Serum decorin is a potential prognostic biomarker in patients with acute exacerbation of idiopathic pulmonary fibrosis.

BACKGROUND: Decorin is a small leucine-rich repeat proteoglycan that plays a critical role in collagen fibrillogenesis, and regulates inflammation, wound healing and angiogenesis. In idiopathic pulmonary fibrosis (IPF), decorin is expressed in fibrotic lesions; furthermore, intratracheal gene transfer of decorin has been demonstrated to inhibit bleomycin-induced pulmonary fibrosis. Although these results suggest the critical role of decorin in pulmonary fibrosis, the role of decorin in the acute exacerbation of idiopathic interstitial pneumonia (AE-IIP) has not been clarified in detail. Thus, the goal of this study was to determine the role of decorin in AE-IIP. METHODS: We retrospectively analyzed AE-IIP patients who had been admitted to our hospital. First, serum decorin levels were compared among patients with AE-IIP, patients with stable idiopathic interstitial pneumonia (SD-IIP), and healthy subjects. Next, the relationship between serum decorin levels and clinical parameters was analyzed in AE-IIP patients. Finally, the association between serum decorin levels and prognosis was evaluated in AE-IIP patients. IIP was divided into IPF and non-IPF, according to the published guidelines. RESULTS: The serum decorin levels of AE-IIP patients were significantly lower than those of both healthy subjects and SD-IIP patients. Serum decorin levels were not related with the clinical parameters and prognosis, when all IIP patients were analyzed. In IPF patients, serum decorin levels had a significant correlation with oxygenation, and IPF patients with low serum decorin levels had a significantly higher survival rate than those with high serum decorin levels. CONCLUSIONS: Serum decorin levels are a potential prognostic biomarker in AE-IPF.

The association between risk of airflow limitation and serum uric acid measured at medical health check-ups.

The prevalence of COPD and asthma is increasing all over the world; however, their morbidities are thought to be greatly underestimated because of unawareness of patients' conditions and respiratory symptoms. Spirometry is useful for the early detection of COPD and asthma with airflow limitation (AL), although it is not yet widely used for screening in epidemiological and primary care settings. A simple predictive marker used in combination with spirometry for AL is expected to be established. In medical health check-ups, serum uric acid (s-UA) is measured when screening for gout and has recently been suggested to have an association with several respiratory disorders, including asthma and COPD. However, whether s-UA influences the development of AL remains unclear. Therefore, the aims of this study were to examine the relationship between AL and s-UA and to investigate s-UA as a potential auxiliary marker for predicting AL risk in medical health check-ups. A total of 8,662 subjects aged >40 years were included. They were administered a simple questionnaire and assessed using pulmonary function tests, blood pressure (BP) measurements, and blood samplings. One hundred and fifty-six subjects (1.8%) had AL, just 29% of whom had experienced respiratory symptoms. The subjects with AL had significantly higher s-UA levels compared with never-smoking subjects without AL. Forced expiratory volume in 1 second (FEV1) %predicted showed significant correlations with age, smoking index, body mass index (BMI), mean BP, white blood cells, hemoglobin A1c, s-UA, and high-density lipoprotein cholesterol. In multiple logistic regression analysis, s-UA, in addition to age, smoking index, respiratory symptoms, and BMI, was independently associated with AL. In conclusion, elevated s-UA levels, together with respiratory symptoms, high smoking index, and weight loss, may epidemiologically predict the development of AL risk.

Association of asthma education with asthma control evaluated by asthma control test, FEV1, and fractional exhaled nitric oxide.

