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OBJECTIVES: Educational simulation systems using virtual reality (VR) with head-mounted devices are spreading into the medical field. We developed an innovative training system whereby experienced ostomates can share their proficient stoma self-care techniques with novice ostomates through VR simulations, enabling anytime, anywhere learning. We examined the questionnaire study to assess the acceptance of VR simulation training for stoma care by healthcare providers. METHODS: This study was conducted for the participants, nurses, and doctors, at the 39th Kyushu Stoma Rehabilitation Research Meeting with the organizer's permission. We created two VR simulation prototypes from the perspective of ostomates and caregivers using modeled stomas. We conducted a qualitative study through a questionnaire with healthcare professionals regarding their experiences of viewing VR videos. RESULTS: The study included 20 (52.6%) nurses certified in wound, ostomy, and continence (WOC) care, 16 (42.1%) non-WOC nurses, and two (5.3%) medical doctors. Over 90% of participants showed a positive inclination towards the practical application of the system in clinical settings for both scenarios. A significantly higher number of nurses in the non-WOC nurse group expressed a definite interest in using the imaging from the ostomate's perspective versus that in the WOC nurse group (81.3% vs. 40%, P=0.013). CONCLUSIONS: From this survey, we concluded that the respondents felt a VR training system was a positive experience, to say it is acceptable means that it was as good as the standard of care. ââââââParticularly, non-WOC nurses, with fewer opportunities in stoma care compared to WOC nurses, showed stronger interest in practically implementing this innovative training system.
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Interleukin-6 (IL-6) is known to be involved in the pathogenesis of various inflammatory diseases, but its role in the development of pulmonary emphysema remains unclear. Wild-type (WT) and IL-6-deficient mice received either phosphate-buffered saline (PBS) or porcine pancreatic elastase (PPE) intratracheally. The development of emphysema was determined by measuring the mean linear intercept (Lm). The lung specimens were also subjected to immunohistochemistry for single-stranded DNA to detect apoptotic cells. Lung mechanics and airway responsiveness to inhaled methacholine were analyzed. Bronchoalveolar lavage (BAL) fluid was subjected to evaluation of inflammatory cell accumulation and cytokine measurement. PPE treatment caused significant increases in Lm and lung compliance, which was attenuated by IL-6 deficiency. The increases in apoptotic cells in the lung were attenuated in IL-6 null mice. Airway responsiveness was not affected by PPE challenge or IL-6 deficiency. Intratracheal PPE increased the cell counts in BAL fluid throughout the observation, which was suppressed in IL-6 null mice. In BAL fluid, PPE-induced increases in the levels of macrophage inflammatory protein (MIP)-1alpha and eotaxin were mitigated by IL-6 deficiency. PPE-induced up-regulation of matrix metalloproteinase (MMP)-12 in the lung was attenuated by IL-6 deficiency. These results indicate that IL-6 may play an important role in the development of elastase-induced lung inflammatory changes.
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Interleucina-6/metabolismo , Pulmão/imunologia , Pneumonia/imunologia , Enfisema Pulmonar/imunologia , Resistência das Vias Respiratórias , Animais , Apoptose , Testes de Provocação Brônquica , Líquido da Lavagem Broncoalveolar/citologia , Líquido da Lavagem Broncoalveolar/imunologia , Citocinas/metabolismo , Modelos Animais de Doenças , Regulação Enzimológica da Expressão Gênica , Imuno-Histoquímica , Interleucina-6/deficiência , Interleucina-6/genética , Pulmão/enzimologia , Pulmão/patologia , Pulmão/fisiopatologia , Complacência Pulmonar , Metaloproteinase 12 da Matriz/genética , Camundongos , Camundongos Knockout , Elastase Pancreática , Pneumonia/induzido quimicamente , Pneumonia/genética , Pneumonia/patologia , Pneumonia/fisiopatologia , Enfisema Pulmonar/induzido quimicamente , Enfisema Pulmonar/genética , Enfisema Pulmonar/patologia , Enfisema Pulmonar/fisiopatologia , Mecânica Respiratória , Fatores de TempoRESUMO
BACKGROUND: Patients with Mycobacterium avium-intracellulare complex (MAC) pulmonary disease often suffer from weight loss. Adipokines are factors secreted by adipocytes, including leptin and adiponectin, as well as some inflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 (IL-6). Body mass index (BMI) is known to be inversely correlated with adiponectin and positively with leptin, TNF-alpha, and IL-6. OBJECTIVE: We aimed to evaluate the levels of serum adipokines, including adiponectin, leptin, TNF-alpha, and IL-6 in patients with MAC pulmonary disease. METHODS: Forty consecutive patients with MAC pulmonary disease (8 males; median age 62 years; median BMI 18.1) were examined. Serum levels of adiponectin, leptin, TNF-alpha, and IL-6 were measured with ELISA. Age-, sex- and BMI-matched healthy subjects served as controls. RESULTS: Serum adiponectin was significantly elevated in patients with MAC pulmonary disease compared with the controls (p < 0.01). In both the patients and controls, serum adiponectin levels were inversely correlated with BMI (p < 0.05). No significant correlation was observed between serum adiponectin levels and C-reactive protein or lung function. Serum leptin levels, which were positively correlated with BMI, did not differ between patients and controls. Serum levels of TNF-alpha and IL-6 were significantly greater in patients with MAC pulmonary disease than in controls. The levels of TNF-alpha and IL-6 were not correlated with BMI and other adipokines examined. CONCLUSION: The results of the present study indicate that, in patients with MAC pulmonary disease, adiponectin is inappropriately secreted and may play a role in the pathophysiology of the disease.
