Clinical characteristics and treatment outcomes of tuberculosis in the elderly: a case control study.

BACKGROUND: The purpose of this study was to evaluate the differences in clinical characteristics and treatment outcomes between older and younger tuberculosis (TB) patients in Korea. METHODS: We retrospectively analyzed the medical records of 271 younger (20-64 years old at diagnosis) and 199 older (≥65 years) TB patients who had been newly diagnosed and treated at Chonnam National University Hospital from May 2008 to August 2010. RESULTS: Dyspnea and comorbid medical conditions were more frequent and positive TB culture rates were higher in older TB patients. In chest computed tomography (CT) scans of pulmonary TB patients, older patients were less likely to have micronodules (<7 mm in diameter), nodules (<30 mm in diameter), masses (>30 mm in diameter), and cavities compared with younger patients, but were more likely to have consolidations. Incidence of adverse drug reactions did not differ between the two groups, except for severe gastrointestinal disorders. There were no significant differences in favorable treatment outcomes between younger and older TB patients (97% vs. 94%, respectively; p = 0.251). CONCLUSIONS: Older TB patients had more frequent dyspnea and less frequent active TB findings on chest CT. Treatment success and adverse drug reaction rates were similar in older and younger TB patients.

Invariant natural killer T cells in chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVE: Invariant natural killer T (iNKT) cells may play an important role in regulating the innate and acquired immune systems in chronic obstructive pulmonary disease (COPD). However, there is little information regarding the potential role of iNKT cells in the pathogenesis of COPD. To investigate whether iNKT cells have an important role in COPD, the frequency of iNKT cells in peripheral blood of patients with COPD was analysed. METHODS: This was a comparative study of 28 patients with COPD and 19 age-matched healthy control subjects. Blood iNKT cells were stained with 6B11 mAb, anti-T cell receptor Vα24 mAb, anti-T cell receptor Vß11 mAb or α-galactosylceramide-loaded CD1d-tetramer, and analysed by flow cytometry. RESULTS: The frequency of CD4(+) 6B11(+) iNKT, CD4(+) Vα24(+) iNKT, CD4(+) Vß11(+) iNKT and CD3(+) 6B11(+) iNKT cells was significantly lower in peripheral blood of patients with COPD than in that of healthy control subjects. The frequency of CD4(+) 6B11(+) iNKT cells was significantly lower in patients with exacerbations of COPD compared with those with stable COPD. CONCLUSIONS: The frequency of iNKT was decreased in peripheral blood of patients with COPD. These results strongly suggest that iNKT cells may play an important role in the pathogenesis of COPD.

Plasma N-terminal pro-brain natriuretic peptide: a prognostic marker in patients with chronic obstructive pulmonary disease.

BACKGROUND: Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are elevated in patients with secondary pulmonary hypertension and chronic lung disease with right ventricular overload. The aim of the present study was to investigate the use of plasma NT-proBNP levels as a prognostic marker of severe COPD with chronic respiratory failure and latent pulmonary hypertension. METHODS: Plasma NT-proBNP levels were measured in 61 patients with stable COPD. Plasma NT-proBNP levels, pulmonary function, PaO(2), and PaCO(2) levels and systolic pulmonary artery pressure were compared according to COPD severity. In addition, we examined correlations between plasma NT-proBNP levels and pulmonary function, PaO(2), PaCO(2), and systolic pulmonary artery pressure. RESULTS: The levels of plasma NT-proBNP significantly increased in patients with stage IV and stage III COPD compared to individuals with stage II COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. The area under the receiver-operating characteristic curve of plasma NT-proBNP for severe to very severe COPD (FEV(1) <50%) was 0.707 (95% confidence interval [CI] 0.566-0.847, P=0.008). Plasma NT-proBNP levels significantly correlated with %FEV(1) (r= -0.557; P < 0.001), arterial blood gas parameters such as PaCO(2) (r = 0.476; P < 0.001) and PaO(2) (r = -0.347; P = 0.031), and systolic pulmonary artery pressure (r = 0.435; P = 0.001). CONCLUSIONS: Plasma NT-proBNP levels increased significantly with disease severity, progression of chronic respiratory failure, and secondary pulmonary hypertension in patients with stable COPD. These results suggest that plasma NT-proBNP can be a useful prognostic marker to monitor COPD progression and identify cases of secondary pulmonary hypertension in patients with stable COPD.

Temozolomide-associated bronchiolitis obliterans organizing pneumonia successfully treated with high-dose corticosteroid.

