The effect of nurse-led problem-solving therapy on coping, self-efficacy and depressive symptoms for patients with chronic obstructive pulmonary disease: a randomised controlled trial.

OBJECTIVE: to examine the effects of nurse-led, problem-solving therapy (PST) on coping, self-efficacy and depressive symptoms for patients with chronic obstructive pulmonary disease (COPD) using a randomised controlled trial. SUBJECTS: a total of 254 patients with COPD were recruited, screened and randomly allocated into the intervention group with nurse-led PST or the comparison group with usual care. A total of 151 patients (intervention = 78 and comparison = 73) completed the study for 6 months. METHODS: the nurse-led PST was an individualised and patient-centred intervention to improve patients' problem-solving skills related to symptom management and lifestyle modification. Twelve telephone-based PST sessions were provided to the intervention group, while the control group received usual care from their primary care providers. RESULTS: there were no group differences of post-test scores in problem-oriented coping, self-efficacy and depressive symptoms between the two groups. However, despite the lack of group differences, the nurse-led PST was effective for clinically depressed patients with COPD, who experienced decreased depressive symptoms (mean difference = 6.8, P = 0.009) and increased self-efficacy (mean difference = -0.6, P = 0.041) in the intervention group (n = 12). CONCLUSION: the nurse-led PST offered to patients with COPD did not demonstrate any different effects compared with usual care over 6 months; however, a subgroup analysis with clinically depressed subjects showed improved self-efficacy and decreased depressive symptoms in the intervention group.

Predictors of low levels of self-efficacy among patients with chronic obstructive pulmonary disease in South Korea.

The aim of this study was to identify related factors of low levels of self-efficacy in patients with Chronic Obstructive Pulmonary Disease (COPD). A cross-sectional research design used descriptive statistics, χ(2) test, t-test, and binary logistic regression. Two hundred and forty-five patients with COPD were recruited from five hospitals in South Korea. The COPD Self-Efficacy Scale, the Bristol COPD Knowledge Questionnaire, Personal Resource Questionnaire 2000, BODE index, and the International Physical Activity Questionnaire short version were utilized to assess self-efficacy, disease-related knowledge, social support, disease severity, and physical activity, respectively. The BODE index, affect-oriented coping, and duration since diagnosis of COPD were included as significant predictors of self-efficacy. These findings suggest possible screening methods to identify patients with low levels of self-efficacy and future intervention targeting for these patients would strengthen the efficiency of an intervention.

Reducing State Conflicts between Network Motifs Synergistically Enhances Cancer Drug Effects and Overcomes Adaptive Resistance.

Inducing apoptosis in cancer cells is a primary goal in anti-cancer therapy, but curing cancer with a single drug is unattainable due to drug resistance. The complex molecular network in cancer cells causes heterogeneous responses to single-target drugs, thereby inducing an adaptive drug response. Here, we showed that targeted drug perturbations can trigger state conflicts between multi-stable motifs within a molecular regulatory network, resulting in heterogeneous drug responses. However, we revealed that properly regulating an interconnecting molecule between these motifs can synergistically minimize the heterogeneous responses and overcome drug resistance. We extracted the essential cellular response dynamics of the Boolean network driven by the target node perturbation and developed an algorithm to identify a synergistic combinatorial target that can reduce heterogeneous drug responses. We validated the proposed approach using exemplary network models and a gastric cancer model from a previous study by showing that the targets identified with our algorithm can better drive the networks to desired states than those with other control theories. Of note, our approach suggests a new synergistic pair of control targets that can increase cancer drug efficacy to overcome adaptive drug resistance.

A gray box framework that optimizes a white box logical model using a black box optimizer for simulating cellular responses to perturbations.

Predicting cellular responses to perturbations requires interpretable insights into molecular regulatory dynamics to perform reliable cell fate control, despite the confounding non-linearity of the underlying interactions. There is a growing interest in developing machine learning-based perturbation response prediction models to handle the non-linearity of perturbation data, but their interpretation in terms of molecular regulatory dynamics remains a challenge. Alternatively, for meaningful biological interpretation, logical network models such as Boolean networks are widely used in systems biology to represent intracellular molecular regulation. However, determining the appropriate regulatory logic of large-scale networks remains an obstacle due to the high-dimensional and discontinuous search space. To tackle these challenges, we present a scalable derivative-free optimizer trained by meta-reinforcement learning for Boolean network models. The logical network model optimized by the trained optimizer successfully predicts anti-cancer drug responses of cancer cell lines, while simultaneously providing insight into their underlying molecular regulatory mechanisms.

Quantitative evaluation and reversion analysis of the attractor landscapes of an intracellular regulatory network for colorectal cancer.

