sotil again participated, with Chumpitaz named South America's captain. Each of the Peruvians scored in a 4–4 draw, which South America won 7–6 on penalties.


title: Peru national football team

text: The Peru national football team has played 645 matches since 1927, including friendlies. The largest margin of victory achieved by a Peru side was a 9–1 win against Ecuador on 11 August 1938, at the Bolivarian Games in Colombia. The team's record defeat was a 7–0 loss to Brazil at the 1997 Copa América in Bolivia.


title: Peru national football team

text: The Peruvian player with the most international caps is Roberto Palacios, who made 128 appearances for the side from 1992 to 2007. The player with the second-most caps is Yoshimar Yotún with 108; Paolo Guerrero is third with 106. The Peruvian goalkeeper with the most appearances is Pedro Gallese with 78. The goalkeeper with the second-most caps is Óscar Ibáñez with 50; Miguel Miranda is third with 47.


title: Peru national football team

text: The team's all-time top goalscorer is Paolo Guerrero, with 38 goals in 106 appearances. He is followed by Jefferson Farfán, with 27 goals in 97 appearances, and Teófilo Cubillas, who scored 26 goals in 81 appearances. Of the top ten scorers for Peru, Teodoro Fernández, with 24 goals in 32 games, holds the best goal-per-appearance ratio (0.75 goals/match). Claudio Pizarro scored Peru's fastest ever goal, coming less than a minute into a match against Mexico on 20 August 2003.


title: Peru national football team

text: Peru's current captain is goalkeeper Pedro Gallese. Midfielder Leopoldo Basurto was the team's first captain. Defender Héctor Chumpitaz held the Peruvian team's leadership position for the longest time, between 1965 and 1981. Forward Claudio Pizarro had the second-longest tenure as captain, from 2003 to 2016. Other notable captains include Rubén Díaz (1981–1985), Julio César Uribe (1987–1989), Juan Reynoso (1993–1999), and Nolberto Solano (2000–2003).


title: Peru national football team

text: Peru has taken part in the World Cup finals five times. The Peruvian team competed at the first World Cup in 1930 by invitation, and has entered each tournament at the qualifying stage since 1958, qualifying for the finals four times: in 1970, 1978, 1982 and 2018. Its all-time record in World Cup qualifying matches, as of 2017, stands at 43 wins, 37 draws and 69 losses. In the finals, the team has won five matches, drawn three and lost ten, with 21 goals in favour and 33 against. Peru won the inaugural FIFA Fair Play Trophy, awarded at the 1970 World Cup, having been the only team not to receive any yellow or red cards during the competition. Peru has the peculiar distinction of having faced the future FIFA World Cup champions during the tournament's finals phase.


title: Peru national football team

text: Luis de Souza Ferreira scored Peru's first World Cup goal on 14 July 1930, in a match against Romania. José Velásquez scored Peru's fastest World Cup finals goal—that is, that scored soonest after kick-off—two minutes into the match against Iran on 11 June 1978. Jefferson Farfán is Peru's top scorer and fifth-overall top scorer in CONMEBOL World Cup qualification, with 16 goals. Teófilo Cubillas is the team's top scorer in the World Cup finals, with 10 goals in 13 games. During the 1930 competition, a Peruvian became the first player sent off in a World Cup—his identity is disputed between sources as either defender Plácido Galindo or midfielder Mario de las Casas. Peru's Ramón Quiroga holds the unusual record of being the only goalkeeper to commit a foul in the opponent's side of the pitch in a match at the World Cup finals.


title: Peru national football team

text: Peru's national team has taken part in 33 editions of the Copa América since 1927, and has won the competition twice (in 1939 and 1975). The country has hosted the tournament six times (in 1927, 1935, 1939, 1953, 1957 and 2004). Peru's overall record in the competition is 52 victories, 33 draws, and 57 losses. Peru won the Fair Play award in the 2015 edition.


title: Peru national football team

text: Demetrio Neyra scored Peru's first goal in the competition on 13 November 1927, in a match against Bolivia. Christian Cueva scored Peru's fastest Copa América goal, two minutes into the match against Brazil on 14 June 2015. Four tournaments have featured a Peruvian top scorer—Teodoro Fernández in 1939 and Paolo Guerrero in 2011, 2015, and 2019. Fernández, the Copa América's third-overall scorer, was named best player of the 1939 tournament; Teófilo Cubillas, voted the best player in the 1975 competition, is the only other Peruvian to win this award.


title: Peru national football team

text: Peru earned its first continental title in 1939, when it won the South American Championship with successive victories over Ecuador, Chile, Paraguay and Uruguay. This marked the first time that the competition had been won by a team other than Uruguay, Brazil, or Argentina. Peru became South American champions for the second time in 1975, when it won that year's Copa América, the first to feature all ten CONMEBOL members. Peru came top of their group in the first round, eliminating Chile and Bolivia, and in the semi-finals drew with Brazil over two legs, winning 3–1 in Brazil but losing 2–0 at home. Peru was declared the winner by drawing of lots. In the two-legged final between Colombia and Peru, both teams won their respective home games (1–0 in Bogota and 2–0 in Lima), forcing a play-off in Caracas that Peru won 1–0.


title: Peru national football team

text: Peru competed in the CONCACAF Gold Cup's fifth edition in 2000. Peru participated, along with Colombia and South Korea, as that year's invitees. The Peruvian team's overall record in the tournament is 1 victory, 1 draw, and 2 losses.


title: Peru national football team

text: Ysrael Zúñiga scored Peru's first goal in the competition on 14 February 2000, in a match against Haiti. Roberto Palacios, the team's top scorer with two goals in four matches, received a spot in that year's "team of the tournament", comprising the competition's eleven best players.


title: Peru national football team

text: Peru progressed past the North American tournament's first stage, despite not winning any of its matches, as the second-best ranked team in Group B behind the United States. Peru next defeated Honduras 5–3 in a heated quarter-finals match that ended a minute early due to a pitch invasion by irate Honduran fans. Colombia defeated Peru 2–1 in the semi-finals, in a match that included an own goal from Peru's Marcial Salazar.


title: Peru national football team

text: Peru's senior side has competed in the Olympic football tournament once, at the 1936 Summer Olympics in Berlin, Germany. The multiracial 1936 team has been latterly described by historian David Goldblatt as "the jewel of the country's first Olympic delegation". It had a record of two victories, scoring 11 goals and conceding 5.