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Adiponectina/sangue , Pneumopatias/microbiologia , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-6/sangue , Leptina/sangue , Pneumopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/sangueRESUMO
A 54-year-old woman was admitted with general fatigue and dyspnea on exertion. Her serum LDH level was markedly elevated to 2145 IU/L, and chest CT revealed diffuse centrilobular opacities. Total cell counts in bronchoalveolar lavage fluid were elevated, and lymphocytes accounted for 98% of the cells. A transbronchial lung biopsy demonstrated numerous CD20-positive atypical cells in the alveolar capillaries, so intravascular lymphoma (IVL) was diagnosed as having. Lymphoma cells were also present in the bone marrow sinusoids, while there was no sign of hemophagocytosis. Combined chemotherapy (CHOP with rituximab) successfully induced complete remission, and she has been free of recurrence for 40 months. In cases with diffuse centrilobular opacities on chest CT, accompanied by elevated serum LDH, it is important to rule out IVL by performing TBLB.
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Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Feminino , Humanos , Pulmão/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Pessoa de Meia-Idade , Radiografia , Neoplasias Vasculares/patologiaRESUMO
BACKGROUND: Inhaled medicines are key drugs for the treatment of asthma or chronic obstructive pulmonary disease. However, the variety of inhaler devices and complicated inhalation procedures have created confusion among patients, affecting their correct understanding of inhalation. Recent studies reported that up to 80% of patients made technical errors in inhalation and emphasized the necessity for patient education. OBJECTIVE: We aimed to assess the importance of inhalation-related instructions and to find clinical factors associated with improvements in the inhalation technique. METHODS: We conducted a retrospective, single-center study at a regional core hospital in Japan. Physicians and community pharmacists constructed an interactive instruction system and shared a common inhalation procedure manual. Patients who received instructions for the inhalation technique at least 3 times were recruited. RESULTS: A total of 125 patients were analyzed in this study. The median age was 73 years (interquartile range, 67-80 years). At the second visit, 67 patients (53.6%) failed to correctly perform the technique despite being guided at the first visit. At the third visit, 48.8% of patients made some errors. After excluding 40 patients who were not subjected to analysis, the remaining 85 were divided into "improvement" and "no-improvement" groups. The total improvement rate was 57.6%. The median time interval between consecutive instructions in the "improvement" groups was 84 days, whereas that in the "no-improvement" group was 128 days (p < 0.05, U test). No significant difference in the age, sex, or primary disease was seen between these groups. CONCLUSION: Repetitive instructions at shorter intervals may be helpful for patients to develop and maintain an improved inhalation technique.
