Association between Dietary Patterns and Chronic Obstructive Pulmonary Disease in Korean Adults: The Korean Genome and Epidemiology Study

In addition to smoking, dietary habits may contribute to the development of chronic obstructive pulmonary disease (COPD). This study aimed to examine the association between dietary patterns and lung function in a Korean community cohort. A total of 5436 participants were included from the Ansan-Ansung cohort study. To identify the dietary patterns, we performed principal component factor analysis using the results of a semi-quantitative food frequency questionnaire. The forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were measured by spirometry. Multiple logistic regression models were used to evaluate the association between dietary patterns and lung function after adjusting for confounders. We identified four major dietary patterns; 'prudent', 'coffee, fat, and sweet', 'westernized', and 'white rice'. After adjusting for potential confounders, the 'coffee, fat, and sweet' dietary pattern was negatively associated with lung function, particularly the FEV1/FVC ratio. Participants with high scores for the 'coffee, fat and sweet' pattern had a higher risk of COPD among men but not women. Therefore, these results indicate that the 'coffee, fat and sweet' dietary pattern is inversely related to lung function in Korean adults. Our results indicate that dietary habits may be modifiable risk factors for COPD.ope

Incidentally found resectable lung cancer with the usage of artificial intelligence on chest radiographs

Purpose: Detection of early lung cancer using chest radiograph remains challenging. We aimed to highlight the benefit of using artificial intelligence (AI) in chest radiograph with regard to its role in the unexpected detection of resectable early lung cancer. Materials and methods: Patients with pathologically proven resectable lung cancer from March 2020 to February 2022 were retrospectively analyzed. Among them, we included patients with incidentally detected resectable lung cancer. Because commercially available AI-based lesion detection software was integrated for all chest radiographs in our hospital, we reviewed the clinical process of detecting lung cancer using AI in chest radiographs. Results: Among the 75 patients with pathologically proven resectable lung cancer, 13 (17.3%) had incidentally discovered lung cancer with a median size of 2.6 cm. Eight patients underwent chest radiograph for the evaluation of extrapulmonary diseases, while five underwent radiograph in preparation of an operation or procedure concerning other body parts. All lesions were detected as nodules by the AI-based software, and the median abnormality score for the nodules was 78%. Eight patients (61.5%) consulted a pulmonologist promptly on the same day when the chest radiograph was taken and before they received the radiologist's official report. Total and invasive sizes of the part-solid nodules were 2.3-3.3 cm and 0.75-2.2 cm, respectively. Conclusion: This study demonstrates actual cases of unexpectedly detected resectable early lung cancer using AI-based lesion detection software. Our results suggest that AI is beneficial for incidental detection of early lung cancer in chest radiographs.ope

New targeted therapies for non-small cell lung cancer

Background: Lung cancer is representative of a high frequency and high mortality disease and ranks at the top in incidence and mortality in Korea, when excluding thyroid cancer. In this manuscript, we focused on current targeted therapies for lung cancer used widely in the medical field. Current Concepts: The majority of patients with lung cancer cannot be treated with surgery only and require chemotherapeutics or radiation therapy. Currently, classical chemotherapeutic agents, targeted agents, and immune checkpoint inhibitors are the most widely used. Recently, the Research and Development of antibody drug conjugates is gaining attention, and this may become a more widely prescribed treatment in the future. Among the available treatment options, targeted therapy is becoming increasingly feasible and widespread for treating inoperable lung cancers, where driver mutations have been identified, and for adjuvant or neoadjuvant therapies. Next-generation sequencing (NGS) improves the ability to identify driver mutations that were previously difficult to detect and can also be performed on blood samples where no cancer tissue is available for testing. This makes it possible to identify therapeutic targets for targeted therapy more rapidly. Discussion and Conclusion: The most common type of lung cancer in Korea is adenocarcinoma, for which a driver mutation has been identified. Newly developed drugs target previously problematic mutations or cancer cell lines that have acquired resistance induced during the treatment process. The survival rate of patients with lung cancer is expected to improve with the development of tailored treatments for targets identified from the NGS data of the patient. This paper will help clinicians understand the current state of targeted therapies for lung cancer treatment.ope

Sex differences in risk factors for depressive symptoms in patients with COPD: The 2014 and 2016 Korea National Health and Nutrition Examination Survey

