Clinical significance of nuclear factor erythroid 2-related factor 2 in patients with chronic obstructive pulmonary disease

BACKGROUND/AIMS: Several studies have identified a role for nuclear factor erythroid 2-related factor 2 (Nrf2) in the development of chronic obstructive pulmonary disease (COPD). However, the relationship between the plasma Nrf2 level and the extent of systemic inflammation associated with COPD status remains unclear. METHODS: Patients diagnosed with COPD were recruited from St. Paul’s Hospital, The Catholic University of Korea, between July 2009 and May 2012. Patients were classified into two groups according to the severity of their symptoms on initial presentation, a COPD-stable group (n = 25) and a COPD-exacerbation group (n = 30). Seventeen patients were enrolled as a control group (n = 17). The plasma levels of Nrf2 and other systemic inf lammatory biomarkers, including interleukin 6 (IL-6), surfactant protein D (SP-D), and C-reactive protein (CRP), were measured. We collected clinical data including pulmonary function test results, and analyzed the relationships between the biomarker levels and the clinical parameters. RESULTS: Plasma Nrf2 and CRP levels significantly increased in a stepwise manner with an increase in inflammatory status (control vs. COPD-stable vs. COPD-exacerbation) (p = 0.002, p < 0.001). Other biomarkers of systemic inflammation (IL-6, SP-D) exhibited similar tendencies, but significant differences were not apparent. Furthermore, we observed negative correlations between the plasma level of Nrf2 and both the forced expiratory volume in 1 second (FEV1) (r = –0.339, p = 0.015) and the forced expiratory ratio (FEV1/forced vital capacity [FVC]) (r = –0.342, p = 0.014). However, CRP level was not correlated with any measured parameter. CONCLUSIONS: Plasma Nrf2 levels gradually increased in line with disease severity and the extent of systemic inflammation in patients with COPD.

The Authors Reply: Should Very Old Patients Be Admitted to the Intensive Care Units? / 대한중환자의학회지

No abstract available.

Factors Related to the Diagnostic Yield of Flexible Bronchoscopy without Guidance in Bronchoscopically Invisible Peripheral Lung Lesions / 결핵및호흡기질환

BACKGROUND: We aimed to analyze the factors predicting the diagnostic performance of flexible bronchoscopy without guidance in peripheral lung lesions that are endoscopically invisible. METHODS: This was a retrospective study conducted in St. Paul's Hospital, The Catholic University of Korea, between January 2007 and March 2013. We included all patients who received bronchoscopy during this period. The analyzed variables were age, sex, the etiology of the lesion, lesion size, distance from the pleura, and presence of the bronchus sign. We used multiple logistic regression analysis to identify the significant independent factors associated with diagnostic yield. RESULTS: We included 151 patients in this study. The overall diagnostic yield was 58.3%. The sensitivity was 43.2% for malignant disease and 78.1% for benign disease. The benign lung lesions (p<0.001), lesion size (p=0.015), presence of the exposed type of bronchus sign (p<0.001), and presence of cavitary lung lesions (p=0.005) were factors influencing the yield of flexible bronchoscopy by univariate analysis. In a multivariate logistic regression analysis, the exposed type of bronchus sign and benign lung lesions were independent predicting factors (odds ratio [OR]: 27.95; 95% confidence interval [CI], 7.56–103.32; p<0.001 and OR, 4.91; 95% CI, 1.76–13.72; p=0.002). CONCLUSION: The presence of the exposed type of bronchus sign and benign lung lesions are determining factors of the diagnostic yield in flexible bronchoscopy in evaluating peripheral lesions that are not endoscopically visible.

Demographic Changes in Intensive Care Units in Korea over the Last Decade and Outcomes of Elderly Patients: A Single-Center Retrospective Study / 대한중환자의학회지

BACKGROUND: Aging is a significant issue worldwide, and Korea is one of the most rapidly aging countries. Along with the demographic transition, the age structure of intensive care unit (ICU) patients changes as well. METHODS: The aim of this study was to analyze the change in age distribution of the ICU patients over the last 10 years and its effect on clinical outcomes. Single-center, retrospective analysis of all patients aged ≥18 years admitted to either the medical or surgical ICU at St. Paul's Hospital, The Catholic University of Korea, between January 2005 and December 2014 was conducted. For clinical outcome, in-hospital mortality, duration of ICU stay, and hospital stay were analyzed. Cost analysis was performed to show the economic burden of each age strata. RESULTS: A total of 10,366 ICU patients were admitted to the chosen ICUs during the study period. The proportion of elderly patients aged ≥65 years increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of the very elderly patients aged ≥80 years increased from 12.8% to 20.7%. However, this increased proportion of elderly patients did not lead to increased in-hospital mortality. The percent of ICU treatment days attributable to elderly patients increased from 51.1% in year 2005 to 64.0% in 2014. The elderly ICU patients were associated with higher in-hospital mortality compared to younger age groups. CONCLUSIONS: The proportion of elderly patients admitted to ICUs increased over the last decade. However, overall in-hospital mortality has not increased during the same period.