title: Peru national football team

text: Teodoro Fernández scored Peru's first goal in the tournament in the match against Finland on 6 August, and finished as the team's top scorer with six goals in two games, including Peru's only hat-trick at the Olympics.


title: Peru national football team

text: The 1935 South American Championship in Lima acted as the qualifying stage for the 1936 Olympic tournament. Uruguay won undefeated and Argentina came second, but neither took up their Olympic spot because of economic issues. Peru, who had come third, duly represented South America. The Peruvian team began the competition with a 7–3 win over Finland, after which it faced Austria, managed by Jimmy Hogan and popularly known as the "Wunderteam", in the quarter-finals. After the game ended 2–2, Peru scored twice in extra time to win 4–2. Peru expected to then face Poland in the semi-finals, but events off the pitch led to the withdrawal of Peru's Olympic delegation before the match.


title: Mudvayne

text: Mudvayne is an American heavy metal band formed in Peoria, Illinois in 1996. Known for their sonic experimentation, face and body paint, masks and uniforms, the band has sold over six million records worldwide, including nearly three million in the United States. The group consists of guitarist Greg Tribbett, drummer Matthew McDonough, lead vocalist Chad Gray, and bassist Ryan Martinie. The band became popular in the late-1990s Peoria, Illinois underground music scene, and found success with the single "Dig" from their debut album "L.D. 50" (2000). After releasing four more albums and touring relentlessly for nearly a decade, Mudvayne went on hiatus in 2010. They reunited in 2021 and continue to perform live.


title: Mudvayne

text: Mudvayne, formed in 1996 in Peoria, Illinois, originally consisted of lead singer Chad Gray, bassist Shawn Barclay, guitarist Greg Tribbett and drummer Matthew McDonough. The band's lineup finalized when Gray, who was earning $40,000 a year in a factory, quit his day job to become its singer. In 1997, Mudvayne financed its debut EP, "Kill, I Oughtta".


title: Mudvayne

text: During the EP's recording Barclay was replaced by Ryan Martinie, former bassist for the progressive rock band Broken Altar. After self-distributing "Kill, I Oughtta", Mudvayne adopted stage names and face paint.


title: Mudvayne

text: Chuck Toler managed the band as they recorded their 2000 debut album "L.D. 50". For the album, Mudvayne experimented with a ragged, dissonant sound; a sound collage, prepared for the album, was used as a series of interludes. "L.D. 50" was produced by the band and Garth Richardson, with executive production by Slipknot member Shawn Crahan and Slipknot manager Steve Richards.


title: Mudvayne

text: "L.D. 50" peaked at No. 1 on the "Billboard" Top Heatseekers chart and No. 85 on the "Billboard" 200. The singles "Dig" and "Death Blooms" peaked at No. 33 and No. 32 on the Mainstream Rock Tracks chart. Although the album was praised, some critics found the band hard to take seriously.


title: Mudvayne

text: To promote "L.D. 50", Mudvayne played on the Tattoo the Earth tour with Nothingface, Slayer, Slipknot and Sevendust. Nothingface guitarist Tom Maxwell became friends with Mudvayne vocalist Chad Gray, and they explored the possibility of a supergroup. The following year, Nothingface again toured with Mudvayne; although plans for a supergroup continued, they were put on hold due to scheduling conflicts. Gray and Maxwell had discussed five names for the group, and Mudvayne guitarist Greg Tribbett approached Maxwell "out of the blue" to join it. Although Nothingface drummer Tommy Sickles played on the group's demo, the search for another drummer began.


title: Mudvayne

text: In 2002, Mudvayne released "The End of All Things to Come", which the band considers its "black album" due to its largely-black artwork. Isolation inspired the album's songs. During its mixing, Gray and McDonough stopped at Bob's Big Boy and Gray remembered overhearing someone "say something like, ' ... and he's got to cut his own eye out'". When he asked McDonough if he heard the conversation McDonough said he hadn't, and Gray thought it was someone discussing a scene from a screenplay.


title: Mudvayne

text: The album expanded on "L.D. 50", with a wider range of riffs, tempos, moods and vocals. Because of this experimentation, "Entertainment Weekly" called this album more "user-friendly" than its predecessor and it was one of 2002's most acclaimed heavy-metal albums, it was eventually certified Gold by the RIAA in 2003. The music video for the single "Not Falling" demonstrated Mudvayne's change in appearance from "L.D. 50", with the musicians transformed into veined creatures with white, egg-colored bug eyes. In 2003, Mudvayne participated in the Summer Sanitarium Tour, headlined by Metallica, and in September, Chad Gray appeared on V Shape Mind's debut studio album "Cul-De-Sac".


title: Mudvayne

text: In January 2004, the band began work on its third album, produced by Dave Fortman. As for the previous album, Mudvayne withdrew to write songs; they moved into a house, writing the album in four months before recording began after the Summer Sanitarium tour ended. In February, Gray and Martinie expressed an interest in appearing on "Within The Mind – In Homage to the Musical Legacy of Chuck Schuldiner", a tribute to the founder of the metal band Death, but the album was never produced.


title: Mudvayne

text: In 2005, Chad Gray established independent record label Bullygoat Records and Bloodsimple's debut album, "A Cruel World" (with a guest appearance by Gray), appeared in March. On April 12, Mudvayne released "Lost and Found". The album's first single, "Happy?", featured complex guitar work and Gray described "Choices" as "the eight-minute opus".


title: Mudvayne

text: In August, former Mudvayne bassist Shawn Barclay released his band Sprung's debut album, mastered by King's X guitarist Ty Tabor. That month, rumors spread that Bullygoat Records would release "We Pay Our Debt Sometimes: A Tribute to Alice in Chains", with performances by Mudvayne, Cold, Audioslave, Breaking Benjamin, Static-X and the surviving members of Alice in Chains. A spokesperson for Alice in Chains told the press that the band was unaware of any tribute album, and Mudvayne's manager said that reports of the album were only rumors.


title: Mudvayne

text: In September, the band met with director Darren Lynn Bousman, whose film "Saw II" was in production and would include "Forget to Remember" from "Lost and Found". Bousman showed them a scene of a man cutting his eye out of his skull to retrieve a key. When Gray told Bousman about the conversation at Bob's Big Boy two years earlier, Bousman said he holds his production meetings at the restaurant and "Saw II" was based on a screenplay he wrote years earlier. Gray appeared briefly in the film, and the music video for "Forget to Remember" contained clips from "Saw II".


