Relationship between Lung Functions and Extent of Emphysema in Patients with Chronic Obstructive Pulmonary Disease

Objective: A study was undertaken to investigate whether the extent of emphysema, visually confirmed by high-resolution computed tomography (HRCT), in patients with COPD was associated with different indices of lung function and health-related life quality of patients with COPD. Methods: Eighty-two patients with COPD underwent HRCT scanning; visual assessment of HRCT scan was used in the calculation of the assessment of the severity and extent of emphysematous destruction. The patients were clinically stable at the time of the evaluation. For all subjects, a detailed interview of disease history and symptoms, health-related quality of life (HRQL) measurement, and pulmonary function tests were performed. Results: The mean visual emphysema score in all patients was 2.10 +/- 1.26. While the mean emphysema score in patients with COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage 3 was 2.88 +/- 1.01, it was 1.54 +/- 1.13 in patients with COPD GOLD stage 2 (p<0.001). There was a significant correlation between the percentage of pulmonary emphysema and the numbers of pack-years smoked (r=0.58, p<0.001). The visual emphysema score was inversely correlated with FEV1 (r=-0.56, p<0.0001), FVC (r=-0.38, p<0.001), FEV1/FVC (r=-0.43, p<0.001), PEF (r=-0.44, p<0,001) and with carbon monoxide diffusion capacity (DLCO) (r=-0.50, p<0.001). There was no correlation between emphysema score and SGRQ. Conclusion: These data suggest that HRCT visual scores correlate with functional indices of airflow obstruction and impaired lung diffusing capacity in patients with stable chronic obstructive pulmonary disease of varying severity, and the presence of pulmonary emphysema is best represented by FEV1 and DLCO

Uzak Organ Metastazlı Akciğer Kanseri Hastalarının Değerlendirilmesi**

AMAÇ: Kanser ekonomik olarak gelişmiş ülkelerde önde gelen ölüm nedenidir ve gelişmekte olan ülkelerde ikinci önde gelen ölüm nedenidir. Çalışmanın amacı, uzak organ metastaz olan akciğer kanserli hastaların ve metastazların sağkalım oranları üzerine etkisinin değerlendirilmesidir.YÖNTEM: Uzak organ metastazı olan akciğer kanserli hastalar çalışmaya alındı. Primer tümörlerin lokalizasyonu ve metastaz, metastaz histolojik tipleri, klinik belirti ve bulgular, tümör ve lenf nodlarının etkileşimi, sağkalım oranları üzerindeki metastazların etkisi değerlendirildi.BULGULAR: Çalışmaya 174 hasta dahil edildi. Hastaların sitolojik alt gruplarının küçük hücreli dışı akciğer kanseri (KHDAK) (%75,3) ve küçük hücreli akciğer kanseri (KHAK) (%24,7) olarak iki alt gruba ayrıldı.En sık metastaz bölgleri kemik (%41,4), kontralateral akciğer (%32,8), karaciğer (%23,9) beyin (%27), böbreküstü bezi (%19,5), plevra (%9,2) idi. KHDAK ve KHAK için en sık metastaz yerleri sırasıyla kemik ve karaciğer idi. Skuamöz hücreli karsinom beyin, kemik, böbreküstü ve karşı akciğerde metastaz en yaygın türü oldu. Metastatik plevra sıvıları çoğunlukla genellikle adenokarsinom ve karaciğer metastazları ise küçük hücreli akciğer kanserlerinde kaynaklanmıştır. Kemik ve beyin ile ilgili spesifik semptomların varlığı metastaz için güçlü belirleyicilerdi.SONUÇ: Kanserin tipi, metastaz sayısı, kilo kaybı, kötü performans status, kemik ve beyin metastazı yapan KHAK'lerinde semptomların olmamasının, karaciğer metastazında ise semptomların olmasının sağkalım oranları üzerine ters etkisi vardı. Hastaların klinik laboratuvar ve radyolojik bulguları bir bütün incelenmesi metazların tahmininde faydalı olurken, gereksiz cerrahiyi önlemiş olur.AIM: Cancer is the leading cause of death in economically developed countries and the second leading cause of death in developing countries. The aim of the study was to evaluate distant organ metastasis in patients with lung cancer and the effect of metastasis on survival rates.METHODS: Lung cancer patients with distant organ metastasis were enrolled to the study. Localization of primary tumors and metastasis, histological types of the metastasis, clinical symptoms and signs, the interaction of tumor and lymph nodes, the effects of metastasis on survival rates were evaluated.RESULTS: 174 patients were included in the study. Cytologic subgroups of patients were subdivided as non-small cell lung cancer (NSCLC) (75.3%) and small cell lung cancer (SCLC) (24.7%). The most frequent metastatic sites were bone (41.4 %), contralateral lung (32.8%), liver (23.9%) brain (27%), adrenal gland (19,5%), pleura (9.2%). The most common metastasis sites for NSCLC and SCLC were bone and liver respectively. Squamous cell carcinoma was the most common type of metastases in brain, bone, adrenal and contralateral lung metastasis. Metastatic pleural effusions mostly originated from adenocarcinoma and liver metastasis generally originated from small cell lung cancer. Having specific symptoms related to bone and brain were powerful predictors for metastasis.CONCLUSION: Cytological types of the cancer, number of metastasis, weight loss, poor performance status, the absence of symptoms in SCLC with bone and brain metastasis, and presence of the symptoms in liver metastases had adverse effects on survival rates. Evaluation of patients with combination of clinical symptoms, laboratory and radiological findings as whole it may be helpful in predicting metastasis and may prevent unnecessary surgery