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Bacterial genome is characterized by frequent unmethylated cytosine-phosphate-guanine (CpG) motifs. Deleterious effects can occur when synthetic oligodeoxynucleotides (ODN) with unmethylated CpG dinucleotides (CpG-ODN) are administered in a systemic fashion. We aimed to evaluate the effect of intratracheal CpG-ODN on lung inflammation and systemic inflammatory response. C57BL/6J mice received intratracheal administration of CpG-ODN (0.01, 0.1, 1.0, 10, or 100 microM) or control ODN without CpG motif. Bronchoalveolar lavage (BAL) fluid was obtained 3 or 6 h or 1, 2, 7, or 14 days after the instillation and subjected to a differential cell count and cytokine measurement. Lung permeability was evaluated as the BAL fluid-to-plasma ratio of the concentration of human serum albumin that was injected 1 h before euthanasia. Nuclear factor (NF)-kappaB DNA binding activity was also evaluated in lung homogenates. Intratracheal administration of 10 microM or higher concentration of CpG-ODN induced significant inflammatory cell accumulation into the airspace. The peak accumulation of neutrophils and lymphocytes occurred 1 and 2 days after the CpG-ODN administration, respectively. Lung permeability was increased 1 day after the 10 microM CpG-ODN challenge. CpG-ODN also induced nuclear translocation of NF-kappaB and upregulation of various inflammatory cytokines in BAL fluid and plasma. Histopathology of the lungs and liver revealed acute lung injury and liver damage with necrosis, respectively. Control ODN without CpG motif did not induce any inflammatory change. Since intratracheal CpG-ODN induced acute lung injury as well as systemic inflammatory response, therapeutic strategies to neutralize bacterial DNA that is released after administration of bactericidal agents should be considered.
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Ilhas de CpG/genética , Lesão Pulmonar/induzido quimicamente , Lesão Pulmonar/genética , Pulmão/efeitos dos fármacos , Oligodesoxirribonucleotídeos/efeitos adversos , Pneumonia/induzido quimicamente , Pneumonia/genética , Animais , Relação Dose-Resposta a Droga , Masculino , Camundongos , Camundongos Endogâmicos C57BL , TraqueiaRESUMO
BACKGROUND: CC chemokines play important roles in the pathogenesis of interstitial lung diseases. Elevated CC chemokine levels have been observed in bronchoalveolar lavage (BAL) fluid of patients with idiopathic pulmonary fibrosis (IPF). OBJECTIVES: We aimed to examine whether the levels of four CC chemokines, i.e. monocyte chemoattractant protein-1 (MCP-1/CCL2), macrophage inflammatory protein-1 alpha (MIP-1 alpha/CCL3), thymus- and activation-regulated chemokine (TARC/CCL17), and macrophage-derived chemokine (MDC/CCL22), in BAL fluid are predictive of the prognosis of IPF patients. METHODS: We compared the chemokine levels of patients alive 5 years after diagnosis and those who had died. Lung function data, CT scores, and serum markers were also compared. RESULTS: Among 39 patients (29 males, median age, 60 years), 19 patients (48%) died within 5 years after the diagnosis. Whereas percent vital capacity was not different, percent lung diffusion capacity for carbon monoxide was significantly higher in the surviving patients than in the nonsurviving patients (p < 0.01). Median CCL2 levels of surviving and nonsurviving patients were 154.3 (interquartile range, IQR: 67.3-381.8) and 427.2 (IQR: 329.2-1184.1) pg/ml, respectively (p < 0.02). CCL3 levels in BAL fluid did not differ between the surviving and nonsurviving patients. CCL17 was detected in BAL fluid of 7 patients, 6 of whom died within 5 years. CCL22 was detectable in BAL fluid of 10 patients, only 1 of whom survived. Serum levels of KL-6 and lactate dehydrogenase did not differ between the surviving and nonsurviving patients. CONCLUSION: Elevated levels of CCL2, CCL17 and CCL22 in BAL fluid might be predictive of a poor outcome in patients with IPF.
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Líquido da Lavagem Broncoalveolar/química , Quimiocinas CC/metabolismo , Fibrose Pulmonar Idiopática/metabolismo , Idoso , Quimiocinas CC/análise , Feminino , Humanos , Fibrose Pulmonar Idiopática/mortalidade , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Acute exacerbation of interstitial pneumonia (IP-AE) can occasionally occur and has a poor prognosis. Direct hemoperfusion with a polymyxin B immobilized fiber column (PMX-DHP) has been shown to have a beneficial effect on acute respiratory distress syndrome, which has similar pathological features to that of IP-AE. This study was aimed to investigate the effects of PMX-DHP on IP-AE and serum indicators for epithelial damage. Nine patients with a clinical diagnosis of interstitial pneumonia, who developed acute exacerbation, were included in this study. Five patients had been given a diagnosis of idiopathic pulmonary fibrosis (IPF) and 3 cases were diagnosed as collagen vascular disease-associated interstitial pneumonia (CVD-IP). On days 30 and 60, 6 and 4 patients were surviving, respectively. On day 60, all 3 patients with CVD-IP were alive, while 4 of 5 patients with IPF had died. In 4 patients who survived for 60 days or longer, serum levels of LDH, CRP, and SP-D were significantly decreased after PMX-DHP, whereas KL-6 level was unchanged. In 5 patients, who died by day 60, no significant changes in the serum markers were observed. These data suggest that serum levels of LDH, CRP, and SP-D might be predictive of successful PMX-DHP treatment in cases of IP-AE.
