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대한결핵 및 호흡기학회> Tuberculosis and Respiratory Diseases> Comparison of Clinical and Radiologic Characteristics between Anthracofibrosis and Endobronchial Lung Cancer

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Comparison of Clinical and Radiologic Characteristics between Anthracofibrosis and Endobronchial Lung Cancer

Seo Young Yun , Tae Yun Park
  • : 대한결핵 및 호흡기학회
  • : Tuberculosis and Respiratory Diseases 84권3호
  • : 연속간행물
  • : 2021년 07월
  • : 209-216(8pages)
Tuberculosis and Respiratory Diseases

DOI


목차

Introduction
Materials and Methods
Results
Discussion
Authors’ Contributions
Conflicts of Interest
Funding
References

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Background: Endobronchial lung cancer (EBLC) and bronchial anthracofibrosis (BAF) share similar symptoms and radiological findings. The aim of this study was to describe clinical and radiological differences between BAF and EBLC, both of which were confirmed by bronchoscopy.
Methods: This was a retrospective study of patients with BAF or EBLC from 2008 to 2014. Data were derived from a bronchoscopy registry made since January 1, 2008. Clinical and radiological characteristics of both diseases were analyzed.
Results: Among 3,214 patients who underwent bronchoscopy, 167 and 117 patients were enrolled in BAF and EBLC groups, respectively. BAF occurred more predominantly in older non-smoking female patients with a higher chance of tuberculosis (38.3%) than EBLC (6.0%). Cough, sputum, and dyspnea were common symptoms reported for both groups. Bronchoscopic findings revealed that BAF lesions were more common in multiple lobar bronchi (85.0%) or bilateral bronchi (73.7%). Radiologic findings revealed that bronchial stenosis was the most commonly found lesion in both groups (49.1% and 78.6%, respectively). Rates of peribronchial calcification and bronchial wall thickening were higher in the BAF group. The number of patients with lymph node calcification was also higher in the BAF group.
Conclusion: Results of this study demonstrated characteristics of clinical and radiologic findings of BAF and EBLC. Increasing the awareness of both diseases may help clinicians differentiate these two diseases from each other, thus avoiding unnecessary invasive diagnostic procedures.

UCI(KEPA)

I410-ECN-0102-2022-500-000684632

간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 계간
  • : 1738-3536
  • : 2005-6184
  • : 학술지
  • : 연속간행물
  • : 1954-2022
  • : 5055


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1Status of Studies Investigating Asthma- Chronic Obstructive Pulmonary Disease Overlap in Korea: A Review

저자 : Yong Suk Jo

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 101-110 (10 pages)

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There is a considerable number of individuals who exhibit features of both asthma and chronic obstructive pulmonary disease (COPD), defined as asthma-COPD overlap (ACO). Many studies have reported that these patients have a greater burden of symptoms, including cough and dyspnea, and experience more exacerbations and hospitalizations than those with non-ACO COPD or asthma. Although diagnostic criteria for ACO have not yet been clearly established, their clinical significance remains to be determined. As interest in ACO grows, related studies have been conducted in South Korea as well. The present review summarizes ACO-related studies in South Korea to better understand Korean ACO patients and guide further research. Several cohort studies of asthma and COPD and population-based studies for ACO were reviewed and the key results from demographics, clinical features, lung function, biomarkers, treatment, and prognosis were summarized.

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2Concise Clinical Review of Hematologic Toxicity of Linezolid in Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis: Role of Mitochondria

저자 : Amaylia Oehadian , Prayudi Santoso , Dick Menzies , Rovina Ruslami

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 111-121 (11 pages)

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Multidrug-resistant tuberculosis (MDR-TB) is caused by an organism that is resistant to both rifampicin and isoniazid. Extensively drug-resistant TB, a rare type of MDR-TB, is caused by an organism that is resistant to quinolone and one of group A TB drugs (i.e., linezolid and bedaquiline). In 2018, the World Health Organization revised the groupings of TB medicines and reclassified linezolid as a group A drug for the treatment of MDR-TB. Linezolid is a synthetic antimicrobial agent in the oxazolidinone class. Although linezolid has a good efficacy, it can cause substantial adverse events, especially hematologic toxicity. In both TB infection and linezolid mechanism of action, mitochondrial dysfunction plays an important role. In this concise review, characteristics of linezolid as an anti-TB drug are summarized, including its efficacy, pathogenesis of hematologic toxicity highlighting mitochondrial dysfunction, and the monitoring and management of hematologic toxicity.