Temozolomide is an oral alkylating agent with clinical activity against glioblastoma multiforme (GM). It is generally well-tolerated and has few pulmonary side effects. We report a case of temozolomide-associated brochiolitis obliterans organizing pneumonia (BOOP) requiring very high-dose corticosteroid treatment. A 56-yr-old woman presented with a 2-week history of exertional dyspnea. For the treatment of GM diagnosed 4 months previously, she had undergone surgery followed by chemoradiotherapy, and then planned adjuvant chemotherapy with temozolomide. After the 1st cycle, progressive dyspnea was gradually developed. Chest radiograph showed diffuse patchy peribronchovascular ground-glass opacities in both lungs. Conventional dose of methylprednisolone (1 mg/kg/day) was begun for the possibility of BOOP. Although transbronchial lung biopsy findings were compatible with BOOP, the patient's clinical course was more aggravated until hospital day 5. After the dose of methylprednisolone was increased (500 mg/day for 5 days) radiologic findings were improved dramatically.

A Survey of Datasets, Preprocessing, Modeling Mechanisms, and Simulation Tools Based on AI for Material Analysis and Discovery.

Research has become increasingly more interdisciplinary over the past few years. Artificial intelligence and its sub-fields have proven valuable for interdisciplinary research applications, especially physical sciences. Recently, machine learning-based mechanisms have been adapted for material science applications, meeting traditional experiments' challenges in a time and cost-efficient manner. The scientific community focuses on harnessing varying mechanisms to process big data sets extracted from material databases to derive hidden knowledge that can successfully be employed in technical frameworks of material screening, selection, and recommendation. However, a plethora of underlying aspects of the existing material discovery methods needs to be critically assessed to have a precise and collective analysis that can serve as a baseline for various forthcoming material discovery problems. This study presents a comprehensive survey of state-of-the-art benchmark data sets, detailed pre-processing and analysis, appropriate learning model mechanisms, and simulation techniques for material discovery. We believe that such an in-depth analysis of the mentioned aspects provides promising directions to the young interdisciplinary researchers from computing and material science fields. This study will help devise useful modeling in the materials discovery to positively contribute to the material industry, reducing the manual effort involved in the traditional material discovery. Moreover, we also present a detailed analysis of experimental and computation-based artificial intelligence mechanisms suggested by the existing literature.

The impact of the 2007 ATS/IDSA diagnostic criteria for nontuberculous mycobacterial disease on the diagnosis of nontuberculous mycobacterial lung disease.

BACKGROUND: In 2007, the American Thoracic Society (ATS) and Infectious Disease Society of America (IDSA) published new diagnostic guidelines for nontuberculous mycobacterial (NTM) disease. Bacteriological criteria have become simpler compared to the 1997 ATS diagnostic criteria. OBJECTIVE: For assessing the impact of the 2007 ATS/IDSA diagnostic criteria, we compared the diagnosis rate and time to diagnosis of NTM lung disease using the 1997 and 2007 ATS guidelines. METHODS: Sixty-four patients who had excreted Mycobacterium intracellulare, M. avium, M. abscessus or M. kansasii at least one time in their respiratory specimens at Chonnam National University Hospital were reviewed. The 1997 ATS and 2007 ATS/IDSA guidelines were applied to these patients. RESULTS: Thirty-seven of 64 patients (57.8%) were diagnosed with NTM lung disease by the 1997 ATS criteria. When the 2007 ATS/IDSA criteria were applied, 6 patients were newly diagnosed with NTM lung disease. The diagnosis rate significantly increased from 57.8 to 67.2% (p < 0.001). The time to diagnosis in the 1997 ATS and 2007 ATS/IDSA guidelines was 46.4 ± 53.0 and 36.2 ± 38.5 days, respectively (p = 0.002). CONCLUSION: These data suggest that we can shorten the time to diagnose NTM lung disease and diagnose more simply by using the 2007 ATS/IDSA guidelines. Further study will be needed to assess that these changes affect the management of NTM disease.

Influence of diaphragmatic mobility on hypercapnia in patients with chronic obstructive pulmonary disease.

A reduction in diaphragm mobility has been identified in patients with chronic obstructive pulmonary disease (COPD) and has been associated with a decline in pulmonary function parameters. However, little information exists regarding the potential role of diaphragm mobility on hypercapnia in COPD. A new method of assessing the mobility of the diaphragm, using ultrasound, has recently been validated. The purpose of the present study was to investigate the relationship between diaphragm mobility and pulmonary function parameters, as well as that between arterial blood gas values and diaphragm mobility, in COPD patients. Thirty seven COPD patients were recruited for pulmonary function test, arterial blood gas analysis and diaphragm mobility using ultrasound to measure the craniocaudal displacement of the left branch of the portal vein. There were significant negative correlations between diaphragmatic mobility and P(a)CO(2) (r = -0.373, P = 0.030). Diaphragmatic mobility correlated with airway obstruction (FEV(1), r = 0.415, P = 0.011) and with ventilatory capacity (FVC, r = 0.302, P = 0.029; MVV, r = 0.481, P = 0.003). Diaphragmatic mobility also correlated significantly with pulmonary hyperinflation. No relationship was observed between diaphragm mobility and P(a)O(2) (r = -0.028, P = 0.873). These findings support a possibility that the reduction in diaphragm mobility relates to hypercapnia in COPD patients.

