[Relationship between cough peak flow and onset of pneumonia in residents of geriatric health services facilities].

AIM: Sputum expectoration is associated with cough strength, which can be evaluated by cough peak flow (CPF). Since sputum expectoration can be difficult for patients with reduced CPF, they are more likely to have risk factors for pneumonia. We conducted a study to clarify factors contributing to CPF in residents of geriatric health services facilities and to assess the relationship between CPF and the onset of pneumonia. METHODS: We included 41 male residents of geriatric health services facilities from September to the middle of October 2018. We recorded each subject's age, body mass index (BMI), Performance Status (PS), nursing care level, Functional Independence Measure (FIM), pulse rate, percutaneous arterial oxygen saturation (SpO2), hand grip strength, Charlson comorbidity index, underlying diseases and rales upon auscultation. We also used Pearson's correlation analysis to analyze the relationship between CPF and the above factors. Subjects were assigned to 2 groups according to median CPF to determine the between-group relationships of these factors. Finally, subjects were followed up for 6 to 11 months after CPF measurement to confirm whether or not they developed pneumonia. RESULTS: CPF was positively correlated with BMI (nutritional parameter), hand grip strength (index of systemic muscular strength), and SpO2 The median CPF was 240 L/minute, and subjects were divided into 2 groups based on this valus: CPF ≤240 L/minute group (n=21) and CPF >240 L/minute group (n=20). Subjects in the CPF ≤240 L/minute group demonstrated lower BMI and hand grip strength but more pronounced rales upon auscultation. No statistically significant difference was observed between the 2 groups during the 6-month folloe-up. However, the 11-month follow-up demonstrated a higher incidence of pneumonia in the CPF ≤240 L/minute group. CONCLUSION: The above findings suggest that subjects with reduced CPF are more likely to develop pneumonia. To increase CPF, muscle rehabilitation therapy and nutrition management should be provided to residents of geriatric health services facilities to prevent pneumonia.

The effect of body position on pulmonary function, chest wall motion, and discomfort in young healthy participants.

OBJECTIVE: The purpose of this study was to investigate the effect of different recumbent positions on pulmonary function, chest wall motion, and feelings of discomfort in young nonobese healthy volunteers. METHODS: Twenty healthy volunteers (age, 28.0±1.4 years; height, 167.5±10.1 cm; weight, 62.3±10.2 kg) were studied in the sitting position and in the following 6 recumbent positions: supine, left retroversion at a 45° tilt, left anteversion at a 45° tilt, right retroversion at a 45° tilt, right anteversion at a 45° tilt, and prone. After 5 minutes of a selected position, pulmonary functions, including vital capacity (VC), forced expiratory volume in 1 second, maximal inspiratory and expiratory mouth pressures (MIP and MEP, respectively), and breathing pattern components at the chest wall were assessed. Discomfort was assessed using a modified Borg scale. RESULTS: When participants changed position from sitting to each of the 6 recumbent positions, forced expiratory volume in 1 second values decreased significantly (P < .05). None of the participants showed changes in the MIP or MEP in any of the 6 recumbent positions. Rib cage motion was restricted in all recumbent positions except supine, left anteversion at a 45° tilt, and prone. In all 6 recumbent positions, discomfort was experienced during the pulmonary tests. However, in the left retroversion at a 45° tilt position, no discomfort was experienced during the MIP and MEP assessments. CONCLUSION: In young, nonobese, healthy volunteers, recumbent positions caused diminished pulmonary functions and induced feelings of discomfort.

Postoperative Rotation Deformity of Head-Neck Fragments in Unstable Intertrochanteric Fractures Fixed with Intramedullary Nails.

BACKGROUND: Our purpose was to quantify the postoperative rotation deformity (RD) after osteosynthesis of unstable intertrochanteric fractures (ITFx) using 3D-CT / image processing software, and to clarify the clinical meaning of RD. METHODS: Forty-six consecutive patients with unstable intertrochanteric fractures were enrolled in this study. All were fixed with Gamma 3 Trochanteric nail and RC Lag Screw® (Stryker). We performed 3D-CT evaluations for the rotational deformity of head-neck fragments, the medial cortex support (MCS) between main fragments and bone healing at 3 months postoperatively. RESULTS: The RD was significantly larger in the patients without the MCS (5.1 ± 4.0°, N = 9) than those with the MCS (2.4 ± 2.6°, N = 37) (P = 0.006*). Delayed healing (N=3) was observed in patients without the MCS, and the association between RD and delayed healing was significant (P = 0.003*, cut-off value 6.4°, sensitivity 100% and specificity 90.7%, AUC 0.91). CONCLUSIONS: This study proposed a novel method of measuring postoperative RD. Lack of MCS may lead to RD and consequent delayed healing in unstable ITFx fixed with intramedullary nails.