title: Mudvayne

text: In 2006, Gray, Tribbett and Tom Maxwell were joined by former Pantera and Damageplan drummer Vinnie Paul for the supergroup Hellyeah. On March 8, when Mudvayne and Korn performed at the KBPI Birthday Bash in Denver, Thornton waitress Nicole LaScalia was injured during Mudvayne's set. Two years later, LaScalia filed a lawsuit against radio station owner Clear Channel Broadcasting, concert promoter Live Nation, the University of Denver and members of Mudvayne and Korn. During the summer, Gray, Tribbett, Maxwell and Paul recorded an album as Hellyeah. After a tour with Sevendust, Mudvayne released the 2007 retrospective "By the People, for the People" (compiled from selections chosen by fans on the band's website). The album debuted at number 51 on the U.S. Billboard 200 chart, selling about 22,000 copies in its first week.


title: Mudvayne

text: After Gray and Tribbett returned from touring with Hellyeah, Mudvayne began recording "The New Game" with Dave Fortman. After the album's 2008 release, Fortman told MTV that it would be followed in six months by another full-length record.


title: Mudvayne

text: For its self-titled fifth album, Mudvayne hoped to create a "white album", describing its cover art. The album, printed with blacklight paint, was only visible under a black light (a light whose wavelength is primarily ultraviolet). "Mudvayne" was recorded in the summer of 2008 and released in 2009.


title: Mudvayne

text: In 2010, Mudvayne again paused to allow Gray and Tribbett to tour with Hellyeah, and, because of the supergroup's album releases, the band would be on hiatus until at least 2014. With Hellyeah, Tribbett has recorded three albums: "Hellyeah", "Stampede" and "Band of Brothers". Gray has contributed to an additional fourth, fifth and sixth albums, "Blood for Blood", "Unden!able" and "Welcome Home". In 2012, Ryan Martinie toured with Korn as a temporary replacement for bassist Reginald Arvizu, who remained at home during his wife's pregnancy. The following year, Martinie played bass on Kurai's debut EP, "Breaking the Broken", In 2014, Tribbett left Hellyeah.


title: Mudvayne

text: On April 19, 2021, Mudvayne announced that they had reunited and would play their first shows in 12 years in the fall, which included festival appearances at Inkcarceration Music & Tattoo in Mansfield, Aftershock in Sacramento and Welcome to Rockville in Florida; concert promoter and festival organizer Danny Wimmer stated that these would be the band's only live appearances for 2021. The band were previously scheduled to also appear at Louder Than Life in Louisville, before the performance was canceled on September 21 due to Gray and some staff members contracting COVID-19. The members of Mudvayne have reportedly discussed the possibility of new material. The band's reunion resumed in the summer of 2022 with appearances at Upheaval Festival in Grand Rapids and Rock Fest in Cadott, followed by their first US tour in 13 years, which saw Mudvayne co-headline the Freaks on Parade tour with Rob Zombie. The tour's stop in Tampa made headlines when during one show, Gray fell off the stage while performing the song "Not Falling". Gray himself noted the irony, and joked it was "amazing" and "unbelievable".


title: Mudvayne

text: Mudvayne is noted for its musical complexity, complex meters and polyrhythms. The band's music contains what McDonough calls "number symbolism", where certain riffs correspond to lyrical themes. Mudvayne has incorporated elements of death metal, jazz, jazz fusion, progressive rock, speed metal, thrash metal and world music.


title: Mudvayne

text: Mudvayne's influences include Tool, Pantera, King Crimson, Genesis, Emerson, Lake & Palmer, Carcass, Deicide, Emperor, Miles Davis, Black Sabbath, and Rush. Mudvayne have repeatedly expressed admiration for Stanley Kubrick's "", and were influenced by the film during the recording of "L.D. 50".


title: Mudvayne

text: Although Mudvayne has described its style as "math rock" and "math metal", drummer Matthew McDonough said in 2009: "I honestly don't know what 'math metal' is. I made a joke early on in Mudvayne's career that we used an abacus in writing. It seems I should be careful making jokes in interviews. I don't really see Mudvayne as an innovator in anything." Music critics and journalists have categorized the band as alternative metal, nu metal, experimental metal, extreme metal, hard rock, heavy metal, math metal, groove metal, neo-progressive metal, neo-progressive rock, progressive rock, and progressive metal. Eli Enis of "Revolver" magazine wrote that the band "wriggled between nu-metal, alt-metal, prog and hard rock in a way that remains completely unrivaled to this day. No one else has or ever will sound quite like them."


title: Mudvayne

text: Although Mudvayne was known for its appearance, Gray described its aesthetic as "music first, visuals second". When "L.D. 50" was released, the band performed in horror film-style makeup. Epic Records initially promoted Mudvayne without focusing on its members; early promotional materials featured a logo instead of photos of the band, but its appearance and music videos publicized "L.D. 50". The members of Mudvayne were originally known by the stage names Kud, sPaG, Ryknow and Gurrg. At the 2001 MTV Video Music Awards (where they won the MTV2 Award for "Dig"), the band appeared in white suits with bloody bullet-hole makeup on their foreheads. After 2002, Mudvayne changed makeup styles (from multicolored face paint to extraterrestrials) for promotional photos and changed their stage names to Chüd, Güüg, Rü-D, and Spüg, though they would continue to perform in the horror-style makeup live. According to the band, the extravagant makeup added a visual aspect to their music and set them apart from other metal bands. From 2003 up until their dissolution, Mudvayne largely abandoned the use of makeup to avoid image comparisons with the band Slipknot. With their 2021 reunion, they began wearing makeup again when performing live.


title: Sita Ramam

text: Sita Ramam is a 2022 Indian Telugu-language period romance film written and directed by Hanu Raghavapudi. Produced by Vyjayanthi Movies and Swapna Cinema, the film stars Dulquer Salmaan and Mrunal Thakur (in her Telugu debut) in lead roles with Rashmika Mandanna and Sumanth in the supporting roles. Set in 1964, Lieutenant Ram, an orphaned army officer serving at the Kashmir border, gets anonymous love letters from Sita Mahalakshmi, after which Ram is on a mission to find Sita and propose his love.


title: Sita Ramam

text: Principal photography commenced in April 2021 and ended in April 2022 with filming taking place in Hyderabad, Kashmir and Russia. The film's music was composed by Vishal Chandrasekhar while cinematography by P. S. Vinod and Shreyaas Krishna and editing by Kotagiri Venkateswara Rao.


title: Sita Ramam

text: "Sita Ramam" was released theatrically on 5 August 2022 and opened to highly positive reviews from critics and audiences. The film emerged as a huge critical and commercial success, grossing over crore at the box office. It is one of the highest-grossing Telugu films of 2022.