Background: Although depression is a common comorbidity of chronic obstructive pulmonary disease (COPD), the role of sex remains unexplored. We evaluated sex differences of risk factors of depressive symptoms in adults with COPD. Methods: This was a population-based cross-sectional study using data from the 2014 and 2016 Korea National Health and Nutrition Examination Survey. Spirometry was used to identify patients with COPD, defined as a FEV1/FVC ratio < 0.7. Presence of depressive symptoms was defined as a total score ≥ 5 on the Patient Health Questionnaire-9. Results: 17.8% of participants expressed depressive symptoms. Relative regression analysis revealed that female sex (RR 2.38; 95% CI 1.55-3.66; p < 0.001), living alone (RR 1.46; 95% CI 1.08-1.97; p = 0.013), current smoker (RR 1.70; 95% CI 1.15-2.52; p = 0.008), underweight (RR 1.58 95% CI 1.00-2.49; p = 0.049), and GOLD Stage III/IV (RR 1.92; 95% CI 1.19-3.09; p = 0.007) were the risk factors for depressive symptoms. Low income, living alone, multiple chronic disorders, and low BMI were risk factors of depressive symptoms in male, whereas low educational attainment, urban living, and current smoking were risk factors in female. Conclusions: Female sex is a main risk factor of depressive symptoms in adults with COPD. As risk factors of depressive symptoms in COPD patients vary according to their sex, different approaches are needed to manage depression in males and females with COPD.ope

Nontuberculous mycobacterial infection after lung transplantation: A single-center experience in South Korea

Purpose: Nontuberculous mycobacteria (NTM) infection is an important issue after lung transplantation. However, a large-scale epidemiological study on this issue in Korea is lacking. We aimed to evaluate the epidemiology of NTM infection after lung transplant surgery in Korea. Methods: Between October 2012 and December 2018, we retrospectively evaluated lung transplant recipients in a referral hospital in South Korea. A total of 215 recipients were enrolled. The median age at transplantation was 56 years (range, 17-75), and 62% were men. Bronchoscopy was performed according to the surveillance protocol and clinical indications. A diagnosis of NTM infection was defined as a positive NTM culture from a bronchial washing, bronchoalveolar lavage sample, or two separate sputum samples. We determined NTM pulmonary disease (NTM-PD) according to the American Thoracic Society/Infectious Disease Society of America 2007 guidelines. The Kaplan-Meier method and log-rank test were used for conditional survival analysis in patients with follow-up of ≥12 months. Results: Fourteen patients (6.5%) were diagnosed with NTM infection at a median of 11.8 months (range, 0.3-51.4) after transplantation. Nine patients (4.2%) were diagnosed with NTM-PD, and the incidence rate was 1980/100,000 person-years. Mycobacterium abscessus was the most common species causing NTM-PD (66%), followed by M. avium complex (33%). The presence of NTM infection did not influence all-cause mortality among those who underwent follow-up for ≥12 months (N = 133, log-rank P = 0.816). Conclusion: The incidence of NTM-PD was considerably high among lung-transplant recipients. M. abscessus was the most common causative species of NTM-PD after lung transplantation.ope

Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation

Background: As lung transplantation (LTx) is becoming a standard treatment for end-stage lung disease, the use of bridging with extracorporeal membrane oxygenation (ECMO) is increasing. We examined the clinical impact of being awake during ECMO as bridging therapy in patients awaiting LTx. Methods: In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019; 64 patients received ECMO support while awaiting LTx. We divided into awake and non-awake groups and compared. Results: Twenty-five patients (39.1%) were awake, and 39 (61.0%) were non-awake. The median age of awake patients was 59.0 (interquartile range, 52.5-63.0) years, and 80% of the group was men. The awake group had better post-operative outcomes than the non-awake group: statistically shorter post-operative intensive care unit length of stay [awake vs. non-awake, 6 (4-8.5) vs. 18 (11-36), p < 0.001], longer ventilator free days [awake vs. non-awake, 24 (17-26) vs. 0 (0-15), p < 0.001], and higher gait ability after LTx (awake vs. non-awake, 92% vs. 59%, p = 0.004), leading to higher 6-month and 1-year lung function (forced expiratory volume in 1 s: awake vs. non-awake, 6-month, 77.5% vs. 61%, p = 0.004, 1-year, 75% vs. 57%, p = 0.013). Furthermore, the awake group had significantly lower 6-month and 1-year mortality rates than the non-awake group (6-month 12% vs. 38.5%, p = 0.022, 1-year 24% vs. 53.8%, p = 0.018). Conclusions: In patients with end-stage lung disease, considering the long-term and short-term impacts, the awake ECMO strategy could be useful compared with the non-awake ECMO strategy.ope

The Association between Behavioral Risk Factors and Nontuberculous Mycobacterial Pulmonary Disease