BACKGROUND: Cancer reversion, converting the phenotypes of a cancer cell into those of a normal cell, has been sporadically observed throughout history. However, no systematic analysis has been attempted so far. RESULTS: To investigate this from a systems biological perspective, we have constructed a logical network model of colorectal tumorigenesis by integrating key regulatory molecules and their interactions from previous experimental data. We identified molecular targets that can reverse cancerous cellular states to a normal state by systematically perturbing each molecular activity in the network and evaluating the resulting changes of the attractor landscape with respect to uncontrolled proliferation, EMT, and stemness. Intriguingly, many of the identified targets were well in accord with previous studies. We further revealed that the identified targets constitute stable network motifs that contribute to enhancing the robustness of attractors in cancerous cellular states against diverse regulatory signals. CONCLUSIONS: The proposed framework for systems analysis is applicable to the study of tumorigenesis and reversion of other types of cancer.

Nutritional status and disease severity in patients with chronic obstructive pulmonary disease (COPD).

The purpose of this study was to identify the relationship between nutritional status and the severity of the disease in patients with COPD in South Korea. This study used pretest data from a larger intervention study. Data were collected from March to October 2010, and 251 patients diagnosed with COPD from five hospitals in South Korea were included in the analysis. All participants were interviewed face-to-face. Actual dietary intake was measured by a 24-h dietary recall, and the body mass index (BMI), obstruction of the airway (FEV1% predicted), degree of dyspnea (modified Medical Research Council: MMRC), and exercise capacity (6min walking distance: 6MWD) (BODE) index was calculated to estimate the severity of the condition. Lower BODE index scores indicate lower risk of mortality. The data were analyzed by descriptive statistics, a χ(2) test, t-tests, analysis of variance (ANOVA), Pearson correlation, and hierarchical multiple regression using SPSS 18.0. The mean age of the participants was 66.83 years and 92.4% of the participants were men. The mean total energy intake was 1431.65kcal, and the mean BODE index score was 2.89. Total energy intake significantly explained additional variance in BODE, BMI, the severity of the perceived dyspnea, and the length of 6min walk after controlling for age, duration after diagnosed with COPD, and physical activities. The findings of this study emphasized the importance of calorie intake in the disease severity among COPD patients. Further research on the effects of nutritional intervention on the health outcomes of patients with COPD is warranted.

Characterization of solitary pulmonary nodules using double phase Tc-99m methoxyisobutylisonitrile scan: Comparison of visual and quantitative analyses.

BACKGROUND: We assessed the diagnostic usefulness of Tc-99m methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) for the evaluation of solitary pulmonary nodule (SPN). METHODS: Thirty-five patients (17 malignant and 18 benign) were recruited. Double phase Tc-99m MIBI SPECT was performed 10 min and then 2 h after an injection of 925 MBq of Tc-99m MIBI. Visual interpretation grades of the Tc-99m MIBI scan were used for the determination of SPN characteristics. Receiver-operator curve analyses were performed for the optimal cut-off values of visual and quantitative indices for differentiation of benign and malignant SPN. RESULTS: The optimal visual grades were grade 4 and 5. When 3+ was used as the cut-off value for the detection of malignant SPN, the sensitivity and specificity of Tc-99m SPECT were 47.1% and 88.9%, respectively. The area under curve (AUC) was 0.758. The optimal planar lesions to non-lesion (L/N) ratios were 2.3 for the early image and 1.6 for the delayed image. The optimal SPECT L/N ratios were 3.1 for the early and 1.6 for the delayed image. The SPECT early L/N was superior to other quantitative indices and visual analysis. CONCLUSION: This study shows that Tc-99m MIBI SPECT is a useful non-invasive method for the evaluation of SPN.

Pulmonary metastasis of Basal cell carcinoma.

Although basal cell carcinoma is the most common skin cancer, it rarely metastasizes. Metastatic basal cell carcinoma may, therefore, initially elude diagnosis and management. We describe the case of a patient with a metastatic basal cell carcinoma present in the lungs. The differential diagnosis of suspected metastatic lesions should include metastases from a cutaneous basal cell carcinoma, in addition to those from more commonly metastasizing carcinomas, especially in patients with a history of a large basal cell carcinoma that has involved the head and neck regions, and was refractory to treatment.

Pulmonary nodular lymphoid hyperplasia associated with Sjögren's syndrome.

Pulmonary nodular lymphoid hyperplasia (NLH) is a term first suggested by Kradin and Mark to describe one or more pulmonary nodules or localized lung infiltrates consisting of reactive lymphoid proliferation. To date, there have been only a few cases of pulmonary NLH reported associated with autoimmune disorders. There is no case of NLH associated with Sjögren's syndrome from Korea in the medical literature. A 56-year-old woman was referred to our hospital with cough productive of sputum and chest tightness. The Computed tomography scans of the chest revealed multiple and well-defined peribronchiolar nodular opacities. A video assisted thoracoscopic surgery (VATS) biopsy was performed and the nodular opacity in the lung parenchyma was pathologically confirmed as NLH. Through meticulous review of patient's record, we found that she had been suffering from dry eye and dry mouth. The symptoms suggested Sjögren's syndrome, which was confirmed by specific laboratory tests including the Schirmer test, anti-nuclear antibody and anti-Ro/La antibody. The patient is followed regularly and has no further progression of symptoms.

Gated blood pool SPECT for measurement of left ventricular volumes and left ventricular ejection fraction: comparison of 8 and 16 frame gated blood pool SPECT.