BACKGROUND: Asthma education is an important adjunct for asthma control although the way asthma education affects asthma outcomes is poorly understood. The asthma control test (ACT), forced expiratory volume in 1 s (FEV(1)), and fractional exhaled nitric oxide (FeNO) have all been used as markers of asthma control. However, the use of FeNO as a surrogate marker remains controversial. OBJECTIVES: (i) To examine whether asthma education is associated with asthma control; (ii) to compare absolute levels and changes of ACT, FEV(1), and FeNO over a year; and (iii) to evaluate whether FeNO can be used as an additional marker of asthma control. METHODS: Fifty asthmatics with poor adherence (12 mild, 21 moderate, and 17 severe) received asthma education at study entry. Medications were unchanged for the first 3 months, and ACT, FEV(1), and FeNO measurements were recorded at entry, 3, 6, and 12 months. Asthma control was assessed at each visit and patients were categorized as either "stable" or "unstable" asthmatics according to the global initiative for asthma (GINA) guidelines. RESULTS: A significant decrease in FeNO and increase in ACT score were noted in the stable asthmatic group at 3 months (p < .001), and this persisted over 12 months. Significant correlations were seen between changes (Δ) in FeNO, ACT, and FEV(1) over time. However, significant correlations between the absolute levels were not maintained over 12 months. A decrease of ≥18.6% in FeNO and a ≥3-point increase in ACT score (sensitivity: 80% and 73.3% and specificity: 83.3% and 87.5%, respectively) were associated with stable asthma control although the absolute levels were not. CONCLUSIONS: Asthma education may be useful to achieve stable control. In addition, changes rather than absolute levels of FeNO and ACT may be better markers of asthma control.

Four cases of Trousseau's syndrome associated with lung adenocarcinoma.

Cancer patients are at high risk of venous thromboembolism (VTE), and the combination of these two conditions is well known as Trousseau's syndrome. Here we present four cases of Trousseau's syndrome associated with advanced lung adenocarcinoma. In addition to fibrinogen degradation products (FDP) and D-dimer, the levels of mucin-producing markers, such as KL-6, were elevated. There is a possibility that mucin production may be associated with cancer-related VTE.

Validation study of asthma screening criteria based on subjective symptoms and fractional exhaled nitric oxide.

BACKGROUND: In the latest Global Initiative for Asthma guideline, neither sputum eosinophilia nor fractional exhaled nitric oxide (FeNO) have been evaluated prospectively as an aid in asthma diagnosis, but these measurements are being evaluated for potential use in determining optimal treatment. OBJECTIVE: To report criteria for screening asthma using subjective symptoms and FeNO levels and results of a prospective validation study using these criteria. METHODS: Sixty-one outpatients with recurrent cough, wheezing, or dyspnea underwent measurements of FeNO levels, pulmonary function, methacholine airway responsiveness, and inflammatory cells in induced sputum. The sensitivity, specificity, and concordance achieved using the FeNO-based criteria (at least 1 of the following subjective symptoms: recurrent cough, wheezing, or dyspnea and/or FeNO level ≥ 40 ppb) were analyzed and compared with the values obtained using conventional asthma diagnostic criteria, which includes subjective symptoms with any 2 of the following conditions: airway hyperresponsiveness, reversible airflow limitation, and eosinophilia in induced sputum. RESULTS: Of the 61 patients, 41 were diagnosed as having asthma by the conventional criteria, and 33 were diagnosed as having asthma by the FeNO-based criteria, which showed a sensitivity of 78.6%, a specificity of 89.5%, and a concordance rate of 0.62. Nine of 42 patients were misdiagnosed as not having asthma by FeNO-based criteria (mean [SD] FeNO level, 23.9 [8.0] ppb). Seven of 9 patients were diagnosed as having nonatopic asthma according to IgE levels. CONCLUSIONS: Asthma may be accurately diagnosed in daily practice on the basis of subjective symptoms and FeNO levels, particularly in atopic patients.

[Differences of fractional exhaled nitric oxide (FeNO) levels performed using two different analyzers].