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Biomarcadores/sangue , Hemoperfusão/métodos , Doenças Pulmonares Intersticiais/terapia , Polimixina B , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Doenças Pulmonares Intersticiais/sangue , Masculino , Proteína D Associada a Surfactante Pulmonar/sangueRESUMO
BACKGROUND: Smoking is a cause of cancer and polycythemia. Therefore, surgeons who treat patients with cancer may also encounter patients with polycythemia. However, few cases of surgical patients with polycythemia have been reported; in particular, a surgical case involving smokers' polycythemia has never been reported. We herein report a patient with lung cancer and smokers' polycythemia who successfully underwent lobectomy with control of hematocrit based on a modified formula in the perioperative period. CASE PRESENTATION: A 67-year-old man underwent abdominoperineal resection for rectal carcinoma in June 2008. A ground glass opacity had been identified in the upper lobe of the right lung and was gradually enlarging. In March 2012, bronchoscopic cytology for investigation of the mass revealed non-small cell lung cancer, suggesting primary lung non-small cell carcinoma (T1bN0M0, Stage IA). When he was referred to our hospital for surgery, his complete blood count showed a red blood cell level of 6.50×106/µL, hemoglobin of 21.0 g/dL, and hematocrit of 60.1%. The hematologists' diagnosis was secondary polycythemia due to heavy smoking (smokers' polycythemia) because the white blood cell and platelet counts were within normal limits and the erythropoietin was not increased. We calculated the appropriate phlebotomy and infusion volumes based on a formula that we modified. After 550 g of blood was phlebotomized to reduce the hematocrit to approximately 55%, video-assisted right lung upper lobectomy with lymph node dissection was performed in April 2012. The hematocrit was maintained at <50% postoperatively, and the patient was uneventfully discharged on postoperative day 7. The predictive hematocrit and measured hematocrit were very closely approximated in this case. CONCLUSION: We experienced a patient with smokers' polycythemia who underwent right upper lobectomy for adenocarcinoma. The findings in this case report are meaningful for surgeons treating cancer patients because there are few reports discussing the perioperative care of surgical patients with polycythemia.
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Adenocarcinoma/cirurgia , Neoplasias Pulmonares/cirurgia , Policitemia/complicações , Fumar , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Idoso , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios XRESUMO
With the recent increasing use of nanoparticles, there is concern that they may become an environmental risk factor as airborne particles. However, the impact of these particles on susceptible subjects with predisposing lung disease have not been sufficiently elucidated. In the present study, we investigated the effects of nanoparticles on pulmonary inflammatory and fibrotic changes induced by intratracheal bleomycin (BLM) challenge in mice. Mice were intratracheally administered either vehicle, 14-nm carbon black nanoparticles (CBNPs), BLM or BLM plus CBNP. First, we assessed lung collagen content, lung compliance and fibrotic changes in histopathology on day 21 after instillation. Then, to elucidate how CBNP contributes to the development of BLM-induced fibrosis, we collected bronchoalveolar lavage (BAL) fluid on days 2, 7, 14 and 21 and determined the total and differential cell counts and concentrations of two proinflammatory cytokines (keratinocyte chemoattractant [KC] and interleukin [IL]-6) and two fibrogenic mediators (CC chemokine ligand 2 [CCL2] and transforming growth factor-ß(1) [TGF-ß(1)]). Expression of nitrotyrosine, an indicator of oxidant injury, was also evaluated on days 7 and 21. CBNP, when combined with BLM, significantly enhanced BLM-induced increase in lung collagen content, decrease in lung compliance, and fibrotic changes in histopathology. CBNP significantly augmented BLM-induced increase in the numbers of inflammatory cells in BAL fluid on days 2 and 7 and levels of KC and IL-6 on day 2. In addition, CBNP administered in combination with BLM significantly elevated the levels of CCL2 on days 2, 7 and 14, and TGF-ß(1) on day 14 in BAL fluid as compared with BLM alone. Nitrotyrosine expression was also increased by BLM plus CBNP compared with BLM alone. In contrast, CBNP did not exert any significant effect on these parameters by itself. These results indicate that CBNP can exaggerate BLM-induced inflammatory and fibrotic changes in the lung, suggesting the potential impact of nanoparticles on lung inflammation and fibrosis.