Purpose: We aimed to determine the relationship between environmental exposure and nontuberculous mycobacterial pulmonary disease (NTM-PD) in Korea. Materials and methods: A group of 150 patients with NTM-PD and a control group of 217 patients with other respiratory diseases were prospectively enrolled between June 2018 and December 2020 in Seoul, Korea. They were surveyed with a standardized questionnaire, and their medical records were reviewed. Odds ratio (OR) and 95% confidence intervals (CI) were calculated with multivariate logistic regression analysis. Results: The mean ages of the NTM-PD and control groups were similar (63.8±9.2 years vs. 63.5±10.0 years; p=0.737), and most patients were female (76.0% vs. 68.7%; p=0.157) and nonsmokers (82.0% vs. 72.8%; p=0.021). Mycobacterium avium (49.3%) was the most commonly identified strain among NTM-PD patients, followed by M. intracellulare (32.0%) and M. abscessus subspecies massiliense (12.7%). There were no differences in housing type or frequency of soil- or pet-related exposure between the case and the control groups. However, in subgroup analysis excluding patients with M. intracellulare infection, more case patients frequently visited public baths ≥1 time/week (35.3% vs. 19.4%, p=0.003); this remained significant after multivariate analysis (OR, 2.84; 95% CI, 1.58-5.17). Conclusion: Frequent exposure to water at public baths might affect the odds of contracting NTM-PD, excluding individuals infected with M. intracellulare strains.ope

Characteristics and Treatment Outcomes of Isoniazid Mono-Resistant Tuberculosis: A Retrospective Study

Purpose: Isoniazid (INH) mono-resistant tuberculosis (Hr-TB) is a highly prevalent type of drug-resistant TB, possibly associated with unfavorable treatment outcomes. However, definitive guidelines on an optimal treatment regimen and duration for Hr-TB are currently under discussion. We evaluated the characteristics and treatment outcomes of Hr-TB patients. Materials and methods: We retrospectively reviewed the medical records of Hr-TB patients treated at a South Korean tertiary referral hospital from January 2005 to December 2018. Results: We included 195 Hr-TB patients. 113 (57.9%) were male, and the median age was 56.6 [interquartile range, 40.2-68.6] years. Mutations in katG were the most frequent [54 (56.3%)], followed by those in the inhA [34 (35.4%)]. Favorable and unfavorable outcomes were noted in 164 (84.1%) and 31 (15.9%) patients, respectively. Smoking history [odds ratio (OR)=5.606, 95% confidence interval (CI): 1.695-18.543, p=0.005], low albumin level (OR=0.246, 95% CI: 0.104-0.578, p=0.001), and positive acid-fast bacilli culture at 2 months (OR=7.853, 95% CI: 1.246-49.506, p=0.028) were associated with unfavorable outcomes. Conclusion: A tailored strategy targeting high-risk patients is imperative for improved treatment outcomes. Further research on the rapid and accurate detection of resistance to INH and other companion drugs is warranted.ope

Clinical impact of pneumothorax in patients with Pneumocystis jirovecii pneumonia and respiratory failure in an HIV-negative cohort

Background: Pneumocystis jirovecii pneumonia (PCP) with acute respiratory failure can result in development of pneumothorax during treatment. This study aimed to identify the incidence and related factors of pneumothorax in patients with PCP and acute respiratory failure and to analyze their prognosis. Methods: We retrospectively reviewed the occurrence of pneumothorax, including clinical characteristics and results of other examinations, in 119 non-human immunodeficiency virus patients with PCP and respiratory failure requiring mechanical ventilator treatment in a medical intensive care unit (ICU) at a tertiary-care center between July 2016 and April 2019. Results: During follow up duration, twenty-two patients (18.5%) developed pneumothorax during ventilator treatment, with 45 (37.8%) eventually requiring a tracheostomy due to weaning failure. Cytomegalovirus co-infection (odds ratio 13.9; p = 0.013) was related with occurrence of pneumothorax in multivariate analysis. And development of pneumothorax was not associated with need for tracheostomy and mortality. Furthermore, analysis of survivor after 28 days in ICU, patients without pneumothorax were significantly more successful in weaning from mechanical ventilator than the patients with pneumothorax (44% vs. 13.3%, p = 0.037). PCP patients without pneumothorax showed successful home discharges compared to those who without pneumothorax (p = 0.010). Conclusions: The development of pneumothorax increased in PCP patient with cytomegalovirus co-infection, pneumothorax might have difficulty in and prolonged weaning from mechanical ventilators, which clinicians should be aware of when planning treatment for such patients.ope

Effective use of an advanced isolation unit during the COVID-19 pandemic: A retrospective cohort study

We described a strategy for preventing virus transmission within hospitals through screening and advanced isolation during the coronavirus pandemic. Patients were screened and admitted to the adult advanced isolation unit from February to April 2020. Our process minimized exposure without delaying proper treatment and prevented virus transmission within the hospital.ope