UNLABELLED: Gated blood pool SPECT (GBPS) is an alternative to planar radionuclide ventriculography (PRNV) and offers potential advantages. The aim of this study was to compare 8 and 16 frame GBPS for the determination of left ventricular ejection fraction(LVEF) and left ventricular volumes (LV) in subjects underwent two consecutive GBPS. METHOD: About 66 consecutive patients (30 men, 36 women; mean age 62.3 +/- 10.4 years) referred for PRNV for evaluation of preoperative cardiac risk stratification (n = 40), prechemotherapy cardiac function evaluation (n = 18, breast cancer), and congestive heart failure patients (n = 8). All patients underwent PRNV of 16 frame and GBPS with both of 8 and 16 frame. RESULTS: The mean LVEF calculated with PRNV (58.3 +/- 16.8), showed statistically lower than 8-GBPS (70.6 +/- 17.7), and 16-GBPS (69.9 +/- 16.8) (PRNV vs. 8-GBPS, p < 0.01; PRNV vs 16-GBPS, p < 0.01; 8-GBPS vs 16-GBPS, p > 0.05). The correlation of LVEFS between 8-GBPS and 16-GBPS showed a correlation coefficient of 0.9194 (p < 0.01, 95% CI = 0.8712-0.9500). The mean left ventricular end-diastolic volumes (EDV) calculated with 8-GBPS (83.2 +/- 33.5 ml), and 16-GBPS (88.4 +/- 36.8 ml) showed no statistical differences (p > 0.05). The mean left ventricular end-systolic volumes (ESV) calculated with 8-GBPS (28.1 +/- 31.4 ml), and 16-GBPS (30.5 +/- 33 ml) showed also no statistical differences (p > 0.05). Comparison of EDV from 8 and 16-GBPS yielded a correlation coefficient of 0.7430 (p < 0.01, 95% CI = 0.6108-0.8349). The correlation between ESV of 8-GBPS and 16-GBPS showed a correlation coefficient of 0.9522 (p < 0.01, 95% CI = 0.9228-0.9705). CONCLUSION: This study demonstrated that the LVEFs of 8-GBPS correlated well with that of 16-GBPS. The LVEF of PRNV was significantly lower than those of 8 and 16-GBPS. Also, left ventricular EDV and ESV of 8-GBPS correlated well with those of 16-GBPS. Also, further studies, involving large lumber patients, should be performed to validate the usefulness of GBPS for the evaluation of left ventricular diastolic function.

Normal gallbladder visualization during post-ablative iodine-131 scan of thyroid cancer.

Whole body iodine-131 scan is a well-established imaging method for the detection of metastatic or residual tumor sites in patients with well-differentiated thyroid cancer. Many false-positive iodine-131 scan findings mimicking metastatic thyroid cancer have long been reported. The authors describe a false positive uptake in normal gallbladder on post-ablative iodine-131 scan in a patient with papillary thyroid cancer. This finding should be considered to be another possible false-positive finding on iodine-131 whole body scan.

Automatic quantification of right ventricular volumes and right ventricular ejection fraction with gated blood pool SPECT: Comparison of 8- and 16-frame gated blood pool SPECT with first-pass radionuclide angiography.

BACKGROUND: The aim of this study was to compare 8- and 16-frame gated blood pool single photon emission computed tomography (SPECT) (GBPS) for the determination of right ventricular ejection fraction (RVEF) and right ventricular (RV) volumes in subjects who underwent two consecutive GBPS studies. METHODS AND RESULTS: In this study 65 consecutive patients (29 men and 36 women) referred for first-pass radionuclide angiography (FP-RNA) underwent FP-RNA and both 8- and 16-frame GBPS. The mean FP-RNA RVEF was statistically lower than RVEF determined by 8-frame GBPS (P < .001) and 16-frame GBPS (P < .001). Comparison of RVEF by FP-RNA and GBPS yielded coefficients of 0.8666 (P < .0001) for 16-frame GBPS and 0.7290 (P < .0001) for 8-frame GBPS. The correlation of RVEF between 8- and 16-frame GBPS showed a coefficient of 0.6657 (P < .0001). The mean RV end-diastolic volume (EDV) calculated with 8- and 16-frame GBPS showed no statistical differences (P = .3580). The mean RV end-systolic volume (ESV) calculated with 8- and 16-frame GBPS also showed no statistical differences (P = .2265). Comparison of EDV by 8- and 16-frame GBPS yielded a coefficient of 0.7327 (P < .0001). The correlation between ESV by 8-frame GBPS and 16-frame GBPS showed a coefficient of 0.6067 (P < .0001). CONCLUSION: GBPS is a simple and reproducible acquisition method for the assessment of RVEF and RV volumes. RVEF values calculated by 8- and 16-frame GBPS correlated well with FP-RNA, although mean RVEF values from FP-RNA were lower than GBPS RVEF values. In addition, RV ESV and EDV were both well correlated with 8- and 16-frame GBPS. GBPS should prove to be useful in diagnosis, as well as in following disease progression and evaluating the efficacy of therapeutic interventions, in patients with biventricular dysfunction.