Plasma C-reactive protein and endothelin-1 level in patients with chronic obstructive pulmonary disease and pulmonary hypertension.

Pulmonary hypertension is a frequent complication of chronic obstructive pulmonary disease (COPD) and associated with a worse survival and increased risk of hospitalization for exacerbation of COPD. However, little information exists regarding the potential role of systemic inflammation in pulmonary hypertension of COPD. The purpose of the present study was to investigate the degree of C-reactive protein (CRP) and endothelin-1 (ET-1) levels in COPD patient with and without pulmonary hypertension. The levels of CRP and ET-1 were investigated in 58 COPD patient with pulmonary hypertension and 50 patients without pulmonary hypertension. Pulmonary hypertension was defined as a systolic pulmonary artery pressure (Ppa) ≥35 mmHg assessed by Doppler echocardiography. Plasma CRP and ET-1 levels were significantly higher in patients with pulmonary hypertension than in patients without hypertension. There were significant positive correlations between the plasma ET-1 level and CRP level in the whole study groups. For COPD patients, systolic Ppa correlated significantly with plasma CRP levels and plasma ET-1 levels. These findings support a possibility that CRP and ET-1 correlate to pulmonary hypertension in COPD patients.

Sinus histiocytosis with massive lymphadenopathy: a case report with pleural effusion and cervical lymphadenopathy.

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder characterized by a nonneoplastic proliferation of distinctive histiocyte cells within lymph node sinuses and lymphatics in extranodal sites. SHML occurs worldwide and is primarily a disease of childhood and early adulthood. A 26-yr-old man presented with painless palpable lymph node in cervical area. Radiographic studies revealed pleural effusion with lymphadenopathy and calcification in mediastinum. The cervical lymph node biopsy showed dilated sinuses filled with histiocytes with clear cytoplasm. The cells stained positive with CD68 and S-100. These cytologic and immunohistochemical findings were considered consistent with the diagnosis of SHML.

Bacterial pathogens of ventilator associated pneumonia in a tertiary referral hospital.

BACKGROUND: This study evaluates the bacterial pathogens of Ventilator-associated pneumonia (VAP) in a tertiary referral hospital. METHODS: A total of 109 bacterial pathogens from 91 adult patients with VAP, who were admitted to the medical intensive care unit from January 2008 to December 2009, were examined. Clinical characteristics, bacterial pathogens, and resistance profiles were analyzed. RESULTS: Staphylococcus aureus (44%) was the most frequently isolated. Acinetobacter baumanii (30%), Pseudomonas aeruginosa (12%), Stenotrophomonas maltophilia (7%), Klebsiella pneumoniae (6%), and Serratia marcescens (2%) were isolated from the transtracheal aspirates or bronchoalveolar lavage in patients with VAP. There was no significant difference of bacterial pathogens between early and late onset VAP. All isolated S. aureus were methicillin resistant S. aureus; the imipenem resistance rate of A. baumanii was 69%. CONCLUSION: The two most frequent pathogens of VAP were S. aureus and A. baumanii. There were no pathogenic differences between early and late onset VAP.

Proportion and characteristics of transient nodules in a retrospective analysis of pulmonary nodules.

BACKGROUND: Pulmonary nodules manifest as pure or mixed ground glass opacities (GGOs), or solid nodules. METHODS: We retrospectively surveyed 317 cases with pulmonary nodules to observe the proportion and predictive factors of transient lesions in patients with pulmonary nodules. RESULTS: At the initial computed tomography scan, 63.7% showed solid nodules, while 20.2% had mixed GGOs and 16.1% of cases manifested as pure GGOs. Nodules from 114 cases (36%) disappeared or decreased in size during follow up, while in 203 cases (64%), they did not change or became enlarged. During follow up, more than half of the GGOs resolved (66.7% in pure GGOs, 54.7% in mixed GGOs), while only 22.3% of solid nodules resolved. Between transient and persistent pulmonary nodules, significant differences were observed in age, gender, smoking history, presence of eosinophilia, size, and radiologic attenuation of nodules (solid or GGO). In multivariate analysis, age (≤55 years), size of nodules (>15 mm), eosinophilia, and GGO were significant independent predictors of transient nodules. The main causes of transient nodules were pneumonia or eosinophilic pulmonary infiltrates. CONCLUSION: Thirty-six percent of pulmonary nodules resolved spontaneously or with medical treatment. Transient nodules showed different clinical and radiological characteristics from persistent nodules.