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3Chronic Obstructive Pulmonary Disease Combined with Interstitial Lung Disease

저자 : Joon Young Choi , Jin Woo Song , Chin Kook Rhee

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 122-136 (15 pages)

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Although chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have distinct clinical features, both diseases may coexist in a patient because they share similar risk factors such as smoking, male sex, and old age. Patients with both emphysema in upper lung fields and diffuse ILD are diagnosed with combined pulmonary fibrosis and emphysema (CPFE), which causes substantial clinical deterioration. Patients with CPFE have higher mortality compared with patients who have COPD alone, but results have been inconclusive compared with patients who have idiopathic pulmonary fibrosis (IPF). Poor prognostic factors for CPFE include exacerbation, lung cancer, and pulmonary hypertension. The presence of interstitial lung abnormalities, which may be an early or mild form of ILD, is notable among patients with COPD, and is associated with poor prognosis. Various theories have been proposed regarding the pathophysiology of CPFE. Biomarker analyses have implied that this pathophysiology may be more closely associated with IPF development, rather than COPD or emphysema. Patients with CPFE should be advised to quit smoking and undergo routine lung function tests, and pulmonary rehabilitation may be helpful. Various pharmacologic agents and surgical approaches may be beneficial in patients with CPFE, but further studies are needed.

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4Effects of Farinelli Breating Exercise on Respiratory Function and Symptoms in Patients with Chronic Obstructive Pulmonary Disease

저자 : Supawit Ittinirundorn , Naiyana Wongsaita , Dujrath Somboonviboon , Wannaporn Tongtako

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 137-146 (10 pages)

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Background: Farinelli breathing (FB) exercise is a typical breathing exercise used by singers. This study aimed to compare effects of FB exercise and diaphragmatic breathing (DB) exercise on respiratory function and symptoms in patients with chronic obstructive pulmonary disease (COPD).
Methods: Sixteen patients aged 51-80 years with mild or moderate COPD were recruited for this study. They were divided into two groups: DB group (n=8) and FB group (n=8). Both groups received complete breathing exercise training five times per week for 8 weeks. Their respiratory functions, COPD symptoms, cytokine levels, and oxidative stress variables were analyzed during pre- and post-tests. Dependent variables were compared between pre- and posttests using paired t-tests. An independent t-test was used to compare variables between the groups. Differences were considered significant at p<0.05.
Results: The maximal expiratory pressure (MEP), maximum oxygen consumption (VO2max), and COPD Assessment Test (CAT) scores changed significantly in the DB group after the 8-week intervention compared to those at pre-test, whereas force vital capacity, forced expiratory volume in the first second, maximum voluntary ventilation, maximal inspiratory pressure (MIP), MEP, VO2max, CAT score, tumor necrosis factor-α, and malondialdehyde level changed significantly in the FB group at post-test compared to those at pre-test. Moreover, both MIP and MEP in the FB group were significantly higher than those in the DB group.
Conclusion: FB exercise improved respiratory functions and COPD symptoms of patients with COPD. It might be an alternative breathing exercise in pulmonary rehabilitation programs for patients with COPD.

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5Afatinib Mediates Autophagic Degradation of ORAI1, STIM1, and SERCA2, Which Inhibits Proliferation of Non-Small Cell Lung Cancer Cells

저자 : Mi Seong Kim , So Hui Kim , Sei-hoon Yang , Min Seuk Kim

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 147-154 (8 pages)