title: Sita Ramam

text: In 1964, Pakistani extremist Ansari conspires to disturb the understanding between Kashmiri Muslims and Hindus and resorts to use Indian Army as a pawn in his machination. As a part of his scheme, he sends a few brainwashed teenagers to intrude Kashmir and masquerade as natives.


title: Sita Ramam

text: In 1985, Afreen, a fierce rabble-rouser from Pakistan graduating in London faces an ultimatum to either apologize an Indian philanthropist, Anand Mehta or pay a compensation of 1 million (10 lakhs INR) for burning his car in retaliation for burning Pakistani flag. Unwilling to apologize an Indian, Afreen turns to her estranged grandfather Abu Tariq, who served as a Brigadier to Pakistani Army but perceives that he succumbed to his illness and in his will, wants her to deliver a letter, meant for Sita Mahalakshmi of Hyderabad, India, written by Indian Army Lieutenant Ram before 20 years. The letter couldn't be delivered to Sita by means of post in the past 20 years. To get the money, she has to pay for Mehta, Afreen flies to Hyderabad and realizes that the receiver's address: a palace, written in the letter is now a women's college donated by Princess Noor Jahan for the education of girls and the identity of Sita is unknown in there. Therefore, Afreen reluctantly seeks help from her senior in London's university, Balaji who takes her to Subramanyam, who was employed at the palace as the accountant of Nawab during the time of Nizams. Subramanyam fails to identify anyone called Sita, disappointing Afreen, who resorts to learn about Ram for finding about Sita.


title: Sita Ramam

text: Afreen and Balaji meet Ram's regiment-mate Vikas Varma. Vikas narrates that in 1965, Ansari intentionally leaked the details of teenagers to the Indian Army causing Major Selvan to order Ram's superior Vishnu Sharma to kill the teenagers despite Ram suspecting a plot behind it. The murders of teenagers, along with Ansari's instigation on radio turned Kashmiri Muslims against the Indian Army, who were boycotted. Infuriated Muslims burned Agarta, a place inherited by Kashmiri Pandits but Ram and his regiment-mates thwarted their attempts and exposed Ansari's conspiracy, uniting the religions back when the Muslims helped Hindus put off the fire. Recognizing Ram and his mates' role behind preventing a religious riot, a reporter Vijayalakshmi arrived to interview them and realized that Ram was an orphan, with none to even write a letter for him. With herself writing a letter to Ram addressing him as her son, Vijayalakshmi asked all the listeners on radio to write to Ram and send their love for him. As a result, Ram received several letters from various parts of country with people recognizing him as their son, brother and etc.


title: Sita Ramam

text: Surprisingly, Ram received a letter from mysterious woman with no sender's address, Sita Mahalakshmi, who addressed him as her husband. Ram figured it out that Sita would board a train to Hyderabad from Delhi using details in her letter and boarded the train with Vikas. He finally found Sita and repeated a riddle given by her to recognize her. Asking her to call his friend Durjoy Sharma, where he would stay for next few days, Ram left her compartment and unintentionally boarded a train to Madras. Upon reaching Hyderabad, he realized that the telephone of Durjoy had been dead for few days and presumed that he wouldn't be able to get in touch with Sita again. However, Sita arrived at Durjoy's place searching for Ram but left without giving any of her details to him. Vikas, presently reveals that he couldn't join Army back because of personal problems and never got to meet Ram or get in touch with him. Afreen takes Durjoy's address and Vishnu's contact from Vikas and dials Vishnu's number but fails to talk to him. Excited as Afreen wanted to talk about Ram, Vishnu hurriedly postpones his plans to search for her. Afreen and Balaji meet Durjoy and learn what happened later. Ram traced Sita to a magic show, she said she wanted him to take to, in one of her letters. At the show, Ram learnt from Sita's friend Rekha that Sita was employed as Bharatanatyam teacher to Princess Noor Jahan. Ram realized that he rescued Sita from riots at Agarta causing him to fall in love with his generousity. Fooling the account Subramanyam, Ram and Durjoy managed to enter the palace and the former got to meet Sita, to whom he proposed marriage. Resisted by an unknown matter, she left without giving an answer yet another time leaving him disappointed.


title: Sita Ramam

text: Presently, Afreen learns that Durjoy knows nothing more than that but earns a photo of Sita, that Ram clicked from Durjoy's camera. She goes to the women's college for showing the photo to Subramanyam so that he could identify Sita but realizes that she is in reality, Princess Noor Jahan. Afreen and Balaji, stunned meet Rekha through Subramanyam and listens to the rest of story. Noor Jahan was truly in love with Ram, but the issues surrounding her dynasty restrained her from accepting his proposal. Her family had lost all of their assets in Oman due to financial crisis and her brother arranged for a truce with the royal family of Oman proposing to get Noor married to Prince of Oman. Rekha advised Noor to reveal her identity to Ram and she planned to do it by accompanying him to meet all the people, who wrote to him for four days. However, she failed to do so and in fact, her attachment to Ram further intensified. Unbeknownst to her, a journalist Marthandam clicked their pictures together and published them in newspaper for increment in his salary. When Prince of Oman requested for an explanation for this from Noor through an ambassador, Noor exposed her love for Ram shocking her brother. Noor left to Kashmir for meeting Ram and got acquainted with all of his regiment mates but didn't get a chance to reveal about herself to him.


title: Sita Ramam

text: A teenager of Pakistan, who was not harmed attempted to murder Vishnu when the latter was on a dinner with his wife Vaidehi, daughter, Ram and Noor but Ram managed to resist the attack. Ram managed to learn about the base of Ansari by exposing the latter's intentions to the teenager and promises to protect his toddling sister Waheeda from Ansari. Brigadier Y. K. Joshi and Selvan assigned Vishnu, Ram and other soldiers on a secret mission to assassinate Ansari off record and announced that the one who would not return shall be declared as deserted soldiers of the army. Ram, after bidding a tearful bye to Noor left for his mission and she thought of revealing about her identity to him once he returned.


