Chronic obstructive pulmonary disease severity in middle-aged and older men with osteoporosis associates with decreased bone formation.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is a risk factor for osteoporosis. Nevertheless, much remains unclear regarding the bone metabolism dynamics associated with COPD. The present study focuses on the associations between the COPD severity and serum bone metabolism biomarkers. METHODS: We enrolled 40 patients who visited the orthopedics departments at our institutions and underwent dual-energy X-ray absorptiometry between September 2015 and December 2017. Only male osteoporosis patients over 45 years of age were included, and 5 patients were excluded due to disease or use of internal medicines affecting bone metabolism. All subjects underwent lung function testing, spine radiography, and blood tests. We measured percent forced expiratory volume in 1 second (%FEV1), which reflects COPD severity, and we examined the relationships between %FEV1 and serum levels of bone metabolism biomarkers. RESULTS: All subjects were diagnosed with osteoporosis based on T-scores. %FEV1 correlated with body weight, body mass index (BMI), and Z-score/T-scores. %FEV1 moderately correlated with serum levels of alkaline phosphatase (ALP), procollagen type 1 N-terminal propeptide (P1NP), and tartrate-resistant acid phosphatase 5b in the partial correlation analysis adjusted for BMI or T-score in the lumbar vertebrae. We performed a hierarchical multiple regression analysis to identify that serum ALP and P1NP were the independent explanatory variables to %FEV1 independent of other factors. CONCLUSIONS: The data suggest that the COPD severity in middle-aged and older men with osteoporosis associates with decreased bone formation. COPD patients may exhibit bone metabolism dynamics characterized by low bone turnover with osteogenesis dysfunction as COPD becomes severe.

Molecular characterization of AfuFleA, an L-fucose-specific lectin from Aspergillus fumigatus.

Aspergillus fumigatus causes life-threatening infections in immunocompromised patients. We have found that extracts of mycelial mats of A. fumigatus contain a potent hemagglutinin. To clarify the characteristics of this factor, the hemagglutinin was purified from late-stage cultures and characterized at the molecular level. The hemagglutinin is a 32-kilodalton protein that shows activity as an L-fucose lectin. The gene encoding this protein, AfufleA, was identified from a genomic DNA library utilizing consensus primers designed for amino acid sequences obtained from peptides following limited trypsin proteolysis. An open reading frame was found that consists of 942 nucleotides encoding 314 amino acids with a deduced molecular mass of 34,498 and contains all seven of trypsin-digested peptide sequences; four short introns, 49-63 bp, were also identified. AfufleA shares homology with a fucose-specific lectin produced by the orange peel mushroom, Aleuria aurantia. The role of AfufleA fucose-specific lectin is not clear, but this lectin may enhance attachment of fungal spores to mammalian cell membranes and contribute to the pathogenicity of A. fumigatus.

[Effects of smoking on video-assisted thoracic surgery lobectomy for lung cancer].

The purpose of this study was to examine the effect of smoking on a video-assisted thoracic surgery lobectomy in 83 male patients with clinical stage I primary lung cancer. Forty-two patients who had smoked until 1 week to 2 months before surgery (Smoker group) were retrospectively compared with 35 ex-smokers who had continued smoking cessation for 15 years on average and 6 non-smokers (Non- & Ex-smoker group), regarding the demographic, perioperative, histopathologic and outcome variables. Except for age, cigarette consumption and comorbid chronic obstructive pulmonary disease (COPD), the two groups showed no differences in the demographic, operative and histopathologic variables. The smoker group demonstrated a significantly younger age (P = 0.0497), more cigarette consumption (P = 0.0086), more COPD (P = 0.0004), longer chest tube drainage (P = 0.0451), longer length of hospitalization (P = 0.0181) and more postoperative complications (P = 0.0278) than the ex- and non-smoker groups. No mortality was observed in either group. The two groups had comparable survival rates. The results indicate that an early cessation of smoking is desirable even when a video-assisted thoracic surgery lobectomy is performed.