The Authors Reply: Should Very Old Patients Be Admitted to the Intensive Care Units? / 대한구급학회지

No abstract available.

Demographic Changes in Intensive Care Units in Korea over the Last Decade and Outcomes of Elderly Patients: A Single-Center Retrospective Study / 대한구급학회지

BACKGROUND: Aging is a significant issue worldwide, and Korea is one of the most rapidly aging countries. Along with the demographic transition, the age structure of intensive care unit (ICU) patients changes as well. METHODS: The aim of this study was to analyze the change in age distribution of the ICU patients over the last 10 years and its effect on clinical outcomes. Single-center, retrospective analysis of all patients aged ≥18 years admitted to either the medical or surgical ICU at St. Paul's Hospital, The Catholic University of Korea, between January 2005 and December 2014 was conducted. For clinical outcome, in-hospital mortality, duration of ICU stay, and hospital stay were analyzed. Cost analysis was performed to show the economic burden of each age strata. RESULTS: A total of 10,366 ICU patients were admitted to the chosen ICUs during the study period. The proportion of elderly patients aged ≥65 years increased from 47.9% in 2005 to 63.7% in 2014, and the proportion of the very elderly patients aged ≥80 years increased from 12.8% to 20.7%. However, this increased proportion of elderly patients did not lead to increased in-hospital mortality. The percent of ICU treatment days attributable to elderly patients increased from 51.1% in year 2005 to 64.0% in 2014. The elderly ICU patients were associated with higher in-hospital mortality compared to younger age groups. CONCLUSIONS: The proportion of elderly patients admitted to ICUs increased over the last decade. However, overall in-hospital mortality has not increased during the same period.

Risk Factor and Clinical Outcome of Bronchiolitis Obliterans Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation

PURPOSE: The development of bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (HSCT) deteriorates patients' quality of life. This study aimed to analyze the prevalence, clinical features, risk factors and prognostic factors of BOS. MATERIALS AND METHODS: This retrospective study included patients who underwent allogeneic HSCT from January 2002 to December 2008 and survived for > or =100 days after transplantation. RESULTS: Of 860 patients who survived for > or =100 days, 36 (4.2%) met the diagnostic criteria. The duration of BOS development after transplantation was 466.00 (284.00-642.75) [median (interquartile range)] days. The risk factor for the development of BOS was peripheral blood as the stem cell source with a hazard ratio (HR) of 2.550 [95% confidence interval (CI): 1.274-5.104, p=0.008]. In multivariate analysis, pretransplant FEV1/FVC (HR: 0.956, 95% CI: 0.921-0.993, p=0.020) and time from HSCT to diagnosis of BOS (HR: 0.997, 95% CI: 0.994-0.999, p=0.009) were independent prognostic factors associated with mortality. CONCLUSION: Peripheral blood as a stem cell source is a risk factor for the development of BOS. A decreased pretransplant FEV1/FVC and shorter duration of time from transplantation to diagnosis of BOS are poor prognostic factors for BOS.

Dyspnea as a Prognostic Factor in Patients with Non-Small Cell Lung Cancer

PURPOSE: To investigate associations between dyspnea and clinical outcomes in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: From 2001 to 2014, we retrospectively reviewed the prospective lung cancer database of St. Paul's Hospital at the Catholic University of Korea. We enrolled patients with NSCLC and evaluated symptoms of dyspnea using modified Medical Research Council (mMRC) scores. Also, we estimated pulmonary functions and analyzed survival data. RESULTS: In total, 457 NSCLC patients were enrolled, and 259 (56.7%) had dyspnea. Among those with dyspnea and whose mMRC scores were available (109 patients had no mMRC score), 85 (56.6%) patients had an mMRC score <2, while 65 (43.3%) had an mMRC score ≥2. Significant decreased pulmonary functions were observed in patients with dyspnea. In multivariate analysis, aging, poor performance status, advanced stage, low forced expiratory volume in 1 second (%), and an mMRC score ≥2 were found to be significant prognostic factors for patient survival. CONCLUSION: Dyspnea could be a significant prognostic factor in patients with NSCLC.

