Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in the Pleural Fluid.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be detected via a nasopharyngeal swab and in sputum, blood, urine, and feces. However, there is only limited data on the real-time reverse transcriptase polymerase chain reaction (RT-PCR) results of coronavirus disease 2019 (COVID-19) patients with pleural fluid. We report a case of COVID-19 with SARS-CoV-2 detected in both sputum and pleural fluid. A 68-year-old male patient came to the hospital with a chief complaint of dyspnea. He was diagnosed with lung cancer. A biopsy was performed, and a pneumothorax was found. As a result, a chest tube was placed into the right pleural space. During his hospital stay, the patient was confirmed as COVID-19 positive. We identified the presence of SARS-CoV-2 through real-time RT-PCR assay from the pleural fluid. Although pleural effusion is an uncommon finding in the COVID-19, care should be taken to avoid exposure when handling the pleural fluid sample.

Occupational values of nurses who succeeded their mothers in nursing.

AIMS: To investigate how nurses who succeeded their mothers in the occupation are affected by their mothers and to explore how such nurses value their occupation. BACKGROUND: Although children who succeed their parents in an occupation have shown high job satisfaction and persistence, no study has presented this phenomenon in nursing perspectives. DESIGN: A qualitative study using interpretative phenomenological analysis. METHODS: Data were collected from July 2016-September 2017 through in-depth interviews with seven mother-daughter nurse dyads. Data were analysed using dyadic analysis and interpretative phenomenological analysis. RESULTS: Three essential themes were derived: having affection for nursing per se; regarding the person per se as the primary value in nursing, instead of the person as a patient; and making a resolution to become a good nurse to follow their mothers' footsteps. Person-centred nursing was the core occupational value of nurses who succeeded their mothers in nursing. CONCLUSION: Although daughters felt burdened by following their mothers into the nursing profession, they had a sense of responsibility to fulfill their duties in nursing and indicated that maintaining a balance between being responsible and feeling burdened was more important than anything else. IMPACT: The present study can serve as a useful educational material for understanding the consequences of the succession of parents' occupation in the perspective of nursing. It illustrates how nurses who succeed their mothers in the profession are influenced by their mothers to value person-centred nursing and subsequently their rapid clinical adaptation.

A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy.

Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supraclavicular lymph node core needle biopsy. We treated him with fluconazole at 400 mg/day for 9 months according to the guideline. This is the first case that cryptococcal pneumonia was diagnosed from a percutaneous lymph node biopsy in South Korea.

The start of chemotherapy until the end of radiotherapy in patients with limited-stage small cell lung cancer.

BACKGROUND/AIMS: Chemotherapy combined with radiation therapy is the standard treatment for limited stage small cell lung cancer (LS-SCLC). Although numerous studies indicate that the overall duration of chemoradiotherapy is the most relevant predictor of outcome, the optimal chemotherapy and radiation schedule for LS-SCLC remains controversial. Therefore we analyzed the time from the start of any treatment until the end of radiotherapy (SER) in patients with LS-SCLC. METHODS: We retrospectively analyzed 29 patients diagnosed histologically with LS-SCLC and divided them into two groups: a short SER group (< 60 days) and a long SER (> 60 days) group. Patients were treated with irinotecan-based chemotherapy and thoracic radiotherapy. RESULTS: Sixteen patients were in the short SER group and 13 patients were in the long SER group. Short SER significantly prolonged survival rate (p = 0.03) compared with that of long SER. However, no significant differences in side effects were observed. CONCLUSIONS: Short SER should be considered to improve the outcome of concurrent chemoradiotherapy for LS-SCLC.

The immune tolerance of cancer is mediated by IDO that is inhibited by COX-2 inhibitors through regulatory T cells.

Prostaglandin (PGE2), synthesized by cyclooxygenase-2 (COX-2), is associated with cellular immune tolerance during the process of cancer development. Induction of tolerance requires a specific environment in which dendritic cells and regulatory T cells (Tregs) play an essential role. It was recently shown that maturation of dendritic cells in the presence of indoleamine 2, 3-dioxygenase (IDO) results in activation of Tregs, and inhibition of COX-2 activity regulated IDO expression within the tumor microenvironment. Thus, we hypothesized that the tumor immune tolerance would be inhibited by COX-2 inhibitor and this inhibition would be mediated by IDO-dependent Tregs inhibition. The PGE2 in Lewis lung cancer cells (3LL) and serum of mice were measured for the evaluation of COX-2 inhibitors' local and systemic effects. The production of PGE2 in 3LL cells and serum of 3LL tumor-bearing mice were decreased by COX-2 inhibition. However, there were no significant differences in serum PGE2 levels among normal control and celecoxib-treated nontumor-bearing mice. The accumulation of Tregs was reduced in the celecoxib-treated 3LL tumor-bearing mice. In addition, the expressions of COX-2, IDO, and Foxp3 were reduced in the mice treated with a COX-2 inhibitor, and this was found to correlate with a reduction in the size of tumor mass and metastasis. These results suggest that the antitumor effects of COX-2 inhibitors seemed to be correlated with the inhibition of IDO and Tregs. Therefore, COX-2 inhibitors might provide a therapeutic strategy for Tregs-induced tumor immune tolerance.

Potential use of an anticancer drug gefinitib, an EGFR inhibitor, on allergic airway inflammation.

The EGFR plays an essential role in goblet cell hyperplasia and mucus hypersecretion. EGFR has an intrinsic tyrosine kinase activity that, when activated, induces the production of MUC5AC through the signaling kinase cascade in the airway epithelium. We have investigated the effects of an EGFR tyrosine kinase inhibitor, gefitinib, on ovalbumin (OVA)-induced, allergic inflammation in airway epithelia of mice. OVA-sensitized mice were pretreated with gefitinib at two different doses (12.5 and 50 mg/kg) and then challenged with OVA. The OVA challenge increased the total cell count and eosinophil count in bronchoalveolar lavage fluid (BALF), as well as the concentrations of T-helper2 (Th2) cytokines, such as IL-4 and IL-13, overall eosinophil recruitment in the lung tissue and airway hyperresponsiveness (AHR). Pretreatment with gefitinib reduced the inflammatory cell counts and released cytokine concentrations (IL-4 and IL-13) in BALF, as well as eosinophil recruitment in the lungs and AHR, in a dose-dependent manner. This was associated with decreased EGFR and Akt phosphorylation. We showed that gefinitib inhibits EGFR and phosphoinositol 3'-kinase (PI3K)/Akt activation which were activated in OVA sensitized mice. These findings suggest that inhibitors of the EGFR cascade may have a role in the treatment of asthma.