BACKGROUND: Pulmonary mucormycosis (PM) is an emerging infectious disease and a life-threatening infection with high mortality. The clinical outcomes of PM have not improved significantly over the last decade because early diagnosis of PM is difficult and antifungal agents show limited activity. We evaluated the clinical manifestations of PM in a Korean tertiary hospital and identified the role of transbronchial lung biopsy (TBLB) in diagnosing PM in patients admitted to an intensive care unit. METHODS: The medical records of adult patients (aged 16 years and older) who met the criteria for proven or probable PM in a Korean tertiary hospital were retrospectively reviewed from January 2003 to December 2013. The clinical features, computed tomographic findings, diagnostic methods, treatment, and outcomes in patients with PM were evaluated. RESULTS: Of the nine patients, four were male. The median age was 64 years (range, 12 to 73 years). PM was proven and probable in seven and two cases, respectively. Computed tomography findings of PM were unilateral involvement in eight cases (89%), consolidation in eight (89%), ground glass opacity in four (44%), and reverse halo sign in one (11%). Six of nine cases (67%) were diagnosed as PM from TBLB via portable bronchoscopy. There were no complications after TBLB. Mortality rate was 56% (five of nine cases). CONCLUSIONS: TBLB can be an easy and useful technique for diagnosing PM in the intensive care unit.
Adult ; Antifungal Agents ; Biopsy* ; Bronchoscopy ; Communicable Diseases, Emerging ; Critical Care* ; Early Diagnosis ; Glass ; Humans ; Intensive Care Units ; Lung* ; Male ; Medical Records ; Mortality ; Mucormycosis* ; Retrospective Studies ; Tertiary Care Centers

BACKGROUND: Pulmonary mucormycosis (PM) is an emerging infectious disease and a life-threatening infection with high mortality. The clinical outcomes of PM have not improved significantly over the last decade because early diagnosis of PM is difficult and antifungal agents show limited activity. We evaluated the clinical manifestations of PM in a Korean tertiary hospital and identified the role of transbronchial lung biopsy (TBLB) in diagnosing PM in patients admitted to an intensive care unit. METHODS: The medical records of adult patients (aged 16 years and older) who met the criteria for proven or probable PM in a Korean tertiary hospital were retrospectively reviewed from January 2003 to December 2013. The clinical features, computed tomographic findings, diagnostic methods, treatment, and outcomes in patients with PM were evaluated. RESULTS: Of the nine patients, four were male. The median age was 64 years (range, 12 to 73 years). PM was proven and probable in seven and two cases, respectively. Computed tomography findings of PM were unilateral involvement in eight cases (89%), consolidation in eight (89%), ground glass opacity in four (44%), and reverse halo sign in one (11%). Six of nine cases (67%) were diagnosed as PM from TBLB via portable bronchoscopy. There were no complications after TBLB. Mortality rate was 56% (five of nine cases). CONCLUSIONS: TBLB can be an easy and useful technique for diagnosing PM in the intensive care unit.
Adult ; Antifungal Agents ; Biopsy ; Bronchoscopy ; Communicable Diseases, Emerging ; Critical Care ; Early Diagnosis ; Glass ; Humans ; Intensive Care Units ; Lung ; Male ; Medical Records ; Mortality ; Mucormycosis ; Retrospective Studies ; Tertiary Care Centers