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Background: The expression of calcium signaling pathway molecules is altered in various carcinomas, which are related to the proliferation and altered characteristics of cancer cells. However, changes in calcium signaling in anti-cancer drugresistant cells (bearing a T790M mutation in epidermal growth factor receptor [EGFR ]) remain unclear.
Methods: Afatinib-mediated changes in the level of store-operated Ca2+ entry (SOCE)-related proteins and intracellular Ca2+ level in non-small cell lung cancer cells with T790M mutation in the EGFR gene were analyzed using western blot and ratiometric assays, respectively. Afatinib-mediated autophagic flux was evaluated by measuring the cleavage of LC3B-II. Flow cytometry and cell proliferation assays were conducted to assess cell apoptosis and proliferation.
Results: The levels of SOCE-mediating proteins (ORAI calcium release-activated calcium modulator 1 [ORAI1], stromal interaction molecule 1 [STIM1], and sarco/endoplasmic reticulum Ca2+ ATPase [SERCA2]) decreased after afatinib treatment in non-small cell lung cancer cells, whereas the levels of SOCE-related proteins did not change in gefitinibresistant non-small cell lung cancer cells (PC-9/GR; bearing a T790M mutation in EGFR ). Notably, the expression level of SOCE-related proteins in PC-9/GR cells was reduced also responding to afatinib in the absence of extracellular Ca2+. Moreover, extracellular Ca2+ influx through the SOCE was significantly reduced in PC-9 cells pre-treated with afatinib than in the control group. Additionally, afatinib was found to decrease the level of SOCE-related proteins through autophagic degradation, and the proliferation of PC-9GR cells was significantly inhibited by a lack of extracellular Ca2+.
Conclusion: Extracellular Ca2+ plays important role in afatinib-mediated autophagic degradation of SOCE-related proteins in cells with T790M mutation in the EGFR gene and extracellular Ca2+ is essential for determining anti-cancer drug efficacy.

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6Pretreatment Neutrophil-to-Lymphocyte Ratio and Smoking History as Prognostic Factors in Advanced Non-Small Cell Lung Cancer Patients Treated with Osimertinib

저자 : Ji Young Park , Seung Hun Jang , Chang Youl Lee , Taehee Kim , Soo Jie Chung , Ye Jin Lee , Hwan Il Kim , Joo-hee Kim , Sunghoon Park , Yong Il Hwang , Ki-suck Jung

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 155-166 (12 pages)

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Background: The remarkable efficacy of osimertinib in non-small cell lung cancer (NSCLC) with acquired T790M mutation has been widely documented in clinical trials and real-world practice. However, some patients show primary resistance to this drug. Even patients who initially show a favorable response have inconsistent clinical outcomes later. Therefore, the aim of this study was to identify additional clinical predictive factors for osimertinib efficacy.
Methods: A prospective cohort of patients with acquired T790M positive stage IV lung adenocarcinoma treated with osimertinib salvage therapy in Hallym University Medical Center were analyzed.
Results: Sixty-one eligible patients were analyzed, including 38 (62%) women and 39 (64%) who never smoked. Their mean age was 63.3 years. The median follow-up after treatment with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) was 36.0 months (interquartile range, 24.7-50.2 months). The majority (n=45, 74%) of patients were deceased. Based on univariate analysis, low baseline neutrophil-to-lymphocyte ratios (NLR), age ≥50 years, neversmoking history, stage IVA at osimertinib initiation, and prolonged response to previous TKIs (≥10 months) were associated with a significantly longer progression-free survival (PFS). Multivariate analysis showed that never-smoking status (hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.30-0.98; p=0.041) and a baseline NLR less than or equal to 3.5 (HR, 0.23; 95% CI, 0.12-0.45; p<0.001) were independently associated with a prolonged PFS with osimertinib.
Conclusion: Smoking history and high NLR were independent negative predictors of osimertinib PFS in patients with advanced NSCLC developing EGFR T790M resistance after the initial EGFR-TKI treatment.

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7Assessment of Household Catastrophic Total Cost of Tuberculosis and Its Determinants in Cairo: Prospective Cohort Study

저자 : Manar M. Ellaban , Nashwa I. Basyoni , Dina N. K. Boulos , Mervat Rady , Mohsen Gadallah

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 165-179 (15 pages)

