The effect of cytokines and endotoxin on the nitric oxide production and its relation to mitochondrial aconitase activi

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Pharmacologic Treatment of COPD

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지역사회 폐렴

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Community Acquired Pneumonia

Community acquired pneumonia is a common disease, and it is usually managed by empirical antibiotics therapy from several management guidelines. It is challenged by emergence of drug resistant bacterial strains, especially Streptococcus pneumoniae and recent increasing recognition for the mixed infection by atypical pneumonia pathogens such as Mycoplasma, Chlamydia and Legionella species. Even though community acquired pneumoniae caused by drug resistant S. pneumoina is common in Korea, the treatment results are good with current antibiotics. This review deals with important new findings and management issues of community acquired pneumonia in immunocompetent adults.ope

Diagnostic value of the combined use of radial probe endobronchial ultrasound and transbronchial biopsy in lung cancer

Background: Although the use of radial endobronchial ultrasound (R-EBUS) with a guide sheath has shown improved diagnostic capability in peripheral pulmonary lesions, its utility is still low due to variable performance. To overcome its limitation, we evaluated the feasibility and efficacy of R-EBUS combined with transbronchial biopsy (TBB) under fluoroscopic guidance. Methods: We retrospectively reviewed medical records of 74 patients with non-small cell lung cancer (NSCLC) who underwent R-EBUS combined with TBB or TBB alone as a diagnostic technique. Subjects were grouped according to the diagnostic modality used (R-EBUS combined with TBB vs. TBB alone). Each group was matched for age, sex, and location of the biopsy. The chi-square test and paired t-test were used to compare characteristics and identify factors that affected the diagnostic yield. Results: The mean age of the study cohort was 67.4 ± 12.8 years, with 21 (56.8%) men and 16 (43.2%) women in each group. The lesion size was significantly smaller in the R-EBUS group (23.6 vs. 33.9, P < 0.001). The diagnostic yield with the combined use of R-EBUS and TBB (27/37, 72.9%) was significantly higher than that with standard TBB alone (22/37, 59.4%). Lung lesions with a positive bronchus sign were associated with a higher diagnostic yield (odds ratio = 3.52 [1.17-10.62]; P = 0.025). Conclusions: The combination of R-EBUS with TBB resulted in a higher diagnostic yield than either technique alone. Thus, the addition of R-EBUS biopsy would be helpful to improve the diagnostic yield of TBB. Key points: SIGNIFICANT FINDINGS OF THE STUDY: The combination of R-EBUS with TBB under fluoroscopic guidance improved the diagnostic yield of PPLs compared to TBB alone. A tissue diagnosis was more likely in pulmonary lesions with the air-bronchus sign. What this study adds: The use of R-EBUS could help improve the low diagnostic yield of TBB under fluoroscopic guidance without increasing the incidence of complications.ope

Delamanid for multidrug-resistant pulmonary tuberculosis

BACKGROUND: Delamanid (OPC-67683), a nitro-dihydro-imidazooxazole derivative, is a new antituberculosis medication that inhibits mycolic acid synthesis and has shown potent in vitro and in vivo activity against drug-resistant strains of Mycobacterium tuberculosis. METHODS: In this randomized, placebo-controlled, multinational clinical trial, we assigned 481 patients (nearly all of whom were negative for the human immunodeficiency virus) with pulmonary multidrug-resistant tuberculosis to receive delamanid, at a dose of 100 mg twice daily (161 patients) or 200 mg twice daily (160 patients), or placebo (160 patients) for 2 months in combination with a background drug regimen developed according to World Health Organization guidelines. Sputum cultures were assessed weekly with the use of both liquid broth and solid medium; sputum-culture conversion was defined as a series of five or more consecutive cultures that were negative for growth of M. tuberculosis. The primary efficacy end point was the proportion of patients with sputum-culture conversion in liquid broth medium at 2 months. RESULTS: Among patients who received a background drug regimen plus 100 mg of delamanid twice daily, 45.4% had sputum-culture conversion in liquid broth at 2 months, as compared with 29.6% of patients who received a background drug regimen plus placebo (P=0.008). Likewise, as compared with the placebo group, the group that received the background drug regimen plus 200 mg of delamanid twice daily had a higher proportion of patients with sputum-culture conversion (41.9%, P=0.04). The findings were similar with assessment of sputum-culture conversion in solid medium. Most adverse events were mild to moderate in severity and were evenly distributed across groups. Although no clinical events due to QT prolongation on electrocardiography were observed, QT prolongation was reported significantly more frequently in the groups that received delamanid. CONCLUSIONS: Delamanid was associated with an increase in sputum-culture conversion at 2 months among patients with multidrug-resistant tuberculosis. This finding suggests that delamanid could enhance treatment options for multidrug-resistant tuberculosis. (Funded by Otsuka Pharmaceutical Development and Commercialization; ClinicalTrials.gov number, NCT00685360.).ope