Sugar and heavy atom effects of glycoconjugated chlorin palladium complex on photocytotoxicity.

Palladium(II) complexes of glycoconjugated porphyrin and pyrrolidine-fused chlorin were prepared to examine sugar and heavy atom effects on in vitro photocytotoxicity. Cellular uptake into HeLa cells was enhanced by introducing sugar units regardless of other features, such as the central ion (free base or palladium(II) ion) and the ring structure (porphyrin or chlorin). The palladium(II) complex of glycoconjugated pyrrolidine-fused chlorin (PdPC2) exerted an excellent degree of photocytotoxicity not only on HeLa cells, but also on metastatic B16-BL6 cells, weakly metastatic B16F1 cells, and metastatic 4T1 cells. However, free-base glycoconjugated pyrrolidine-fused chlorin (PC2) also exerted similar or much higher photocytotoxicity rather than PdPC2. Therefore, the palladium(II) ion did not improve the in vitro photocytotoxicity of PC2. The enhanced singlet oxygen generation of palladium(II) complexes (i.e., the heavy atom effect) was confirmed at least in O(2)-saturated D(2)O. In addition, the formation of hydrogen peroxide and hydroxyl radical were also detected in O(2)-saturated phosphate buffered saline. However, the reactive oxygen species (ROS) generation efficiency, which is the product of the (relative) quantum yield of each ROS and the light absorbing ability, did not fit the trends of photocytotoxicity seen for the photosensitizers. In our glycoconjugated photosensitizers tested, the best indicator of the photocytotoxicity was found to be the light absorbing ability (namely, the oscillator strength in the wavelength region applied in the photocytotoxicity test). These results indicated that photochemical characteristics of glycoconjugated photosensitizers were notably susceptible to the microenvironment. The biological characteristics, such as the sugar effect, were a much more reliable approach to improving the photocytotoxicity of photosensitizers.

Highly reproducible secondary electron imaging under electron irradiation using high-pass energy filtering in low-voltage scanning electron microscopy.

The reproducibility of contrast in secondary electron (SE) imaging during continuous electron irradiation, which caused surface contamination, was investigated using SE high-pass energy filtering in low-voltage scanning electron microscopy (SEM). According to high-pass energy-filtered imaging, dopant contrast in an indium phosphide remained remarkably stable during continuous electron irradiation although the contrast in unfiltered SE images decreased rapidly as a contamination layer was formed. Charge neutralization and the SE energy distributions indicate that the contamination layer induces a positive charge. This results in a decrease of low-energy SE emissions and reduced dopant contrast in unfiltered SE images. The retention of contrast was also observed in high-pass energy-filtered images of a gold surface. These results suggest that this imaging method can be widely used when SE intensities decrease under continuous electron irradiation in unfiltered SE images. Thus, high-pass energy-filtered SE imaging will be of a great assistance for SEM users in the reproducibility of contrast such as a quantitative dopant mapping in semiconductors.

[A case of pulmonary sarcoidosis complicated with bronchial asthma that proved eosinophilic invasion].

A 33-year-old man complaining of cough admitted our hospital for examination of bilateral hilar and mediastinal lymphadenopathy. He diagnosed pulmonary sarcoidosis, because of elevation of serum angiotensin converting enzyme (ACE), epitheloid granuloma with noncaseating necrosis from transbronchial lung biopsy (TBLB) specimen, increasing of lymphocyte and elevation of the CD4/CD8 ratio in bronchoalveolar lavage fluid (BALF). Furthermore, eosinophil ratio in BALF was 3%, hyperplasia of goblet cell, eosinophilic invasion to bronchial epithelium, and thickened basal membrane were found in same biopsy specimen. He had mild reversible airway obstruction. He was diagnosed pulmonary sarcoidosis complicated with bronchial asthma. Sarcoidosis is characteristic of the T helper type 1 (Th1) mediated immune response, and bronchial asthma is characteristic of the Th2. This case histopathologically revealed that both Th1 mediated immune response and Th2 could be coexisted.