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Background: One goal of the End tuberculosis (TB) Strategy is to see no TB-affected households experiencing catastrophic costs. Therefore, it is crucial for TB-elimination programs to identify catastrophic costs and their main drivers in order to establish appropriate health and social measures. This study aimed to measure the percent of catastrophic costs experienced by Egyptian TB patients and to identify its determinants.
Methods: We conducted a prospective cohort study with 151 Egyptian TB patients recruited from two chest dispensaries from the Cairo governate from May 2019 to May 2020. We used a validated World Health Organization TB patient-cost tool to collect data on patients' demographic information, household income, and direct and indirect expense of seeking TB treatment. We considered catastrophic TB costs to be total costs exceeding 20% of the household's annual income.
Results: Of the patients, 33% experienced catastrophic costs. The highest proportion of the total came in the pretreatment stage. Being the main breadwinner, experiencing job loss, selling property, and the occurrence of early coronavirus disease 2019 lockdown were independent determinants of the incidence of catastrophic costs. Borrowing money and selling property were the most-often reported coping strategies adopted.
Conclusion: Despite the availability of free TB care under the Egyptian National TB Program, nearly a third of the TB patients incurred catastrophic costs. Job loss and being the main breadwinner were among the significant predictors of catastrophic costs. Social protection mechanisms, including cash assistance and insurance coverage, are necessary to achieve the goal of the End TB Strategy.

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8Pulmonary Functions and Inflammatory Biomarkers in Post-Pulmonary Tuberculosis Sequelae

저자 : Kumar Shanmugasundaram , Anjana Talwar , Karan Madan , Geetanjali Bade

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 175-184 (10 pages)

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Background: Post-tuberculosis (TB) sequelae is a commonly encountered clinical entity, especially in high TB burden countries. This may represent chronic anatomic sequelae of previously treated TB, with frequent symptomatic presentation. This pilot study was aimed to investigate the pulmonary functions and systemic inflammatory markers in patients with post-TB sequelae (PTBS) and to compare them with post-TB without sequelae (PTBWS) participants and healthy controls.
Methods: A total of 30 participants were enrolled, PTBS (n=10), PTBWS (n=10), and healthy controls (n=10). Pulmonary function tests included spirometry and measurement of airway impedance by impulse oscillometry. Serum levels of matrix metalloproteinase (MMP)-1, transforming growth factor-β, and interferon-γ were estimated.
Results: Slow vital capacity (SVC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and peak expiratory flow were significantly lower in PTBS as compared to controls. SVC and FEV1 were significantly less in PTBS as compared to PTBWS. Total airway impedance (Z5), total airway resistance (R5), central airway resistance (R20), area of reactance (Ax), and resonant frequency (Fres) were significantly higher and respiratory reactance at 5 and 20 Hz (X5, X20) were significantly lower in PTBS as compared to PTBWS. Spirometry parameters correlated with impulse oscillometry parameters in PTBS. Serum MMP-1 level was significantly higher in PTBS as compared to other groups.
Conclusion: Significant pulmonary function impairment was observed in PTBS, and raised serum MMP-1 levels compared with PTBWS and healthy controls. Follow-up pulmonary function testing is recommended after treatment of TB for early diagnosis and treatment of PTBS.

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9Clinical Features, Diagnosis, Management, and Outcomes of Idiopathic Pulmonary Fibrosis in Korea: Analysis of the Korea IPF Cohort (KICO) Registry

저자 : Yangjin Jegal , Jong Sun Park , Song Yee Kim , Hongseok Yoo , Sung Hwan Jeong , Jin Woo Song , Jae Ha Lee , Hong Lyeol Lee , Sun Mi Choi , Young Whan Kim , Yong Hyun Kim , Hye Sook Choi , Jongmin Lee ,

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 185-194 (10 pages)

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Background: The Korea Interstitial Lung Disease Study Group has made a new nationwide idiopathic pulmonary fibrosis (IPF) registry because the routine clinical practice has changed due to new guidelines and newly developed antifibrotic agents in the recent decade. The aim of this study was to describe recent clinical characteristics of Korean IPF patients.
Methods: Both newly diagnosed and following IPF patients diagnosed after the previous registry in 2008 were enrolled. Survival analysis was only conducted for patients diagnosed with IPF after 2016 because antifibrotic agents started to be covered by medical insurance of Korea in October 2015.
Results: A total of 2,139 patients were analyzed. Their mean age at diagnosis was 67.4±9.3 years. Of these patients, 76.1% were males, 71.0% were ever-smokers, 14.4% were asymptomatic at the time of diagnosis, and 56.9% were at gender-agephysiology stage I. Occupational toxic material exposure was reported in 534 patients. The mean forced vital capacity was 74.6% and the diffusing capacity for carbon monoxide was 63.6%. Treatment with pirfenidone was increased over time: 62.4% of IPF patients were treated with pirfenidone initially. And 79.2% of patients were treated with antifiboritics for more than three months during the course of the disease since 2016. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality.
Conclusion: In the recent Korean IPF registry, the percentage of IPF patients treated with antifibrotics was increased compared to that in the previous IPF registry. Old age, acute exacerbation, treatment without antifibrotics, and exposure to wood and stone dust were associated with higher mortality.