There is no therapy currently available that influences the natural history of disease progression in patients with chronic obstructive pulmonary disease (COPD). Although stem cell therapy is considered a potential therapeutic option in COPD, there are no clinical trials proving definitive therapeutic effects in patients with COPD. Recently, it was reported that pioglitazone might potentiate the therapeutic effects of stem cells in patients with heart or liver disease. To test the capacity of pioglitazone pretreatment of stem cells for emphysema repair, we evaluated the therapeutic effects of pioglitazone-pretreated human adipose-derived mesenchymal stem cells (ASCs) on elastase-induced or cigarette smoke-induced emphysema in mice. We also investigated the mechanisms of action of pioglitazone-pretreated ASCs. Pioglitazone-pretreated ASCs had a more potent therapeutic effect than non-pretreated ASCs in the repair of both elastase-induced and smoke-induced emphysema models (mean linear intercept, 78.1±2.5 μm vs 83.2±2.6 μm in elastase models and 75.6±1.4 μm vs 80.5±3.2 μm in smoke models, P<0.05). Furthermore, we showed that pioglitazone-pretreated ASCs increased vascular endothelial growth factor (VEGF) production both in vitro and in mouse lungs in the smoke-induced emphysema model. Pioglitazone-pretreated ASCs may have more potent therapeutic effects than non-pretreated ASCs in emphysema mouse models.
Animals ; Disease Progression ; Emphysema* ; Heart ; Humans ; In Vitro Techniques ; Liver Diseases ; Lung ; Mesenchymal Stromal Cells ; Mice* ; Natural History ; Pancreatic Elastase ; Pulmonary Disease, Chronic Obstructive ; Smoke ; Stem Cells* ; Therapeutic Uses* ; Tobacco Products ; Vascular Endothelial Growth Factor A

Percutaneous bronchial artery embolization and lung resection surgery have been effective for treatments of hemoptysis in patients with pulmonary arteriovenous malformation (PAVM). But, it has been little known about management for recurrent massive hemoptsis in patients with PAVM. It has been reported that Pumpless Extracoporeal Interventional Lung Assist (iLA) are effective for removal of hypercapnea in patient with acute respiratory failure. Here, we report a case of iLA support in a patient with PAVM complicating massive hemoptysis. A 38 year old man developed recurrent massive hemoptysis although interventions of bronchial artery embolization and lung resection surgery. The cause of recurrent hemoptysis was turned out PAVM. After a massive hemoptysis, the patient had severe hypercapnea and acidosis though mechanical ventilation and oxygenation. After iLA implantation, the hypercapnea was resolved and the clinical condition of the patient was improved, temporally. In conclusion, iLA may be a useful for bridge support in patients with prolonged massive hemoptysis.
Acidosis ; Arteriovenous Malformations* ; Bronchial Arteries ; Hemoptysis* ; Humans ; Lung* ; Oxygen ; Respiration, Artificial ; Respiratory Insufficiency

Diabetes insipidus caused by impaired production or reduced responses to vasopressin, can occasionally be seen postoperatively in neurosurgical patients, but rarely occurs during anesthesia and surgery. An 8-year old female patient with suprasellar germinoma was scheduled for tumor resection. Anesthesia was induced smoothly and maintained mainly with sevoflurane. Several hours after anesthesia and surgery, urine output was increased with increased serum sodium concentration, indicating the occurrence of diabetes insipidus. To prevent sodium increase and replace fluid loss, 2.5% dextrose half saline was used. Though sodium concentration did not increase further, the concomitant increase of glucose complicated anesthetic management. After the completion of anesthesia and surgery, serum sodium increased further but then gradually returned to normal with conservative management. The patient was discharged without any complications.
Anesthesia ; Brain ; Child ; Diabetes Insipidus ; Female ; Germinoma ; Glucose ; Humans ; Hypernatremia ; Methyl Ethers ; Sodium ; Vasopressins