title: Sita Ramam

text: Currently, Afreen receives Noor's address from Rekha and learns that she has been staying in Kashmir. Afreen and Balaji fly to Kashmir but the former is apprehended by Vishnu, who narrates about the events that occurred later. Ram, Vishnu and others successfully managed to assassinate Ansari but Ram, along with Vishnu was captivated by Pakistani Army when Ram tried to protect Waheeda from fires. Abu Tariq, who was Army General then was generous to duo and through an Indian diplomat Rahul Varma arranged for an exchange with the Indian Army. At the same time, Noor tried her best to get back to Ram and finally learnt from Joshi that Ram was arrested by Pakistani Army. Pakistani Army planned on releasing only one of Ram and Vishnu and hence, Vishnu was released. Later, Pakistani Army attacked Indian Army bases in Kashmir killing 32 soldiers and Ram was presumed to be the traitor due to which Sita had to bear the humiliation. At present, Vishnu reveals to Afreen that she is Waheeda who was adopted by Tariq. Afreen blames herself for the separation of Sita and Ram and Vishnu promises to deliver Ram's letter to Noor and send Afreen back to Pakistan safely. Meanwhile, Balaji meets Noor and delivers Ram's letter for her.


title: Sita Ramam

text: Through his letter, it is revealed that Pakistani Army planned on releasing the one who would leak the details of Indian Army bases' coordinates. Vishnu gave in to rescue Vaidehi and his children and has been living his life in regret. Along with Ram's letter, there is a newspaper article about "Princess Noor Jahan falling in love with a common man", revealing to the audience that Ram was aware of Sita's true identity as a Muslim but did not care. Using his letter, Sita restores the respect for him in the Indian Army by proving him as a patriot while Vishnu commits suicide due to disgrace. Sita receives a medal as a token for his patriotism while Afreen is said to have apologized Mehta along with having 11 soldiers of India, released from Pakistani Army's custody.


title: Sita Ramam

text: Hanu Raghavpudi got the idea for the film when he bought a book that had an unopened inland letter. Regarding the same, he told "The Hindu", "The letter I found in that book, in 2007, was from a mother to her son. I gathered that their family is from Vijayawada and the son is living in a hostel. She had enquired about his well being and asked when he would be home. It got me thinking, what if the contents of the letter had something crucial that could change the course of events?". Army backdrop was later included in the story as suggested by Rajkumar Kandamudi. Sheetal Sharma was hired as the costume designer for the film. The film was announced in July 2020. In April 2022, its title "Sita Ramam" was announced.


title: Sita Ramam

text: Dulquer Salmaan was roped in to play the lead role as a military officer, and it is his second collaboration in Telugu cinema with Vyjayanthi Movies after "Mahanati" (2018). In May 2020, Pooja Hegde was approached to play Sita but it did not materialize due to date clash, eventually after which Hindi cinema actress Mrunal Thakur was signed to play Sita, marking her debut in Telugu cinema. Raashi Khanna was considered to play Afreen before Rashmika Mandanna was finalized for the role.


title: Sita Ramam

text: Principal photography commenced in April 2021 in Kashmir and first schedule wrapped up in July 2021. After another schedule in Russia and Hyderabad, final schedule took place in April 2022.


title: Sita Ramam

text: The music and soundtrack was composed by Vishal Chandrasekhar. The audio rights were acquired by Sony Music India. The first single titled "Oh Sita Hey Rama" was released on 9 May 2022. "Ala Nemaliki - Inthandam Reprise" version sung by S. P. Charan was released later.


title: Sita Ramam

text: "Sita Ramam" was released on 5 August 2022 in Telugu along with dubbed versions of Tamil and Malayalam languages. The Hindi dubbed version of the film was released on 2 September 2022.


title: Sita Ramam

text: The film's screening was banned in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates. According to an article published by "News18", the ban was a result of the film hurting religious sentiments. Later, the ban in the United Arab Emirates was lifted and the film released on 11 August 2022. A pre-release event was conducted in Hyderabad in 3 August 2022 with Prabhas attending as guest. The team promoted the film at events in Hyderabad, Vijayawada, Vizag, Chennai and Kochi.


title: Sita Ramam

text: The film is distributed in Nizam region by Asian Cinemas, Krishna and Uttarandhra region by Annapurna Studios, Tamil Nadu by Lyca Productions and Wayfarer Films in Kerala. The Hindi version rights were acquired by Pen Studios. In the United States, it is distributed by S. Radha Krishna's Radhakrishna Entertainments. The worldwide theatrical rights of the film were sold at a cost of 18.70 crore.


title: Sita Ramam

text: The digital distribution rights of the film were acquired by Amazon Prime Video. The film premiered on Amazon Prime Video on 9 September 2022 in Telugu and dubbed versions of Tamil and Malayalam languages. The film is set to premiere on Disney+ Hotstar in Hindi on 18 November, 2022.


title: Sita Ramam

text: "Sita Ramam" received highly positive reviews from critics. Neeshita Nyayapati of "The Times of India" rated the film 3.5 out of 5 stars and wrote, "With "Sita Ramam", Hanu manages to deliver a story that's moving and a film that's visually aesthetic and pleasing". Jayadeep Jayesh of "Deccan Herald" rated the film 3.5 out of 5 stars and wrote, ""Sita Ramam" shares its soul with the Bollywood classic "Veer Zara". Yet, it maintains an identity of its own". Jeevi of "Idlebrain" rated the film 3 out of 5 stars and wrote, "On the whole, Sita Ramam is a classy tale of eternal love". Priyanka Sundar of Firstpost rated the film 3 out of 5 stars and called the film "a visually beautiful tale of love and loss". Anji of "Sakshi" rated the film 3 out of 5 stars, praised the music, cinematography, and direction and called the film 'a beautiful love story'. Soundarya Athimuthu of "The Quint" rated the film 2.5 out of 5 stars and wrote, ""Sita Ramam" delivers a poignant love story laced with socio-political messaging".


title: Sita Ramam

text: Janani K of "India Today" rated the film 2.5 out of 5 stars and wrote, "Sita Ramam is also a musical, as opposed to a romantic story about war". Balakrishna Ganeshan of "The News Minute" rated the film 2.5 out of 5 stars and wrote, ""Sita Ramam" tries hard to make the love story between Sita and Ram a poignant tale, but with weak writing, the film does not get the desired response". He also opined that Vennala Kishore's character is related to Lord Hanuman, who helps Rama in his journey to find Sita in the Ramayanam. Manoj Kumar R of "The Indian Express" rated the film 2 out of 5 stars and wrote, "The screen presence of Dulquer Salmaan and Mrunal Thakur does add a little vigour to the otherwise dull narration. The film majorly leverages the good looks of its actors to make it tolerable". Gautama Bhaskaran of "News 18" rated the film 1.5 out of 5 stars and wrote, "Sita Ramam has all the ingredients of a puffed-up plot, peppered with coincidences and made to look like a web of implausibilities".