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10A Comprehensive Analysis of 5-Year Outcomes in Patients with Cancer Admitted to Intensive Care Units

저자 : Yoonki Hong , Woo Jin Kim , Ji Young Hong , Yun-jeong Jeong , Jinkyeong Park

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 85권 2호 발행 연도 : 2022 페이지 : pp. 195-201 (7 pages)

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Background: The aim of this study was to evaluate the long-term (5-year) clinical outcomes of patients who received intensive care unit (ICU) treatment using Korean nationwide data.
Methods: All patients aged >18 years with ICU admission according to Korean claims data from January 2008 to December 2010 were enrolled. These enrolled patients were followed up until December 2015. The primary outcome was ICU mortality.
Results: Among all critically ill patients admitted to the ICU (n=323,765), patients with cancer showed higher ICU mortality (18.6%) than those without cancer (13.2%, p<0.001). However, there was no significant difference in ICU mortality at day 28 among patients without cancer (14.5%) and those with cancer (lung cancer or hematologic malignancies) (14.3%). Compared to patients without cancer, hazard ratios of those with cancer for ICU mortality at 5 years were: 1.90 (1.87-1.94) for lung cancer; 1.44 (1.43-1.46) for other solid cancers; and 3.05 (2.95-3.16) for hematologic malignancies.
Conclusion: This study showed that the long-term survival rate of patients with cancer was significantly worse than that of general critically ill patients. However, short term outcomes of critically ill patients with cancer were not significantly different from those of general patients, except for those with lung cancer or hematologic malignancies.

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1Korean Guidelines for Diagnosis and Management of Interstitial Lung Diseases: Part 4. Cryptogenic Organizing Pneumonia

저자 : Sue In Choi , Won Jai Jung , Eun Joo Lee

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 171-175 (5 pages)

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Cryptogenic organizing pneumonia (COP) is a type of idiopathic interstitial pneumonia with an acute or subacute clinical course. Bilateral lung consolidations located in the subpleural area and bronchovascular bundle are the most common findings on chest high-resolution computed tomography. The pathologic manifestations include granulation tissue in the alveoli, alveolar ducts, and bronchioles. COP responds fairly well to glucocorticoid monotherapy with rapid clinical improvement, but recurrence is common. However, treatment with combined immunosuppressant agents is not recommended, even if the COP patient does not respond to glucocorticoid monotherapy with expert opinion.

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2Experience of Treating Critically Ill COVID-19 Patients in Daegu, South Korea

저자 : Kyeong-cheol Shin

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 176-181 (6 pages)

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At the beginning of February 2020, Daegu faced a serious situation due to the rapid outbreak of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2. The healthcare system in Daegu Metropolitan City was ill-prepared for this sudden disaster situation. The COVID-19 pandemic is still ongoing in South Korea. Daegu has limited medical resources compared to the Seoul Metropolitan Area, and it is hypothesized that a review of the outbreak therein could provide information that will be valuable for dealing with future outbreaks. The likelihood of death due to COVID-19 depends on the capacity of the area for the treatment of critically ill patients. This report reviews the overall treatment process followed for critically ill patients in Daegu.

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3Measurement of Fractional Exhaled Nitric Oxide in Adults: Comparison of Two Different Analyzers (NIOX VERO and NObreath)

저자 : Sung-yoon Kang , Sang Min Lee , Sang Pyo Lee

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 182-187 (6 pages)