Efficacy of Team-Based Financial Incentives for Smoking Cessation in the Workplace

Worksite smoking cessation programs offer accessibility of the target population, availability of occupational health support, and the potential for peer pressure and peer support. The purpose of this study was to identify the efficacy of the financial incentives given to various teams in the workplace. St. Paul's Hospital's employees were enrolled. Each team of employees consisted of smoking participants and non-smoking fellow workers from the same department. The financial incentive of 50000 won (about $45) was rewarded to the team for each successful participant-not to individual members-after the first week and then after one month. If the smokers in the team remained abstinent for a longer time period, the team was given an incentive of 100000 won for each successful participant after 3 and 6 months. A total 28 smoking participants and 6 teams were enrolled. Self-reported abstinence rates validated by urinary cotinine test at 3, 6, and 12 months after the initial cessation were 61%, 54%, and 50%, respectively. Smokers with high nicotine dependence scores or those who began participation 1 month after enrollment initiation had a lower abstinence rate at 3 months, but not at 6 and 12 months. Participants who succeeded at smoking cessation at 12 months were more likely to be older and have a longer smoking duration history. The financial incentives given to teams could be promising and effective to improve long-term rates of smoking cessation. This approach could use peer pressure and peer support in the workplace over a longer period.

Takotsubo Cardiomyopathy Caused by Pulmonary Tuberculosis: A Case Report / 결핵및호흡기질환

Takotsubo cardiomyopathy (TTC) is defined as a reversible, acute ventricular dysfunction without any evidence of coronary artery obstruction. There have been reports of TTC caused by emotional or physical stress, drug use, hormone imbalance, or medical conditions such as pulmonary disease, sepsis, and trauma, but a relationship between TTC and pulmonary tuberculosis has not previously been reported. From our knowledge, this is the first report of TTC caused by pulmonary tuberculosis.

Takotsubo Cardiomyopathy Caused by Pulmonary Tuberculosis: A Case Report / 결핵및호흡기질환

Takotsubo cardiomyopathy (TTC) is defined as a reversible, acute ventricular dysfunction without any evidence of coronary artery obstruction. There have been reports of TTC caused by emotional or physical stress, drug use, hormone imbalance, or medical conditions such as pulmonary disease, sepsis, and trauma, but a relationship between TTC and pulmonary tuberculosis has not previously been reported. From our knowledge, this is the first report of TTC caused by pulmonary tuberculosis.

Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis / 대한구급학회지

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.

Endobronchial Relapse of Acute Myeloid Leukemia after Allogeneic Stem Cell Transplantation / 대한내과학회지

Myeloid sarcoma is an uncommon extramedullary tumor of immature myeloid cells or myeloblasts. It may occur alone or concurrently with an underlying hematological malignancy. Although it can develop anywhere in the body, common sites include bones, particularly the skull and vertebra, soft tissues, and lymph nodes. However, there have been few reports of myeloid sarcoma occurring in the respiratory system, especially the large airways. We describe a case of endobronchial relapse of acute myeloid leukemia in a patient who achieved complete remission after allogeneic stem cell transplantation. To our knowledge, this is the first such report in Korea.

A Case of Choledochoduodenal Fistula as a Delayed Complication after Biliary Metallic Stent Placement in Distal Cholangiocarcinoma / 대한소화기학회지

Biliary drainage in patients with malignant biliary obstruction relieves jaundice and prevents the development of cholangitis or hepatic failure from biliary obstruction. Therefore, this may result in better quality of life along with survival prolongation. Biliary stent placement is an effective and safe measure for biliary decompression and is preferred than bypass surgery in high risk patients. Entero-biliary perforation-communication is one of the rare complications of biliary stent. We herein report a case of duodeno-biliary perforation-communication in patient with distal cholangiocarcinoma who presented with duodenal ulcer and obstruction, occurring 4 years later from the metallic biliary stent insertion. Patient was managed with a pyloric metal stent and conservative care.

A Case of Patent Ductus Arteriosus Associated with Pulmonary Valve Endocarditis

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.

A Case of Patent Ductus Arteriosus Associated with Pulmonary Valve Endocarditis

Isolated infective endocarditis in the native pulmonary valve is unusual in non-intravenous drug user. Intravenous drug abuse, alcoholism, sepsis, catheter related infections and congenital heart diseases account for the majority of predisposing factors. We report a case of patent ductus arteriosus complicating infective endocarditis involving pulmonary valve. A 24-year-old female was admitted with fever of unknown origin Physical examination revealed continuous murmur at left 2nd intercostals space. Transthoracic and transesophageal echocardiography was performed and patent ductus arteriosus and vegetation at the pulmonary valve were noted. Chest CT scan revealed multiple patch infiltrate suggestive of septic emboli. After 4 weeks of antibiotic treatment, she had no clinical signs of fever, and blood culture be negative. Percutaneous trans-catheter closure of patent ductus arteriosus was done after 2 months.