Kronik obstrüktif akciğer hastalığında nötrofil-lenfosit oranının öngörücü rolü]

Objective: Recently neutrophil-to-lymphocyte ratio (NLR) -the level of neutrophil reflecting the severity of inflammation and lymphocyte occurring after physiological stress has been gaining popularity, which was, along with other inflammatory markers, commonly accepted as an accurate marker of the inflammatory status. In this multi-centered study, an early, rapid, and low-cost diagnosis method was investigated. To this end, the correlation between chronic obstructive pulmonary disease and inflammation was planned to be utilized and whether neutrophil-to-lymphocyte ratio can be used as a valid tool in the diagnosis of acute exacerbations of chronic obstructive pulmonary disease was investigated. Method: We retrospectively enrolled the 467 patients. Control group included sex and age-matched healthy people. C-Reactive protein, forced expiratory volume-1, forced vital capacity, complete blood count and clinical data A receiver-operating characteristic curve analysis was performed to determine the best cut-off value of N/L ratio and C-Reaktif protein to predict the exacerbation. Two-sided p values <0.05 were considered statistically significant. Results: By spearman analysis, there was a strong correlation between. C-Reactive protein and N/L ratio in both stable group (r=0.436, p<0.001) and exacerbation group (r=0.534, p=0.001). Conclusion: Neutrophil/lymphocyte ratio may be a useful predictor of inflammation in chronic obstructive pulmonary disease and acute exacarbation of chronic obstructive pulmonary disease patients

Relationship between vitamin D in obstructive sleep apnea syndrome and psoriasis patients

Introduction: Although psoriasis and obstructive sleep apnea syndrome (OSAS) are associated with systemic inflammation, studies on their potential bilateral relationship are not sufficient. Aim: To investigate vitamin D levels and receptor gene polymorphisms in patients with OSAS and psoriasis and the associations with these diseases. Material and methods: One hundred thirty-seven patients included in the study consisted of 4 different groups: group 1, those with both diseases; group 2, those with OSAS only; group 3, patients with psoriasis only; and group 4, healthy controls. The patients??? serum calcium, phosphorus, AHI, Epworth Sleepiness Scale, Psoriasis Area Severity Index, and VDR TagI, ApaI, BsmI polymorphisms were compared. Results: Vitamin D levels of groups 1, 2 and 3 were found to be lower than in controls. There was no statistically significant correlation between VDR TagI, ApaI, BsmI gene polymorphisms of the groups. Vitamin D levels were significantly higher in patients with heterozygous ApaI genotype (A/C) compared to patients with normal (A/A) or homozygous mutant (C/C) genotype (p < 0.05). No relationship was determined between VDR TagI, ApaI, BsmI, and the other parameters. Conclusions: In our study, 1,25(OH)2-vitamin D3 levels were significantly lower in all disease groups compared to the control group. Although there is no difference between the groups in terms of VDR gene polymorphism, we think that there may be a bidirectional relationship between these diseases based on the low vitamin D levels.Namik Kemal University Scientific Research Projects Coordination Unit [NKUBAP.02, 18.188]A this study was supported by Namik Kemal University Scientific Research Projects Coordination Unit (Project Number NKUBAP.02.GA.18.188)