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Background: Fractional exhaled nitric oxide (FeNO) is a non-invasive marker for eosinophilic airway inflammation and a good predictor of response to corticosteroids. There is a need for a reliable and accurate measurement method, as FeNO measurements have been widely used in clinical practice. Our study aimed to compare two FeNO analyzers and derive a conversion equation for FeNO measurements in adults.
Methods: We included 99 participants who had chief complaints of chronic cough and difficulty in breathing. The participants underwent concurrent FeNO measurement using NIOX VERO (Circassia AB) and NObreath (Bedfont). We compared the values of the two devices and analyzed their correlation and agreement. We then formulated an equation to convert FeNO values measured by NObreath into those obtained by NIOX VERO.
Results: The mean age of the participants was 51.2±17.1 years, with a female predominance (58.6%). Approximately 60% of the participants had asthma. The FeNO level measured by NIOX VERO (median, 27; interquartile range [IQR], 15-45) was significantly lower than that measured by NObreath (median, 38; IQR, 22-58; p<0.001). There was a strong positive correlation between the two devices (r=0.779, p<0.001). Additionally, Bland-Altman plots and intraclass correlation coefficient demonstrated a good agreement. Using linear regression, we derived the following conversion equation: natural log (Ln) (NObreath)=0.728×Ln (NIOX VERO)+1.244.
Conclusion: The FeNO values of NIOX VERO and NObreath were in good agreement and had positive correlations. Our proposed conversion equation could help assess the accuracy of the two analyzers.

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4Correlation between Telomere Length and Chronic Obstructive Pulmonary Disease-Related Phenotypes: Results from the Chronic Obstructive Pulmonary Disease in Dusty Areas (CODA) Cohort

저자 : Da Hye Moon , Jeeyoung Kim , Myoung Nam Lim , So Hyen Bak , Woo Jin Kim

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 188-203 (16 pages)

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Background: Chronic obstructive pulmonary disease (COPD) is a common chronic respiratory disease with increased prevalence in the elderly. Telomeres are repetitive DNA sequences found at the end of the chromosome, which progressively shorten as cells divide. Telomere length is known to be a molecular marker of aging. This study aimed to assess the relationship between telomere length and the risk of COPD, lung function, respiratory symptoms, and emphysema index in Chronic Obstructive Pulmonary Disease in Dusty Areas (CODA) cohort.
Methods: We extracted DNA from the peripheral blood samples of 446 participants, including 285 COPD patients and 161 control participants. We measured absolute telomere length using quantitative real-time polymerase chain reaction. All participants underwent spirometry and quantitative computed tomography scan. Questionnaires assessing respiratory symptoms and the COPD Assessment Test was filled by all the participants.
Results: The mean age of participants at the baseline visit was 72.5±7.1 years. Males accounted for 72% (321 participants) of the all participants. The mean telomere length was lower in the COPD group compared to the non-COPD group (COPD, 16.81±13.90 kb; non-COPD, 21.97±14.43 kb). In COPD patients, 112 (75.7%) were distributed as tertile 1 (shortest), 91 (61.1%) as tertile 2 and 82 (55%) as tertile 3 (longest). We did not find significant associations between telomere length and lung function, exacerbation, airway wall thickness, and emphysema index after adjusting for sex, age, and smoking status.
Conclusion: In this study, the relationship between various COPD phenotypes and telomere length was analyzed, but no significant statistical associations were shown.

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5Role of Krebs von den Lungen-6 (KL-6) in Assessing Hypersensitivity Pneumonitis

저자 : Amira Ismail Mostafa , Ayman Elsayed Salem , Heba Allah Moussa Ahmed , Aml Ibrahim Bayoumi , Radwa M. Abdel Halim , Rasha M. Abdel Samie

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 200-208 (9 pages)

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Background: Hypersensitivity pneumonitis (HP) is an increasingly recognized form of diffuse parenchymal lung disease. Krebs von den Lungen-6 (KL-6) is now classified as a human MUC1 mucin protein, and regenerating type II pneumocytes are the primary cellular source of KL-6/MUC1 in the affected lungs of patients with interstitial lung diseases (ILD). Serum KL-6/MUC1 levels have been demonstrated to be useful for the evaluation of various ILD. To determine the role of circulating KL-6 in evaluating the disease activity and management of HP.
Methods: An observational cross-sectional study was conducted on 51 patients with HP and 20 healthy controls. Serum KL-6 levels were measured in both groups. Patients were further assessed based on chest high-resolution computed tomography (HRCT), pulmonary function test, 6-minute walk test, echocardiography, bronchioalveolar lavage, and/or transbronchial biopsy. Patients were divided into the fibrotic and non-fibrotic groups according to the HRCT findings.
Results: The median serum KL-6 levels were significantly higher in HP patients as compared to the control group. The median serum KL-6 levels were found to be higher in the non-fibrotic HP group (1,900 IU/mL) as compared to the fibrotic group (1,200 IU/mL). There was a significant inverse correlation between serum KL-6 serum level and the dose of steroids as well as the duration of steroid therapy.
Conclusion: The presence of higher KL-6 levels in the non-fibrotic HP group implies its enhanced production by regenerating pneumocytes in response to alveolar injury. The significant association between serum KL-6 levels and the dose and the duration of steroid therapy emphasizes the significant role of steroids in the stabilization of the disease.

