Lung Volume Reduction Surgery in Patients with Heterogenous Emphysema: Selecting Perspective

BACKGROUND: Lung volume reduction surgery (LVRS) was introduced to alleviate clinical conditions in selected patients with heterogenous emphysema. Clarifying the most suitable patients for LVRS remained unclear. AIM: This study was undertaken to specifically analyze the preoperative factor affecting to LVRS. METHODS: The prospective study was conducted at 103 Military Hospital between July 2014 and April 2016. Severe heterogenous emphysema patients were selected to participate in the study. The information, spirometry, and body plethysmographic pulmonary function tests in 31 patients who underwent LVRS were compared with postoperative outcomes (changing in FEV1 and CAT scale). RESULTS: Of the 31 patients, there was statistically significant difference in the outcome of functional capacity, lung function between two groups (FEV1 ≤ 50% and > 50%) (∆FEV1: 22.46 vs 18.32%; p = 0.042. ∆CAT: 6.85 vs 5.07; p = 0.048). Changes of the FEV1 and CAT scale were no statistically significant differences in three groups residual volume. Patients with total lung capacity < 140% had more improved than others (∆FEV1: 23.81 vs 15.1%; p = 0.031). CONCLUSION: Preoperative spirometry and body plethysmographic pulmonary function tests were useful measures to selected severe heterogenous emphysema patients for LVRS. Patients with FEV1 ≤ 50%, TLC in the range of 100-140% should be selected

Higher tacrolimus trough levels and time in the therapeutic range are associated with the risk of acute rejection in the first month after renal transplantation

Abstract Background Tacrolimus trough levels (C0) are used in most transplant centres for therapeutic drug monitoring (TDM) of tacrolimus (Tac). The target range of Tac C0 has been remarkably changed, with a target as low as 3–7 ng/ml in the 2009 European consensus conference and a target of 4–12 ng/ml (preferably to 7–12 ng/ml) following the second consensus report in 2019. Our aim was to investigate whether reaching early Tac therapeutic targets and maintaining time in the therapeutic range (TTR) according to the new recommendations may be necessary for preventing acute rejection (AR) during the first month after transplantation. Methods A retrospective study including 160 adult renal transplant patients (113 men and 47 women) with a median age of 36.3 (20–44) years was conducted between January 2018 and December 2019 at 103 Military Hospital (Vietnam). Tac trough levels were recorded in the first month, and episodes of AR were confirmed by kidney biopsy. Tac TTR was calculated as the percentage of time within the target range of 7–12 ng/ml, according to the 2019 second consensus report. Multivariate Cox analysis was performed to identify the correlation between the Tac target range and TTR with AR. Results In the first month after RT, 14 (8.8%) patients experienced AR. There was a significant difference in the incidence of AR between the Tac level groups of  7 ng/ml (p = 0.0096). In the multivariate Cox analysis, after adjusting for related factors, a mean Tac level > 7 ng/ml was associated with an 86% decreased risk of AR compared with that of 4–7 ng/ml in the first month (HR, 0.14; 95% CI, 0.03–0.66; p = 0.0131). Every 10% increase in TTR was associated with a 28% lower risk of AR (HR, 0.72; 95% CI, 0.55–0.94; p = 0.014). Conclusion Gaining and maintaining Tac C0 according to the 2019 second consensus report might reduce the risk of AR in the first month following transplantation

Relationship between serum TNF-α, IL-6, and IL- 10 levels and disease severity, and changes in the cytokines after treatment in patients with bacterial community-acquired pneumonia

Introduction The role of some cytokines, such as interleukin (IL) and tumor necrosis factor-α (TNF-α), in serum in community-acquired pneumonia (CAP) has been mentioned. There are few results on changes in serum cytokines in patients with bacterial CAP. This study aimed at the relationship between serum TNF-α, IL-6, and IL-10 levels, disease severity, and changes in serum cytokines in patients with bacterial CAP. Methods A descriptive follow-up study was conducted on 78 hospitalized patients with CAP. Serum IL-6, IL-10, and TNF-α levels were measured by fluorescence covalent microbead immunosorbent assay technique. Changes in serum cytokine levels were measured on admission’s first and seventh day. Results TNF-α, IL-6, and IL-10 medians were 0.76, 2.15, and 1.18 pg/ mL, respectively. There was no difference in interleukin levels between the two groups, namely those aged 0.05). The levels of IL-10 in patients with Gram-positive bacteria pneumonia were significantly higher than those with Gram-negative bacteria (2.23 pg/mL vs 1.15 pg/mL, respectively, p=0.03). Logistic regression analysis revealed that IL-10 (OR=0.92; 95% CI: 0.86–0.99, p=0.03) was associated with the prognosis of disease severity. IL-6 levels decreased statistically on day 7 after treatment (1.12 pg/mL vs 2.15 pg/mL, p=0.003). The change in TNF-α and IL-10 after treatment was not significant (p>0.05). Conclusions Serum IL-10 levels during hospitalization time are related to the prognosis of disease severity. After 7 days of treatment, IL-6 levels decreased statistically; however, TNF-α and IL-10 levels did not change