COVID-19 HASTALARINDA SEKONDER ENFEKSİYONLAR VE LİTERATÜRÜN GÖZDEN GEÇİRİLMESİ: ÜNİVERSİTE HASTANESİNDE YAPILAN RETROSPEKTİF BİR ÇALIŞMA

Sekonder enfeksiyonlar, COVID-19 ile hastaneye yatırılan hastalarda yüksek mortaliteye yol açan başlıca komplikasyonlar arasındadır. Bu çalışmada, COVID-19 hastalarında gelişen sekonder enfeksiyonların prevalansı, risk faktörleri, etiyolojik ajanları ve antimikrobiyal direnç paternlerinin belirlenmesi amaçlanmıştır. Çalışmaya 48 saat hastanede yattıktan sonra sekonder bakteriyel ve fungal enfeksiyon gelişen, COVID-19 PCR testi pozitif olan hastalar dahil edilmiştir. Hastaların klinik örneklerinden elde edilen bakteri ve mantar kültürlerinin sonuçları retrospektif olarak değerlendirilmiştir. Bu çalışmanın sonunda hastanede yatan 267 hastanın %16.1'inde (n=43) sekonder enfeksiyon geliştiği belirlenmiştir. Sekonder enfeksiyonlar erkeklerde (n=28, %65.1) kadınlara (n=15, %34.9) göre daha fazla saptanmıştır (p=0.024). Sekonder enfeksiyonu olan hastaların medyan yaşı (65.0 yıl) daha yüksek bulunmuştur (p<0.05). Sekonder enfeksiyonlu 43 hastanın %93'ünde (n=40) komorbidite saptanmıştır. Sekonder enfeksiyon gelişen hastaların 29'unun (%67.4) yoğun bakım ünitelerinde, 14'ünün (%32.6) servislerde tedavi gördüğü belirlenmiştir (p<0.001). Sekonder enfeksiyonların hastanede kalış süresini uzattığı (ortalama 25.5 gün) ve mortaliteyi artırdığı (n=16, %37.2) bulunmuştur (p<0.001). Etken ajan olarak tanımlanan ilk üç mikroorganizma, metisiline dirençli koagülaz negatif stafilokoklar (n=21, %16.3), Acinetobacter baumannii (n=19, %14.7) ve Candida albicans’tır (n=14, %10.9). Acinetobacter baumannii izolatlarının karbapenem direnç oranları %94.7 saptanmıştır. Koagülaz negatif stafilokokların %100'ünde metisilin direnci bulunurken vankomisin, teikoplanin ve linezolid direnci saptanmamıştır. C. albicans (%10.9) izolatlarında test edilen antifungal ajanlara karşı direnç bulunmamıştır. Sekonder enfeksiyonlar arasında özellikle pnömoni (n=25, %36.3), kan dolaşımı enfeksiyonları (n=19, %27.6) ve idrar yolu (n=18, %26.1) enfeksiyonları ilk sırada yer almıştır. COVID-19 ile ilişkili olarak gelişen sekonder enfeksiyonların ve risk faktörlerinin saptanması, etken mikroorganizmaların tanımlanması ve antimikrobiyal direnç paternlerinin belirlenmesi hastalığın prognozu, enfeksiyon kontrolü ve antimikrobiyal yönetimi açısından oldukça önemlidir