Energy-filtered imaging in a scanning electron microscope for dopant contrast in InP.

We demonstrate that energy-filtered secondary electron (SE) imaging can be used effectively to observe dopant contrast from an InP surface covered with a contamination layer formed by continuous electron irradiation. Although dopant contrast from a surface covered with a contamination layer was almost invisible in a normal SE image, it was still clearly seen in the energy-filtered image. The contrast mechanism is explained in terms of a metal-semiconductor contact charging model and energy shift between the SE distributions across p-type and n-type regions. The results suggest that energy-filtered imaging can reduce the effects of a contamination layer.

[A relapse of acute bird-related hypersensitivity pneumonitis due to the use of a feather duvet by a housemate].

In December 2007, a 78-year-old woman was admitted to our hospital complaining of cough and low-grade fever for 1 month. We performed various medical tests and diagnosed acute hypersensitivity pneumonitis. We suspected that the cause of illness was the prolonged use (10 years) of a feather duvet. She was treated with corticosteroids and was advised to avoid using feather duvets. This treatment improved her symptoms. However, she relapsed after 1 year. She had never used a feather duvet since the last admission, but her housemate used a feather duvet in the same room during winter. Bronchoalveolar lavage revealed lymphocytosis. Specific antibodies against pigeon and budgerigar-dropping extracts were present in her serum. On the basis of these findings, we diagnosed acute bird-related hypersensitivity pneumonitis. This condition is rarely caused by indirect exposure. Therefore, we reiterate the significance of obtaining of a detailed medical history to identify relevant antigens.

[Primary pulmonary cryptococcosis with multiple infiltrative shadows complicated by obstructive sleep apnea syndrome].

In November 2007, a 30-year-old obese woman was admitted to our hospital with a complaint of persistent dry cough. Her chest-X-ray and computed tomography revealed multiple infiltrative shadows with air bronchograms in all lung fields. The bronchoalveolar lavage fluid revealed small bodies of Cryptococcus species. Cryptococcal serum antigen was also positive. To examine the cause of her snoring, polysomnography was done and revealed obstructive sleep apnea syndrome. The patient was given a diagnosis of primary pulmonary cryptococcosis with obstructive sleep apnea syndrome. After 12 months of treatment with fluconazole, the infiltrative shadows disappeared. Pulmonary cryptococcosis should be considered in the differential diagnosis of pulmonary multiple infiltrated shadows in patients without immunological abnormalities.

Bronchodilator Reversibility Occurring during the Acute Phase of Paragonimiasis westermani Infection.

A 43-year-old woman was referred to our hospital with peripheral blood hypereosinophilia and abnormal chest X-ray findings. Her pleural effusion revealed hypereosinophilia and a low glucose level. She was diagnosed with pulmonary paragonimiasis based on an elevated antibody level of Paragonimiasis westermani. Although she had no medical history of allergic disorders, a pulmonary function test revealed bronchodilator reversibility. After praziquantel therapy, her symptoms, hypereosinophilia in peripheral blood, and pleural effusion were improved. A repeated pulmonary function test after praziquantel therapy showed a negative bronchodilator response. Pulmonary paragonimiasis may induce bronchodilator reversibility during the acute phase of infection.

[A case of endobronchial actionomycosis evaluated by FDG-PET].

In April 2005, a 78-year-old man was admitted to our hospital because an abnormal chest shadow had been noted on a medical examination. Our investigation revealed primary squamous cell lung carcinoma in the right lower lobe (stage IIIA). Right middle and lower lobectomies including resection of the chest wall were performed. 18Fluorodeoxyglucose-positron emission tomography (FDG-PET) conducted 18 months later demonstrated nodular lesions with intense FDG activity in the right upper lobe and the presence of a post-resection positive bronchial stump. Fiberoptic bronchoscopic examination revealed a pus-coated mass located in the endobronchial lesion, and Actinomyces was identified in a biopsy specimen of the mass. Endobronchial actinomycosis was diagnosed. An FDG-PET examination conducted after the patient was treated with amoxicillin (AMPC) for 2 months, did not indicate any FDG activity in the endobronchial lesion.

Early Intensive Nutrition Intervention with Dietary Counseling and Oral Nutrition Supplement Prevents Weight Loss in Patients with Advanced Lung Cancer Receiving Chemotherapy: A Clinical Prospective Study.