The measurement of fractional exhaled nitric oxide (FeNO) is going to become more wide-spread as a noninvasive marker for diagnosing and controlling bronchial asthma. In Japan, both stationary and portable FeNO analyzers are now available. However, the difference between these analyzers has not been fully examined. Therefore, the aim of this study is to determine whether there is a difference between a stationary FeNO analyzer (NA623NP, CHEST inc. Tokyo, Japan) and a portable analyzer (NIOX MINO, Aerocrine, Solna, Sweden). One hundred subjects (17 non-treated asthma cases, 45 asthma cases treated with inhaled corticosteroids, 21 with other respiratory disorders, 17 healthy subjects) were enrolled in the study. All the subjects were non- or ex-smokers. There was a strong positive correlation between FeNO (CHEST) and FeNO (MINO) (r = 0.970, p < 0.001). However, when FeNO levels between FeNO (CHEST) and FeNO (MINO) were compared in all subjects and each subject group, the levels of FeNO (MINO) were significantly lower than those of FeNO (CHEST) (p < 0.05). Finally, the following conversion equation was calculated: FeNO (CHEST) = FeNO (MINO) x 1.278 + 3.065. From these results, the following conclusion was drawn: when FeNO is measured by different analyzers, there might be differences between devices. Therefore, the conversion equation could help clinicians and researchers to compare data obtainable by these two analyzers.

[Transesophageal endoscopic ultrasonography guided-fine needle aspiration for the diagnosis of sarcoidosis].

Sarcoidosis is a multi-organ disorder of unknown etiology characterized by noncaseating epithelioid cell granulomas. The specimen for histopathological diagnosis is usually obtained by transbronchial lung biopsy (TBLB), but the diagnostic accuracy rate of TBLB is not satisfactory, especially for stage I patients. Since hilar and mediastinal lymphadenopathy is a common finding in patients with sarcoidosis, an approach to lymph nodes is expected to have a good diagnosis yield. We present 3 sarcoidosis patients in whom specimens obtained by TBLB, transbronchial needle aspiration (TBNA) and transesophageal endoscopic ultrasonography guided-fine needle aspiration (EUS-FNA). The histopathological appearance of specimens obtained by EUS-FNA for swollen mediastinal lymph nodes showed noncaseating epithelioid granulomas which are characteristic of sarcoidosis in all 3 patients. On the other hand, no specific findings were recognized in the specimens obtained by TBLB and TBNA in 2 out of 3 patients. These results suggest that EUS-FNA is useful to obtain diagnostic specimens in cases of sarcoidosis.

[Solitary pulmonary nodule due to Mycobacterium intracellulare showing intense uptake on 18F-fluorodeoxyglucose-positron emission tomography].

A 71-year-old woman with no respiratory symptoms, was admitted because of a solitary pulmonary nodule on a chest radiograph. Computed tomography revealed a 2.0 cm nodule with pleural indentation in the right S2. 18F-fluorodeoxyglucose-positron emission (18F-FDG-PET) showed positive tumor uptake (maximum standardized uptake value = 4.8). Bronchoscopy yielded no specific histological or bacterial findings. Lung biopsy using video-associated thoracoscopy revealed an epithelial granuloma with caseation, but no acid-fast bacilli were detected. PCR revealed Mycobacterium intracellulare (M. intracellulare). A solitary nodule caused by M. intracellulare is rare, but it should be considered in the differential diagnosis even with intense uptake on 18F-FDG-PET.

Problematic behaviours of 3-year-old children in Japan: relationship with socioeconomic and family backgrounds.

AIM: The purpose of our study was to elucidate factors in socioeconomic and family backgrounds of 3-year-old children in Tokyo, Japan that were associated with problematic behaviours among the children. STUDY DESIGN: 670 eligible 3-year-old children underwent an evaluation of problematic behaviour by the Japanese Child Behaviour Checklist (CBCL/2-3) and of socioeconomic and family backgrounds. RESULTS: Stepwise multi-logistic regression analyses using all 28 variables showed that longer hours watching TV, smoking during pregnancy, coffee drinking during and after pregnancy increased, whereas higher family income, a larger number of older brothers/sisters, higher educational level of father decreased problematic behaviours. Maternal anxiety measured by trait anxiety using the STAI was associated with behaviour problems measured by CBCL, particularly with externalizing domains composed by aggressiveness, oppositional and attention domains. CONCLUSION: These results suggest that problematic behaviours among children may be increased by adverse socioeconomic and family backgrounds that may be associated with maternal anxiety.