Respiratory Symptoms Relievers - Antitussives, Mucolytics, Antihistamines-

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The relationship between the severity of pulmonary fibrosis and the lung cancer stage

Background: The incidence of idiopathic pulmonary fibrosis (IPF) and mortality related to the disease have steadily increased in recent years. The risk of cancer is approximately eight times higher in IPF patients than in the general population. The purpose of this study is to determine whether the severity of IPF is related to the time interval between IPF diagnosis and lung cancer diagnosis and to the stage of lung cancer at diagnosis. Methods: In this retrospective cohort study, we reviewed the medical records of patients with lung cancer after IPF diagnosis from two tertiary hospitals in South Korea between 2003 and 2018. We identified 61 patients diagnosed with lung cancer at least 3 months after being diagnosed with IPF. Results: The included patients had a mean age of 71.0 years, and all but one were men (98.4%). The interval between IPF diagnosis and lung cancer diagnosis was not related to the gender-age-physiology (GAP) stage (p=0.662). However, in cox proportional hazard models, a higher GAP stage was significantly correlated with an advanced lung cancer stage (odds ratio 11.1, p=0.003). Conclusions: The lung cancer stage at diagnosis was higher in patients with a higher GAP stage than in those with a lower GAP stage. Physicians should consider implementing more frequent surveillance with computed tomography scans for patients with advanced IPF.ope

Meanings and Indications of pretreatment assessment of esophageal carcinoma with bronchoscopy

Objectives : To determine the yield of bronchos copy for evaluating trach eobronchial spread in esophageal carcinoma and to identify the conditions for bronchos copy in patients with newly diagnosed esophageal carcinoma, who planned to be operated. Methods : From March 1989 to June 1997, 115 patients with esophageal carcinoma had received bronchos copy. Bronchos copic findings were classified into three types : Type I : no definitive endobron chiallesion, Type II : indirect effects (hyperemia and compression), Type III : invasion. CT findings were classified into three classes : Class A : tumors eparated from tracheobronchialtree, Class B : a but ting tree, Class C : compressing tree . We investigated the correlations of c linical presentation and non-invasive tests (including esophagogram) with bronchos copicfindings. Results : 1) Among 115 patients, bronchos copic findings were Type I in 67( 58.3% ), Type II in 34( 29.6% ), Type III in 14( 12.2% ). 2) Abnormal bronchos copic findings are related with length of lesion by esophagogram .(p < 0.05) 3) Class C lesion by chest CT scan were closely correlated with abnormal bronchos copic findings. 4) Chest symptoms were frequently associated with type III lesion of bronchos copy Conclusion : We could recommend preoperative bronchos copy in recently diagnosed a sesophageal carcinoma who got more than 2 of 3 variables listed below : 1) patients who had chest symptoms , suchas cough withs putum, hemoptysis, and dyspnea 2) length of tum or is long in esophagogram(above 5 cm in length), 3) trach eobronchial compressed lesion by chest CT scan. Bronchos copy is not needed in cases with no chest symptom, short lesion length (below 5 cm) and normal chest CT finding for preopera tive evaluation of esophageal carcinoma.ope

Ratio of Autoantibodies of Tumor Suppressor AIMP2 and Its Oncogenic Variant Is Associated with Clinical Outcome in Lung Cancer

Aminoacyl-tRNA synthetase-interacting multi-functional protein 2 (AIMP2) works as potent tumor suppressor, while its splicing variant lacking exon 2 (AIMP2-DX2) competes with AIMP2 for binding to target proteins and compromises its anti-tumor activity. Assuming that AIMP2 and its variant AIMP2-DX2 could be released out to human sera in pathological condition, we investigated the diagnostic and prognostic usefulness of autoantibodies against AIMP2 and AIMP2-DX2 by measuring their serum levels in 80 normal and lung cancer samples that were matched in age, gender and smoking status. The area under the curve of AIMP2-DX2, AIMP2, and AIMP2-DX2/AIMP2 autoantibody ratio was low (0.416, 0.579, and 0.357, respectively), suggesting limited diagnostic value. A total of 165 lung cancer patients were classified into low and high AIMP2-DX2, AIMP2, and AIMP2-DX2/AIMP2 based on the median expression of each parameter. The high AIMP2-DX2 group was older and had larger tumors (>3 cm) than the low AIMP2-DX2 group. The high AIMP2-DX2/AIMP2 group had higher CYFRA-21 levels and significantly shorter overall survival than the low AIMP2-DX2/AIMP2 group (18.6 vs. 48.9 months, P = 0.021, Log Rank Test). Taken together, autoantibodies against AIMP2-DX2 and AIMP2 are detectable in the human blood and the increased ratio of AIMP2-DX2/AIMP2 is related to poor clinical outcome of lung cancer.ope