BACKGROUND: Weight loss in patients with cancer is caused by cancer cachexia and chemotherapy-induced nausea and vomiting (CINV). Recent developments in antiemetic drugs have substantially improved CINV, but nutritional intervention did not improve body weight. This study aimed to investigate the effects of nutrition intervention with appropriate antiemetic treatment in patients with non-small-cell lung cancer during chemotherapy. METHODS: Patients received individualized nutrition counseling by a registered dietitian and were provided with oral supplements for 90 days. Body weight and other parameters were measured at baseline and after 90-day intervention. To evaluate this nutrition intervention, patients were also retrospectively set as control, and then body weight change was compared with inverse probability of treatment weights (IPTW) analysis. RESULTS: Ten patients received individualized nutrition counseling and were provided with oral supplements for 90 days. Of them, 7 patients consumed nutritional supplements, and the mean intake was 130 kcal/day. After 90-day intervention, the patients did not show significant weight and BMI loss during the course of cytotoxic chemotherapy. A total of 38 patients were retrospectively enrolled as controls. The number of the patients who gain the body weight after 90 days in the study cohort was significantly larger than that in the retrospective controls with the IPTW analysis (Odds Ratio (OR) = 8.4; 95% Confidence Interval (CI): 1.6-42; P = 0.01). CONCLUSION: Early intensive nutrition intervention with appropriate antiemetic treatment prevents weight loss. Nutrition interventions might be also beneficial for quality of life, treatment response and survival.

Successful resection of posterior mediastinal thyroid cancer by partial sternotomy combined with video-assisted thoracoscopy.

We report on a rare case of substernal thyroid carcinoma extending into the posterior mediastinum of a 48-year-old man. The tumor was resected by partial sternotomy and a small anterior thoracotomy, combined with video-assisted thoracoscopy. The pathological diagnosis was of a well differentiated papillary adenocarcinoma of the thyroid with mediastinal extension. The patient had an uneventful postoperative course and no recurrence of tumor 6 months after surgical treatment. We describe this surgical approach and discuss the advantage for cervicothoracic tumors extending into the posterior mediastinum.

[A case of tuberculous pleurisy with a rapid decrease in pleural effusion].

We report a rare case of tuberculous pleurisy with a rapid decrease in pleural effusion by levofloxacin. A 73-year-old woman admitted due to dyspnea on exertion of one month duration. She had aortitis syndrome which had been treated with oral prednisolone for 6 months. Chest roentgenogram showed left pleural effusion, which was exudative with lymphocyte predominance and an increased level of adenosine deaminase. One-week administration of levofloxacin remarkably decreased effusion. as demonstrated on chest roentgenogram 2 weeks after treatment. Since Mycobacterium tuberculosis was isolated in culture from bronchial lavage fluid and sputum, we prescribed antituberculous therapy with isoniazid, rifampicin and ethambutol. resulting in complete resolution.

A case of lung abscess successfully treated by transbronchial drainage using a guide sheath.

A 51-year-old man was diagnosed with colon cancer in September 2011, and a solitary pulmonary nodule was detected by computed tomography (CT) scan. We performed a transbronchial biopsy with endobronchial ultrasonography using a guide sheath (GS) and diagnosed lung metastasis of colon cancer. The patient experienced remittent fever after the biopsy in spite of intravenous antibiotic therapies. Moreover, his CT scan showed a large lung abscess at the biopsy site. We performed transbronchial drainage using a GS as salvage therapy. The bloody pus was successfully aspirated, and chest X-ray following the procedure showed dramatic shrinkage of the abscess.

Disseminated Mycobacterium intracellulare infection with multiple abscesses on extremities in a woman with chronic corticosteroid therapy.

A 78-year-old Japanese woman with rheumatoid arthritis was admitted to our hospital due to fever. She had been prescribed prednisolone and bucillamine. Computed tomography revealed abscesses on extremities. M. intracellulare was cultured from her calcaneus osteomyelitis, and this result pointed to a disseminated mycobacterial infection. We drained the abscesses and found M. intracellulare. We started antimycobacterial agents, but the patient died finally. Disseminated mycobacterial infection is rare but critical, and the possibility of such an infection in an immunocompromised patient should be a prime consideration when choosing appropriate drugs and surgical approaches.

Development of fever following first administration of zoledronate as a prognostic factor in advanced non-small cell lung cancer patients with bone metastases.