title: Sita Ramam

text: A critic for "Telangana Today" stated, "The film is however for the grooming Dulquer fan following. He is a natural charmer and understands the nuances of his role". Writing for "Hindustan Times", Haricharan Pudipeddi opined, "Dulquer Salmaan and Mrunal Thakur's film is a tale of love that also takes a mature and sensitive take on the conflict between India and Pakistan". Opining the same, "The Hindu"'s Sangeetha Devi Dundoo wrote, "Hanu Raghavapudi's old-world romance saga brims with earnestness and is helped by charming performances from Dulquer Salmaan and Mrunal Thakur". Princy Alexander of "Onmanorama", stated, ""Sita Ramam" is a heartfelt romantic tale in a strife-torn setting". "123Telugu" wrote, "On the whole "Sita Ramam" is a beautiful love story. The film has a decent first half and great second half. The scintillating performances by all the lead cast, the pleasing narrative, and the poetic writing will make you poignant and heartwarming".


title: Sita Ramam

text: On its opening day, "Sita Ramam" collected a gross collection of in worldwide. On the same day, it collected a gross of $400K at the US box office. In nine days, the film has collected a total gross of $1 million at the United States box office. The film collected a worldwide gross of crore in 10 days, and emerged as a commercial success at the box office. The film's Hindi version netted crore at the box office.


title: Idiopathic pulmonary fibrosis

text: Idiopathic pulmonary fibrosis (IPF), or (formerly) fibrosing alveolitis, is a rare, progressive illness of the respiratory system, characterized by the thickening and stiffening of lung tissue, associated with the formation of scar tissue. It is a type of chronic scarring lung disease characterized by a progressive and irreversible decline in lung function. The tissue in the lungs becomes thick and stiff, which affects the tissue that surrounds the air sacs in the lungs. Symptoms typically include gradual onset of shortness of breath and a dry cough. Other changes may include feeling tired, and abnormally large and dome shaped finger and toenails (nail clubbing). Complications may include pulmonary hypertension, heart failure, pneumonia or pulmonary embolism.


title: Idiopathic pulmonary fibrosis

text: The cause is unknown, hence the term idiopathic. Risk factors include cigarette smoking, acid reflux disease (GERD), certain viral infections, and genetic predisposition. The underlying mechanism involves scarring of the lungs. Diagnosis requires ruling out other potential causes. It may be supported by a HRCT scan or lung biopsy which show usual interstitial pneumonia (UIP). It is a type of interstitial lung disease (ILD).


title: Idiopathic pulmonary fibrosis

text: People often benefit from pulmonary rehabilitation and supplemental oxygen. Certain medications like pirfenidone (Esbriet) or nintedanib (Ofev) may slow the progression of the disease. Lung transplantation may also be an option.


title: Idiopathic pulmonary fibrosis

text: About 5 million people are affected globally. The disease newly occurs in about 12 per 100,000 people per year. Those in their 60s and 70s are most commonly affected. Males are affected more often than females. Average life expectancy following diagnosis is about four years. Updated international guidelines were published in 2022, which some simplification in diagnosis and the removal of antacids as a possible adjunct therapy.


title: Idiopathic pulmonary fibrosis

text: In many people, symptoms are present for a considerable time before diagnosis. The most common clinical features of IPF include the following:


title: Idiopathic pulmonary fibrosis

text: Some of these features are due to chronic hypoxemia (oxygen deficiency in the blood), are not specific for IPF, and can occur in other pulmonary disorders. IPF should be considered in all patients with unexplained chronic exertional dyspnea who present with cough, inspiratory bibasilar crackles, or finger clubbing.


title: Idiopathic pulmonary fibrosis

text: Assessment of "velcro" crackles on lung auscultation is a practical way to improve the earlier diagnosis of IPF. Fine crackles are easily recognized by clinicians and are characteristic of IPF.


title: Idiopathic pulmonary fibrosis

text: If bilateral fine crackles are present throughout the inspiratory time and are persisting after several deep breaths, and if remaining present on several occasions several weeks apart in a subject aged ≥60 years, this should raise the suspicion of IPF and lead to consideration of an HRCT scan of the chest which is more sensitive than a chest X-ray. As crackles are not specific for IPF, they must prompt a thorough diagnostic process.


title: Idiopathic pulmonary fibrosis

text: The cause of IPF is unknown but certain environmental factors and exposures have been shown to increase the risk of getting IPF. Cigarette smoking is the best recognized and most accepted risk factor for IPF, and increases the risk of IPF by about twofold. Other environmental and occupation exposures such as exposure to metal dust, wood dust, coal dust, silica, stone dust, biologic dusts coming from hay dust or mold spores or other agricultural products, and occupations related to farming/livestock have also been shown to increase the risk for IPF. There is some evidence that viral infections may be associated with idiopathic pulmonary fibrosis and other fibrotic lung diseases.


title: Idiopathic pulmonary fibrosis

text: Despite extensive investigation, the cause of IPF remains unknown. The fibrosis in IPF has been linked to cigarette smoking, environmental factors (e.g. occupational exposure to gases, smoke, chemicals or dusts), other medical conditions including gastroesophageal reflux disease (GERD), or to genetic predisposition (familial IPF). However, none of these is present in all people with IPF and therefore do not provide a completely satisfactory explanation for the disease.


title: Idiopathic pulmonary fibrosis

text: IPF is believed to be the result of an aberrant wound healing process including/involving abnormal and excessive deposition of collagen (fibrosis) in the pulmonary interstitium with minimal associated inflammation. Cellular senescence is suspected to be a central contributing cause, a belief which is supported by benefits seen in patients given senolytic therapy.


title: Idiopathic pulmonary fibrosis

text: It is hypothesized that the initial or repetitive injury in IPF occurs to the lung cells, called alveolar epithelial cells (AECs, pneumocytes), which line the majority of the alveolar surface. When type I AECs are damaged or lost, it is thought that type II AECs undergo proliferation to cover the exposed basement membranes. In normal repair, the hyperplastic type II AECs die and the remaining cells spread and undergo a differentiation process to become type I AECs. Under pathologic conditions and in the presence of transforming growth factor beta (TGF-β), fibroblasts accumulate in these areas of damage and differentiate into myofibroblasts that secrete collagen and other proteins. In the current classification of the pathogenesis of IPF, it is believed that it occurs by way of the formation of a UIP (usual interstitial pneumonia) lesion, which then undergoes the aforementioned pathological condition characteristic of IPF. Other proposed repeated injury mechanisms indicate that IPF may result not just from a UIP lesion, but also from NSIP and DAD (nonspecific interstitial pneumonia and diffuse alveolar damage) lesions, or a combination of several.