Treatment outcome of combination therapy including clarithromycin for Mycobacterium avium complex pulmonary disease.

BACKGROUND/AIMS: The frequency of nontuberculous mycobacteria pulmonary disease in HIV-negative patients is increasing; the most common pathogen in Korea is the Mycobacterium avium complex (MAC). However, few studies have evaluated the treatment outcome of MAC pulmonary disease in Korea. METHODS: The efficacy of a clarithromycin-containing regimen for MAC pulmonary disease was studied in 42 patients treated for more than 6 months between January 2005 and December 2008. All patients were treated with a regimen consisting of clarithromycin, rifampin, and ethambutol. Streptomycin was added in 10 patients. RESULTS: Among the 42 patients, a negative culture conversion was achieved in 33 (78.6%), and the median duration of treatment in these patients was 19 months (interquartile range [IQR], 16 to 22). Of the 33 patients with a negative culture conversion, 14 completed treatment. During the follow-up period (median, 10 months; IQR, 4 to 20) for the 14 patients, one relapsed at 24 months after treatment completion. The culture conversion rate was significantly higher in patients who were treated with more than 500 mg/day clarithromycin (87.1% vs. 54.5%, p = 0.038). CONCLUSIONS: The combined regimen including clarithromycin was effective against MAC pulmonary disease. High-dose clarithromycin of more than 500 mg/day may improve the outcome of patients with MAC pulmonary disease.

Apoptosis of T lymphocytes isolated from peripheral blood of patients with acute exacerbation of chronic obstructive pulmonary disease.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation of the airways and progressive destruction of lung parenchyma. Apoptosis is critical for the maintenance of normal tissue homeostasis and is in equilibrium with proliferation and differentiation. This study was undertaken to investigate relationship between apoptosis of peripheral blood lymphocytes during exacerbation of COPD and inflammatory response that characterizes this condition. MATERIALS AND METHODS: Seventeen patients with COPD exacerbation, 21 stable COPD, and 12 control subjects were included. T lymphocytes were isolated from peripheral blood using MACS. Apoptosis of T lymphocytes was assessed with FACS using annexin V and 7-aminoactinomycin. Serum levels of interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF)-α were determined by an immunoassay technique. RESULTS: There was significantly increased percentage of apoptotic lymphocytes, CD 4+, and CD 8+ T cells in the peripheral blood of patients with exacerbation of COPD compared with stable COPD. Serum levels of IL-6, IL-8, and TNF-α were significantly increased in patients with exacerbation of COPD compared with stable COPD. Only TNF-α presented a positive correlation with apoptotic lymphocytes in patients with exacerbation of COPD. CONCLUSION: Increased apoptotic lymphocytes may be associated with upregulation of TNF-α in the peripheral blood of patients with acute exacerbation of COPD.

Can pleuropulmonary paragonimiasis be cured by only the 1st set of chemotherapy? Treatment outcome and clinical features of recently developed pleuropulmonary paragonimiasis.

PURPOSE: Most patients with pleuropulmonary paragonimiasis can be cured by the initial single set of Praziquantel (PZQ) treatment. However, several cases have been reported to have unsatisfactory responses to the initial PZQ treatment. The objective of this study was to evaluate the clinical findings of patients with pleuropulmonary paragonimiasis who needed additional PZQ treatment after the 1st set chemotherapy. PATIENTS AND METHODS: Thirty-two patients who were diagnosed with pleuropulmonary paragonimiasis at our institution between 2003 and 2008 were retrospectively reviewed. RESULTS: All patients were treated initially with PZQ for 3 days (1st set chemotherapy). Twenty-four patients (75.0%) showed improvement in respiratory symptoms and pulmonary involvements. However, eight patients (25.0%) suffered from relapsed respiratory symptoms and pleural effusion. For these patients, an additional 2nd set PZQ treatment resulted in the resolution of the symptoms and pulmonary involvements. The characteristics of patients who needed multi-set treatments were as follows; longer duration of respiratory symptoms (single vs multi-set treatment group; 6.67 ± 8.08 vs 17.86 ± 11.84 weeks, p=0.009), higher IgG titer (optical density, O.D.) for Pargonimus westermani (ELISA O.D. for PW, 0.54 ± 0.19 vs 0.88 ± 0.16 O.D., p=0.001) and higher frequency of multiple pulmonary lesions (% of patients with multiple lesions; 16.7% vs 50.0%, p=0.059). CONCLUSION: The patients who had a longer duration of respiratory symptoms, higher ELISA titer for PW and/or multiple pulmonary lesions needed an additional PZQ treatment after the 1st set of chemotherapy. Close follow-up after the initial treatment is necessary especially for such patients.