Effect of CPAP on New Endothelial Dysfunction Marker, Endocan, in People With Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is associated with increased cardiovascular (CV) morbidity and mortality. Endocan is a surrogate endothelial dysfunction marker that may be associated with CV risk factors. In this study, we tested whether serum endocan is a biomarker for OSA. Serum endocan levels were measured at baseline in 40 patients with OSA and 40 healthy controls and after 3 months of continuous positive airway pressure (CPAP) treatment in the patients with OSA. All participants were evaluated by full polysomnography. Flow-mediated dilatation (FMD) and carotid intima media thickness (cIMT) were measured in all participants. Endocan levels were significantly higher in patients with OSA than in healthy controls. After adjusting confounders, endocan was a good predictor of OSA. Endocan levels correlated with OSA severity (measured by the apnea-hypopnea index [AHI]). After 3 months of CPAP treatment, endocan levels significantly decreased. Endocan levels were significantly and independently correlated with cIMT and FMD after multiple adjustments. The cIMT and FMD also had significant and independent correlation with AHI. Endocan might be a useful marker for the predisposition of patients with OSA to premature vascular disease.NHLBI NIH HHSUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [R01 HL085188, K24 HL093218, T32 HL134632, K24 HL132105] Funding Source: Medline; NATIONAL HEART, LUNG, AND BLOOD INSTITUTEUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [R01HL085188, K24HL093218, T32HL134632, K24HL132105] Funding Source: NIH RePORTE

Bir Tümör Nekroz Faktörü-Alfainhibitörü Olan İnfliksimab'ın Sıçanlardaki Bleomisin Kaynaklı Akciğer Fibrozisi Üzerine Koruyucu Etkisi