title: Idiopathic pulmonary fibrosis

text: In the past, it was thought that inflammation was the first event in initiating lung tissue scarring. Later findings showed that the development of fibroblastic foci precedes the accumulation of inflammatory cells and the consequent deposition of collagen. This pathogenetic model is indirectly supported by the clinical features of IPF, including an insidious onset over several years, relatively infrequent acute exacerbations, and failure to respond to immunosuppressive therapy. However, it is the belief of some researchers that the disease is a multi-mechanistic one, wherein the trigger for the disease may stem from abnormalities in any number of wound healing pathways, including the inflammatory response. Such abnormalities could occur in any number of the nine implicated pathways (clotting cascade, antioxidant pathways, apoptosis, inflammatory cytokines, angiogenesis and vascular remodelling, growth factors, surfactant and matrix regulatory factors), and that through further investigation into all nine, novel therapies and approaches could be proposed on a unique or case-by-case basis should attempts at treating or circumventing complications in any one pathway prove unsuccessful. A number of therapies that target fibroblast activation or the synthesis of extracellular matrix are currently in early testing or are being considered for development.


title: Idiopathic pulmonary fibrosis

text: Familial IPF accounts for less than 5% of the total of patients with IPF and is clinically and histologically indistinguishable from sporadic IPF. Genetic associations include mutations in pulmonary surfactant proteins A1, A2, C (SFTPA1, SFTPA2B) and mucin (MUC5B).


title: Idiopathic pulmonary fibrosis

text: A remarkable aspect of the MUC5B variant is its high frequency of detection, as it is found in approximately 20% of individuals with Northern and Western European ancestry and in 19% of the Framingham Heart Study population.


title: Idiopathic pulmonary fibrosis

text: Mutations in human telomerase genes are also associated with familial pulmonary fibrosis and in some patients with sporadic IPF (e.g. the TERT, TERC genes). Recently an X-linked mutation in a third telomerase-associated gene, dyskerin (DKC1), has been described in a family with IPF.


title: Idiopathic pulmonary fibrosis

text: An earlier diagnosis of IPF is a prerequisite for earlier treatment and, potentially, improvement of the long-term clinical outcome of this progressive and ultimately fatal disease. If IPF is suspected, diagnosis can be challenging but a multidisciplinary approach involving a pulmonologist, radiologist and pathologist expert in interstitial lung disease has been shown to improve the accuracy of IPF diagnosis.


title: Idiopathic pulmonary fibrosis

text: A Multidisciplinary Consensus Statement on the Idiopathic Interstitial Pneumonias published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) in 2000 proposed specific major and minor criteria for establishing the diagnosis of IPF. However, in 2011, new simplified and updated criteria for the diagnosis and management of IPF were published by the ATS, ERS, together with the Japanese Respiratory Society (JRS) and Latin American Thoracic Association (ALAT). Currently, a diagnosis of IPF requires:


title: Idiopathic pulmonary fibrosis

text: In the right clinical setting, it is possible to make the diagnosis of IPF by HRCT alone, obviating the need for surgical lung biopsy.<ref name="ATS/ERS"></ref>


title: Idiopathic pulmonary fibrosis

text: Various technologies using Artificial Intelligence have been developed to help with diagnosis. A deep learning algorithm for categorizing high-resolution CT images reported high accuracy and a research project led by Nagoya University Graduate School of Medicine and Riken used a combination of Deep learning and Machine learning algorithm to accurately diagnose the disease.


title: Idiopathic pulmonary fibrosis

text: Recognizing IPF in clinical practice can be challenging as symptoms often appear similar to those of more common diseases, such as asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure (www.diagnoseipf.com). The key issue facing clinicians is whether the presenting history, symptoms (or signs), radiology, and pulmonary function testing are collectively in keeping with the diagnosis of IPF or whether the findings are due to another process. It has long been recognized that patients with ILD related to asbestos exposure, drugs (such as chemotherapeutic agents or nitrofurantoin), rheumatoid arthritis and scleroderma/systemic sclerosis may be difficult to distinguish from IPF. Other differential diagnostic considerations include interstitial lung disease related to mixed connective tissue disease, advanced sarcoidosis, chronic hypersensitivity pneumonitis, pulmonary Langerhan's cell histiocytosis and radiation-induced lung injury.


title: Idiopathic pulmonary fibrosis

text: Idiopathic pulmonary fibrosis (IPF) belongs to a large group of more than 200 lung diseases known as interstitial lung diseases (ILDs), which are characterized by the involvement of the lung interstitium, the tissue between the air sacs of the lung. IPF is one specific presentation of idiopathic interstitial pneumonia (IIP), which is in turn a type of ILD, also known as diffuse parenchymal lung disease (DPLD).


title: Idiopathic pulmonary fibrosis

text: The 2002 American Thoracic Society/European Respiratory Society (ATS/ERS) classification of IIPs was updated in 2013. In this new classification there are three main categories of idiopathic interstitial pneumonias (IIPs): major IIPs, rare IIPs, and unclassifiable IIPs. The major IIPs are grouped into chronic fibrosing IPs (this includes IPF and non-specific interstitial pneumonia [NSIP]); smoking-related IPs (i.e. respiratory bronchiolitis–interstitial lung disease [RB-ILD] and desquamative interstitial pneumonia [DIP]); and acute/subacute IPs (i.e. cryptogenic organizing pneumonia [COP] and acute interstitial pneumonia [AIP]).


title: Idiopathic pulmonary fibrosis

text: The diagnosis of IIPs requires exclusion of known causes of ILD. Examples of ILD of known cause include hypersensitivity pneumonitis, pulmonary Langerhan's cell histiocytosis, asbestosis, and collagen vascular disease. However, these disorders frequently affect not only the interstitium, but also the airspaces, peripheral airways, and blood vessels.


title: Idiopathic pulmonary fibrosis

text: Chest X-rays are useful in the follow up routine of IPF patients. Plain chest X-rays are unfortunately not diagnostic but may reveal decreased lung volumes, typically with prominent reticular interstitial markings near the lung bases. The radiological evaluation through HRCT is an essential point in the diagnostic pathway in IPF. HRCT is performed using a conventional computed axial tomographic scanner without injection of contrast agents. Evaluation slices are very thin, 1–2 mm.