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6Comparison of Clinical and Radiologic Characteristics between Anthracofibrosis and Endobronchial Lung Cancer

저자 : Seo Young Yun , Tae Yun Park

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 209-216 (8 pages)

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Background: Endobronchial lung cancer (EBLC) and bronchial anthracofibrosis (BAF) share similar symptoms and radiological findings. The aim of this study was to describe clinical and radiological differences between BAF and EBLC, both of which were confirmed by bronchoscopy.
Methods: This was a retrospective study of patients with BAF or EBLC from 2008 to 2014. Data were derived from a bronchoscopy registry made since January 1, 2008. Clinical and radiological characteristics of both diseases were analyzed.
Results: Among 3,214 patients who underwent bronchoscopy, 167 and 117 patients were enrolled in BAF and EBLC groups, respectively. BAF occurred more predominantly in older non-smoking female patients with a higher chance of tuberculosis (38.3%) than EBLC (6.0%). Cough, sputum, and dyspnea were common symptoms reported for both groups. Bronchoscopic findings revealed that BAF lesions were more common in multiple lobar bronchi (85.0%) or bilateral bronchi (73.7%). Radiologic findings revealed that bronchial stenosis was the most commonly found lesion in both groups (49.1% and 78.6%, respectively). Rates of peribronchial calcification and bronchial wall thickening were higher in the BAF group. The number of patients with lymph node calcification was also higher in the BAF group.
Conclusion: Results of this study demonstrated characteristics of clinical and radiologic findings of BAF and EBLC. Increasing the awareness of both diseases may help clinicians differentiate these two diseases from each other, thus avoiding unnecessary invasive diagnostic procedures.

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7The Effect of the Timing of Dexamethasone Administration in Patients with COVID-19 Pneumonia

저자 : Hyun Woo Lee , Jimyung Park , Jung-kyu Lee , Tae Yeon Park , Eun Young Heo

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 217-226 (10 pages)

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Background: Despite the proven benefits of dexamethasone in hospitalized coronavirus disease 2019 (COVID-19) patients, the optimum time for the administration of dexamethasone is unknown. We investigated the progression of COVID-19 pneumonia based on the timing of dexamethasone administration.
Methods: A single-center, retrospective cohort study based on medical record reviews was conducted between June 10 and September 21, 2020. We compared the risk of severe COVID-19, defined as the use of a high-flow nasal cannula or a mechanical ventilator, between groups that received dexamethasone either within 24 hours of hypoxemia (early dexamethasone group) or 24 hours after hypoxemia (late dexamethasone group). Hypoxemia was defined as room-air SpO2 <90%.
Results: Among 59 patients treated with dexamethasone for COVID-19 pneumonia, 30 were in the early dexamethasone group and 29 were in the late dexamethasone group. There was no significant difference in baseline characteristics, the time interval from symptom onset to diagnosis or hospitalization, or the use of antiviral or antibacterial agents between the two groups. The early dexamethasone group showed a significantly lower rate of severe COVID-19 compared to the control group (75.9% vs. 40.0%, p=0.012). Further, the early dexamethasone group showed a significantly shorter total duration of oxygen supplementation (10.45 days vs. 21.61 days, p=0.003) and length of stay in the hospital (19.76 days vs. 27.21 days, p=0.013). However, extracorporeal membrane oxygenation and in-hospital mortality rates were not significantly different between the two groups.
Conclusion: Early administration of dexamethasone may prevent the progression of COVID-19 to a severe disease, without increased mortality.