Clinical background of cases showing a positive culture of pleural effusion at Shin-Kokura Hospital over a period of 5 years.

We investigated the clinical background of patients at Shin-Kokura Hospital who showed a positive culture of pleural effusion during the period from January 1998 through December 2002. Microorganism cultures of the pleural effusions of 127 patients were performed in this 5-year period. Seventeen patients showed a positive microorganism culture from a pleural effusion, and 12 of these patients (70.6%) were 60 years old or more. Ten patients were diagnosed with thoracic empyema. Thirteen patients had an underlying disease such as malignancy (5 cases), diabetes mellitus (4 cases), etc. A purulent effusion and a high concentration of lactic dehydrogenase (LDH) in the pleural fluid were more frequently recognized in the positive-culture group. A total of 21 strains of microorganism were isolated from the 17 patients, including 10 strains of Gram-positive cocci, 6 strains of Gram-negative bacilli, 3 strains of anaerobes, 1 strain of mycobacterium (Mycobacterium tuberculosis), and 1 strain of fungus. Susceptibility to antimicrobial agents was generally good for most of the microorganisms isolated. Of the 17 patients, chest-tube drainage was performed in 13, and 6 needed a surgical operation. Twelve patients improved, but 5 died. In this study, thoracic empyema accounted for 58.8% of the 17 cases with a positive culture of pleural effusion. Of the 10 thoracic empyema patients, 5 patients needed surgical treatment in spite of adequate antimicrobial treatment and chest-tube drainage. Our data indicate that thoracic empyema is still difficult to treat, and thus adequate and rapid treatment is needed for any pleural infection.

Clinical and microbiological characteristics in cases of positive blood cultures at Shin-Kokura Hospital during a period of 5 years.

In order to evaluate the present state of bacteremia, we investigated the clinical and microbiological characteristics of positive blood culture cases hospitalized in Shin-Kokura Hospital from January 1998 through December 2002. Seventy-five cases showed positive blood cultures during the 5 years, and 48 cases (64%) were 70 years old or more. Most of the cases had underlying diseases, such as malignancy. The diagnoses of the infectious diseases found included pneumonia (9 cases), enteric infection (9 cases), hepatobiliary infection (8 cases), urinary tract infection (8 cases), and endocarditis (6 cases). A total of 102 strains of microorganism were isolated, and Gram-positive bacteria accounted for 64.7% of the cases, with Gram-negative bacteria accounting for 29.4%. Most of the isolated microorganisms showed good susceptibility to antimicrobial agents except for MRSA. Antimicrobial agents were used for 54 cases of bacteremia, and 33 patients improved, but 21 patients died, including 10 whose death was due to infection. In this study, the 54 cases of bacteremia (72% of all cases with a positive blood culture) showed a mortality rate of 18.5% due to infection, in spite of adequate antimicrobial treatment. Our data suggest that physicians should recognize the difficulty of treating bacteremia, and should pay close attention to the physical condition of patients with bacteremia.

[A case of anaphylactoid purpura associated with tuberculous pleuritis].

A 46-year-old man was admitted to Shin-Kokura Hospital because of fever and right chest pain. Laboratory studies showed mild leukocytosis, an increased erythrocyte sediment rate, positive C-reactive protein, and abnormal liver function. The tuberculin skin test was positive. A chest X-ray showed massive right pleural effusion, and exudative pleural effusion fluid was obtained by thoracocentesis. The pleural fluid revealed an increased adenosine deaminase concentration and cultures were negative for mycobacteria. A polymerase chain reaction test of the pleural effusion for Mycobacterium tuberculosis was positive. The patient was diagnosed with tuberculous pleuritis, and antitubercular therapy was started. The fever and chest pain was improved, but rashes appeared on the lower extremities. A biopsy of the skin lesion showed anaphylactoid purpura. Steroid ointment improved the skin lesion. Anaphylactoid purpura associated with tuberculosis is rare. The immunological response to mycobacteria may heve been related to the mechanism of the anaphylactoid purpura in this case.