title: Idiopathic pulmonary fibrosis

text: Typical HRCT of the chest of IPF demonstrates fibrotic changes in both lungs, with a predilection for the bases and the periphery. According to the joint ATS/ERS/JRS/ALAT 2011 guidelines, HRCT is an essential component of the diagnostic pathway in IPF which can identify UIP by the presence of:


title: Idiopathic pulmonary fibrosis

text: According to the updated 2011 guidelines, in the absence of a typical UIP pattern on HRCT, a surgical lung biopsy is required for confident diagnosis.


title: Idiopathic pulmonary fibrosis

text: Histologic specimens for the diagnosis of IPF must be taken at least in three different places and be large enough that the pathologist can comment on the underlying lung architecture. Small biopsies, such as those obtained via transbronchial lung biopsy (performed during bronchoscopy) are usually not sufficient for this purpose. Hence, larger biopsies obtained surgically via a thoracotomy or thoracoscopy are usually necessary.


title: Idiopathic pulmonary fibrosis

text: Lung tissue from people with IPF usually show a characteristic histopathologic UIP pattern and is therefore the pathologic counterpart of IPF. Although a pathologic diagnosis of UIP often corresponds to a clinical diagnosis of IPF, a UIP histologic pattern can be seen in other diseases as well, and fibrosis of known origin (rheumatic diseases for example). There are four key features of UIP including interstitial fibrosis in a 'patchwork pattern', interstitial scarring, honeycomb changes and fibroblast foci.


title: Idiopathic pulmonary fibrosis

text: Fibroblastic foci are dense collections of myofibroblasts and scar tissue and, together with honeycombing, are the main pathological findings that allow a diagnosis of UIP.


title: Idiopathic pulmonary fibrosis

text: Bronchoalveolar lavage (BAL) is a well-tolerated diagnostic procedure in ILD. BAL cytology analyses (differential cell counts) should be considered in the evaluation of patients with IPF at the discretion of the treating physician based on availability and experience at their institution. BAL may reveal alternative specific diagnoses: malignancy, infections, eosinophilic pneumonia, histiocytosis X, or alveolar proteinosis. In the evaluation of patients with suspected IPF, the most important application of BAL is in the exclusion of other diagnoses. Prominent lymphocytosis (>30%) generally allows excluding a diagnosis of IPF.


title: Idiopathic pulmonary fibrosis

text: Spirometry classically reveals a reduction in the vital capacity (VC) with either a proportionate reduction in airflows, or increased airflows for the observed vital capacity. The latter finding reflects the increased lung stiffness (reduced lung compliance) associated with pulmonary fibrosis, which leads to increased lung elastic recoil.


title: Idiopathic pulmonary fibrosis

text: Measurement of static lung volumes using body plethysmography or other techniques typically reveals reduced lung volumes (restriction). This reflects the difficulty encountered in inflating the fibrotic lungs.


title: Idiopathic pulmonary fibrosis

text: The diffusing capacity for carbon monoxide (DL) is invariably reduced in IPF and may be the only abnormality in mild or early disease. Its impairment underlies the propensity of patients with IPF to exhibit oxygen desaturation with exercise which can also be evaluated using the 6-minute walk test (6MWT).


title: Idiopathic pulmonary fibrosis

text: Terms such as 'mild', 'moderate', and 'severe' are sometimes used for staging disease and are commonly based on resting pulmonary function test measurements. However, there is no clear consensus regarding the staging of IPF patients and what are the best criteria and values to use. Mild-to-moderate IPF has been characterized by the following functional criteria:


title: Idiopathic pulmonary fibrosis

text: The goals of treatment in IPF are essentially to reduce the symptoms, stop disease progression, prevent acute exacerbations, and prolong survival. Preventive care (e.g. vaccinations) and symptom-based treatment should be started early in every patient.


title: Idiopathic pulmonary fibrosis

text: In the 2011 IPF guidelines, oxygen therapy, or supplementary oxygen for home use, became a strong recommendation for use in those patients with significantly low oxygen levels at rest. Although oxygen therapy has not been shown to improve survival in IPF, some data indicate an improvement in exercise capacity.


title: Idiopathic pulmonary fibrosis

text: Fatigue and loss of muscular mass are common and disabling problems for patients with IPF. Pulmonary rehabilitation may alleviate the overt symptoms of IPF and improve functional status by stabilizing and/or reversing the extrapulmonary features of the disease. The number of published studies on the role of pulmonary rehabilitation in idiopathic pulmonary fibrosis is small, but most of these studies have found significant short-term improvements in functional exercise tolerance, quality of life, and dyspnea on exertion. Typical programs of rehabilitation include exercise training, nutritional modulation, occupational therapy, education and psychosocial counseling. In the late phase of disease, IPF patients tend to discontinue physical activity due to increasing dyspnea. Whenever possible, this should be discouraged.


title: Idiopathic pulmonary fibrosis

text: A number of treatments have been investigated in the past for IPF, including interferon gamma-1β, bosentan, ambrisentan, and anticoagulants, but these are no longer considered effective treatment options. Many of these earlier studies were based on the hypothesis that IPF is an inflammatory disorder.


title: Idiopathic pulmonary fibrosis

text: A Cochrane review comparing pirfenidone with placebo, found a reduced risk of disease progression by 30%. FVC or VC was also improved, even if a mild slowing in FVC decline could be demonstrated only in one of the two CAPACITY trials. A third study, which was completed in 2014 found reduced decline in lung function and IPF disease progression. The data from the ASCEND study were also pooled with data from the two CAPACITY studies in a pre-specified analysis which showed that pirfenidone reduced the risk of death by almost 50% over one year of treatment.


title: Idiopathic pulmonary fibrosis

text: "N"-Acetylcysteine (NAC) is a precursor to glutathione, an antioxidant. It has been hypothesized that treatment with high doses of NAC may repair an oxidant–antioxidant imbalance that occurs in the lung tissue of patients with IPF. In the first clinical trial of 180 patients (IFIGENIA), NAC was shown in previous study to reduce the decline in VC and DLCO over 12 months of follow-up when used in combination with prednisone and azathioprine (triple therapy).


title: Idiopathic pulmonary fibrosis

text: More recently, a large randomized, controlled trial (PANTHER-IPF) was undertaken by the National Institutes of Health (NIH) in the US to evaluate triple therapy and NAC monotherapy in IPF patients. This study found that the combination of prednisone, azathioprine, and NAC increased the risk of death and hospitalizations and the NIH announced in 2012 that the triple-therapy arm of the PANTHER-IPF study had been terminated early.