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8Diagnostic Accuracy of the Quidel Sofia Rapid Influenza Fluorescent Immunoassay in Patients with Influenza-like Illness: A Systematic Review and Meta-analysis

저자 : Jonghoo Lee , Jae-uk Song , Yee Hyung Kim

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 226-236 (11 pages)

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Background: Although the Quidel Sofia rapid influenza fluorescent immunoassay (FIA) is widely used to identify influenza A and B, the diagnostic accuracy of this test remains unclear. Thus, the objective of this study was to determine the diagnostic performance of this test compared to reverse transcriptase-polymerase chain reaction.
Methods: A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and a hierarchical summary receiver-operating characteristic curve (HSROC) of this test for identifying influenza A and B were determined using meta-analysis. A sensitivity subgroup analysis was performed to identify potential sources of heterogeneity within selected studies.
Results: We identified 17 studies involving 8,334 patients. Pooled sensitivity, specificity, and DOR of the Quidel Sofia rapid influenza FIA for identifying influenza A were 0.78 (95% confidence interval [CI], 0.71-0.83), 0.99 (95% CI, 0.98-0.99), and 251.26 (95% CI, 139.39-452.89), respectively. Pooled sensitivity, specificity, and DOR of this test for identifying influenza B were 0.72 (95% CI, 0.60-0.82), 0.98 (95% CI, 0.96-0.99), and 140.20 (95% CI, 55.92-351.54), respectively. The area under the HSROC for this test for identifying influenza A was similar to that for identifying influenza B. Age was considered a probable source of heterogeneity.
Conclusion: Pooled sensitivities of the Quidel Sofia rapid influenza FIA for identifying influenza A and B did not quite meet the target level (≥80%). Thus, caution is needed when interpreting data of this study due to substantial between-study heterogeneity.

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9Comparative Performance of Line Probe Assay (Version 2) and Xpert MTB/RIF Assay for Early Diagnosis of Rifampicin-Resistant Pulmonary Tuberculosis

저자 : Raj Narayan Yadav , Binit Kumar Singh , Rohini Sharma , Jigyasa Chaubey , Sanjeev Sinha , Pankaj Jorwal

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 237-244 (8 pages)

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Background: The emergence of drug-resistant tuberculosis (TB), is a major menace to cast off TB worldwide. Line probe assay (LPA; GenoType MTBDRplus ver. 2) and Xpert MTB/RIF assays are two rapid molecular TB detection/diagnostic tests. To compare the performance of LPA and Xpert MTB/RIF assay for early diagnosis of rifampicin-resistant (RR) TB in acid-fast bacillus (AFB) smear-positive and negative sputum samples.
Methods: A total 576 presumptive AFB patients were selected and subjected to AFB microscopy, Xpert MTB/RIF assay and recent version of LPA (GenoType MTBDRplus assay version 2) tests directly on sputum samples. Results were compared with phenotypic culture and drug susceptibility testing (DST). DNA sequencing was performed with rpoB gene for samples with discordant rifampicin susceptibility results.
Results: Among culture-positive samples, Xpert MTB/RIF assay detected Mycobacterium tuberculosis (Mtb) in 97.3% (364/374) of AFB smear-positive samples and 76.5% (13/17) among smear-negative samples, and the corresponding values for LPA test (valid results with Mtb control band) were 97.9% (366/374) and 58.8% (10/17), respectively. For detection of RR among Mtb positive molecular results, the sensitivity of Xpert MTB/RIF assay and LPA (after resolving discordant phenotypic DST results with DNA sequencing) were found to be 96% and 99%, respectively. Whereas, specificity of both test for detecting RR were found to be 99%.
Conclusion: We conclude that although Xpert MTB/RIF assay is comparatively superior to LPA in detecting Mtb among AFB smear-negative pulmonary TB. However, both tests are equally efficient in early diagnosis of AFB smear-positive presumptive RR-TB patients.

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10Delayed Diagnosis of Tuberculosis Mistaken for Tinea Corporis in a Healthy Adult

저자 : Jae-wang Kim , Jeong Rae Yoo , Hyunjoo Oh , Misun Kim , Sang Taek Heo

발행기관 : 대한결핵 및 호흡기학회 간행물 : Tuberculosis and Respiratory Diseases 84권 3호 발행 연도 : 2021 페이지 : pp. 245-246 (2 pages)

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