Nitrogen-containing bisphosphonates (N-BPs), which are usually used for the treatment of advanced cancer with bone metastasis, occasionally cause fever following the first administration. However, it is unclear as to how the development of fever following the first administration of N-BP is associated with clinical outcome. The aim of the present study was to determine the prognostic value of the development of fever following the first administration of N-BP in advanced non-small cell lung cancer patients with bone metastases. The present study reviewed the data of 46 patients with advanced non-small cell lung cancer who were administered zoledronate (ZOL), an N-BP, for bone metastasis, between March 2009 and March 2011 in the Department of Medical Respirology at Tottori University Hospital. Clinicopathological factors were evaluated using univariate and multivariate analyses, and these factors were compared between the fever and non-fever groups. Of the 46 patients, 15 (32.6%) developed fever following the first administration of ZOL. No significant differences were observed in the clinicopathological characteristics between the two groups. The overall survival in the fever group was significantly longer compared with the non-fever group (median survival time: 33.4 vs. 15.7 months, P=0.04), and the development of fever following the first ZOL administration was independently associated with longer overall survival. The development of fever following the first ZOL administration was an independent prognostic factor in advanced non-small cell lung cancer patients with bone metastases. Thus, ZOL-associated fever may be a predictive factor for an undefined, survival-promoting effect of ZOL.

Relationship between Oxidative Stress, Physical Activity, and Vitamin Intake in Patients with Asthma.

BACKGROUND: Oxidative stress plays an important role in the pathogenesis of bronchial asthma. Antioxidant nutrition and supplementation have been used to reduce oxidative stress. However, a clinical trial with antioxidant supplementation showed no beneficial effects in patients with asthma. On the other hand, physical activity is related to the prognosis of chronic obstructive pulmonary disease (COPD) and is also related to oxidant status. We investigated the relationships between oxidative stress, serum levels of vitamins, dietary vitamin intake, daily activities, and pulmonary functions in patients with asthma. METHODS: Eighteen patients with bronchial asthma were enrolled in this study. Reactive oxidative stress was assessed by measuring organic hydroperoxides (diacron reactive oxygen metabolites: dROM) in sera and by measuring H2O2 levels in exhaled breath condensates. The biological antioxidant capacity in serum was evaluated by measuring antioxidant potential capacity against ferric ion. We also assessed pulmonary functions, fraction of exhaled nitric oxide, serum levels of vitamins, dietary vitamin intake, and physical activities. RESULTS: There were no relationships between the index of oxidative stress (dROM and H2O2 in exhaled breathe condensates) and pulmonary functions, serum levels of vitamins, daily vitamin intakes, and activity levels in patients with asthma. CONCLUSION: The status of transient oxidative stress may not be related to daily activities, vitamin levels, and pulmonary functions in patients with asthma in a real-life setting. However, our results were obtained in the short-term period from a small number of subjects, so a large longitudinal study is required to ascertain the relationships between oxidative stress, physical activity and vitamin intake in patients with asthma.

Frequency of Epidermal Growth Factor Receptor Mutation in Smokers with Lung Cancer Without Pulmonary Emphysema.

BACKGROUND: Chronic obstructive pulmonary disease is a smoking-related disease, and is categorized into the emphysema and airway dominant phenotypes. We examined the relationship between emphysematous changes and epidermal growth factor receptor (EGFR) mutation status in patients with lung adenocarcinoma. PATIENTS AND METHODS: The medical records for 250 patients with lung adenocarcinoma were retrospectively reviewed. All patients were categorized into the emphysema or non-emphysema group. RESULTS: Wild-type EGFR was detected in 136 (54%) and mutant EGFR in 48 (19%). Emphysematous changes were observed in 87 (36%) patients. EGFR mutation was highly frequent in the non-emphysema group (p=0.0014). Multivariate logistic regression analysis showed that emphysema was an independent risk factor for reduced frequency of EGFR mutation (Odds Ratio=3.47, p=0.005). CONCLUSION: Our data showed a relationship between emphysematous changes and EGFR mutation status. There might be mutually exclusive genetic risk factors for carcinogenesis and development of emphysematous changes.

[Successful outpatient treatment with chemotherapy of weekly gemcitabine and vinorelbine for a patient with recurrent lung cancer].

A 68-year-old man with recurrent lung cancer was treated with chemotherapy of weekly gemcitabine and vinorelbine on an outpatient basis. After 2 cycles of the regimen, shadows in the lung completely disappeared. During this treatment, the patient's condition was good. This regimen seems to be effective in maintaining QOL and may be suitable for outpatients.