Bir tümör nekroz faktörü (TNF) -? inhibitörü olan İnfliksimab'ın (IFX), sıçanlarda bleomisin (BLC) ile indüklenen akciğer fibrozu üzerine koruyucu etkisini araştırdık. Sıçanlar aşağıdaki gibi dört gruba ayrıldı: I-BLC grubu, intratrakeal BLC (2.5 mg / kg) verildi; II-kontrol grubu, intra-trakeal salin verildi; III-IFX + BLC grubu, tek doz IFX (7 mg / kg) intra-peritoneal (i.p.)olarak72 saat önce, intratrakeal BLC veriliminden önce uygulandı; IV-IFX grubu, IFX (7 mg / kg) tek başına i.p. olarak IFX + BLC (grup 3) grubu ile aynı gün. Bütün hayvanlar, BLC verildikten 14 sonra sakrifiye edildi. Sıçan serumunda tümör nekroz faktörü (TNF) -?, transforme edici büyüme faktörü (TGF) -?, interlökin (IL) -6, periostin, YKL-40, nitrik oksit (NO) seviyeleri yanı sıra akciğer homojenatlarında da miyeloperoksidaz, süperoksit dismutaz (SOD), katalaz (CAT), glutation peroksidaz (GPx) aktivitesi ve redükte glutatyon (GSH), hidroksiprolin, malondialdehit (MDA) içeriği ölçüldü. Akciğer dokuları, kantitatif histolojik değerlendirme için hematoksilen ve eozin ile boyandı (H & E). Akciğer dokularında indüklenebilir nitrik oksit sentaz (iNOS) ekspresyonu ve hücre apoptozu sırasıyla immünhistokimyasal boyama (INOS) ve TUNEL boyama ile kantitatif olarak belirlendi. BLC verilmesi serum TNF-?, TGF-?, IL-6, periostin, YKL-40 seviyesini artırdı, antioksidan durumunu kötüleştirdi (SOD, CAT, GPx, GSH, MPO gibi) ayrıca MDAile ölçülen lipid peroksidasyonu ve hidroksiprolin ile ölçülen kollajen depolanmasını artırdı. IFX ön-muamelesi TNF-?, TGF-?, IL-6, periostin, YKL-40, lipid peroksidasyonu ve kollajen depozisyonunu düşürürken, antioksidan durumunu ve BLC'nin indüklediği akciğer patolojik değişikliklerini düzeltti. Son olarak, histolojik, immünohistokimyasal ve TUNNEL boyoma, IFX'in BLC'ye bağlı akciğer fibrozunu 7 önlediğini destekledi. Bu çalışmanın sonuçları, IFX ön-muamelesinin BLC ile uyarılan pulmoner fibrozu hafifletebildiğini göstermektedir.We aimed to investigate the preventive effect of Infliximab (IFX), a tumor necrosis factor (TNF)-? inhibitor, on bleomycin (BLC)-induced lung fibrosis in rats. Rats were assigned into four gr- oups as follows: I—BLC group, a single intra-tracheal BLC (2.5 mg/kg) was installed; II—control group, a single intra-tracheal saline was installed; III—IFX+BLC group, a single-dose IFX (7 mg/kg) was administered intraperitoneally (i.p.), 72 h before the intra-tracheal BLC installation; IV—IFX group, IFX (7 mg/kg) was administered alone i.p. on the same day with IFX+BLC (group 3) group. All animals were sacrificed on the 14th day of BLC installation. Levels of tumor necrosis factor (TNF)-?, transforming growth factor (TGF)-?, interleukin (IL)-6, periostin, YKL-40, nitric oxide (NO) in rat serum were measured, as well as, myeloperoxidase (MPO), superoxide dismutase (SOD), catalase (CAT), glutathi-one peroxidase (GPx) activity, and reduced glutathione (GSH), hydroxyproline, malondialdehyde (MDA) content in lung homogenates. Lung tissues were stained with hematoxylin and eosin (H&E) for quantitative histological evaluation. The inducible nitric oxide synthase (iNOS) expression and cell apoptosis in the lung tissues were determined quantitatively by immunohistochemical staining (INOS) and by TUNNEL staining, respectively. BLC installation worsened antioxidant status (such as SOD, CAT, GPx, GSH, MPO), while it increased the serum TNF-?, TGF-?, IL-6, periostin, YKL-40, and lipid peroxidation, and collagen deposition, measured by MDA and hydroxyproline, respectively. IFX pretreatment improved antioxidant status as well as BLC-induced lung pathological changes, while it decreased the TNF-?, TGF-?, IL-6, periostin, YKL-40, lipid peroxidation and collagen deposition. Finally, histological, immunohistochemical, and TUNNEL evidence also supported the ability of IFX to 5 prevent BLC-induced lung fibrosis. The results of the present study indicate that IFX pretreatment can attenuate BLC-induced pulmonary fibrosis

Infliximab, an anti-tumor necrosis factor-alpha attenuates bleomyc-ininduced pulmonary fibrosis in rats

[No Abstract Available

Clinical Feasibility of an Auto-Adjusting Bi-Level PAP Device for the Treatment of Obstructive Sleep Apnea

Introduction: Bi-Level positive airway pressure (BPAP) is an effective alternative to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) who could not tolerate CPAP. An automatically titrating BPAP device has recently been developed, BPAP Auto® with BiFlex™ (BPAPauto). The primary aim of this study was to examine the performance of this new device during attended polysomnography (PSG). Materials and Methods: This was a prospective case series study. Participants with OSA currently using CPAP or BPAP therapy were recruited and undergo in-lab PSG study with BPAPauto. Results: A total of 27 participants met the criteria, enrolled the study. All participants received BPAPauto therapy during an attended PSG. Sleep and respiratory data were examined. The mean apnea hypopnea index was found 2.2±2.5 events/hour. SaO2 (oxygen saturation) was 94.0%±1.8. The mean inspiratory positive airway pressure (IPAP) abolish respiratory events was 14.1±3.4 cmH2O and that of expiratory positive airway pressure (EPAP) was 10.7±3.9 cmH2O. Conclusions: BPAPauto is able to establish an appropriate Bi-Level PAP and control oxygen saturation without excessive disruption of sleep. Further studies using randomized control design are needed to examine potential roles and advantages of BPAPauto for treatment of OSA