BACKGROUND: Asian dust is known to have harmful effects on the respiratory system. Respiratory conditions are also influenced by environmental conditions regardless of the presence of pollutants. The same pollutant can have different effects on the airway when the air is dry compared with when it is humid. We investigated hospital visits for chronic obstructive pulmonary disease (COPD) and asthma in relation to the environmental conditions. METHODS: We conducted a retrospective study using the Korean National Health Insurance Service claims database of patients who visited hospitals in Chuncheon between January 2006 and April 2012. Asian dust, haze, mist, and fog days were determined using reports from the Korea Meteorological Administration. Hospital visits for asthma or COPD on the index days were compared with the comparison days. We used two-way case-crossover techniques with one to two matching. RESULTS: The mean hospital visits for asthma and COPD were 59.37 +/- 34.01 and 10.04 +/- 6.18 per day, respectively. Hospital visits for asthma significantly increased at lag0 and lag1 for Asian dust (relative risk [RR], 1.10; 95% confidence interval [CI], 1.01-1.19; p<0.05) and haze (RR, 1.13; 95% CI, 1.06-1.22; p<0.05), but were significantly lower on misty (RR, 0.89; 95% CI, 0.80-0.99; p<0.05) and foggy (RR, 0.89; 95% CI, 0.84-0.93; p<0.05) days than on control days. The hospital visits for COPD also significantly increased on days with Asian dust (RR, 1.29; 95% CI, 1.05-1.59; p<0.05), and were significantly lower at lag4 for foggy days, compared with days without fog (RR, 0.85; 95% CI, 0.75-0.97; p<0.05). CONCLUSION: Asian dust showed an association with airway diseases and had effects for several days after the exposure. In contrast to Asian dust, mist and fog, which occur in humid air conditions, showed the opposite effects on airway diseases, after adjusting to the pollutants. It would require more research to investigate the effects of various air conditions on airway diseases.
Asian Continental Ancestry Group* ; Asthma ; Dust* ; Gangwon-do ; Humans ; Korea ; National Health Programs ; Pulmonary Disease, Chronic Obstructive ; Respiratory System ; Retrospective Studies ; Weather*

BACKGROUND: Lung cancer is the most common cause of cancer related death. Alterations in gene sequence, structure, and expression have an important role in the pathogenesis of lung cancer. Fusion genes and alternative splicing of cancer-related genes have the potential to be oncogenic. In the current study, we performed RNA-sequencing (RNA-seq) to investigate potential fusion genes and alternative splicing in non-small cell lung cancer. METHODS: RNA was isolated from lung tissues obtained from 86 subjects with lung cancer. The RNA samples from lung cancer and normal tissues were processed with RNA-seq using the HiSeq 2000 system. Fusion genes were evaluated using Defuse and ChimeraScan. Candidate fusion transcripts were validated by Sanger sequencing. Alternative splicing was analyzed using multivariate analysis of transcript sequencing and validated using quantitative real time polymerase chain reaction. RESULTS: RNA-seq data identified oncogenic fusion genes EML4-ALK and SLC34A2-ROS1 in three of 86 normal-cancer paired samples. Nine distinct fusion transcripts were selected using DeFuse and ChimeraScan; of which, four fusion transcripts were validated by Sanger sequencing. In 33 squamous cell carcinoma, 29 tumor specific skipped exon events and six mutually exclusive exon events were identified. ITGB4 and PYCR1 were top genes that showed significant tumor specific splice variants. CONCLUSION: In conclusion, RNA-seq data identified novel potential fusion transcripts and splice variants. Further evaluation of their functional significance in the pathogenesis of lung cancer is required.
Alternative Splicing* ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Exons ; Gene Fusion ; Lung ; Lung Neoplasms ; Multivariate Analysis ; Real-Time Polymerase Chain Reaction ; RNA* ; Sequence Analysis ; Sequence Analysis, RNA*

A 76-year-old Korean woman visited to emergency room because of respiratory arrest and admitted to intensive care unit of the hospital. Severe hypothyroidism was diagnosed after repeated failure of weaning mechanical ventilator. Respiratory arrest and weaning failures were considered to be associated with hypoventilation due to hypothyroidism. She was recovered and weaned from mechanical ventilation after replacement of thyroid hormone. Severe hypothyroidism may be a cause of respiratory failure or weaning failure.
Aged ; Emergency Service, Hospital ; Female ; Humans ; Hypothyroidism* ; Hypoventilation ; Intensive Care Units ; Respiration, Artificial ; Respiratory Insufficiency* ; Thyroid Gland ; Ventilators, Mechanical ; Weaning

BACKGROUND: The development of lung cancer results from the interaction between genetic mutations and dynamic epigenetic alterations, although the exact mechanisms are not completely understood. Changes in DNA methylation may be a promising biomarker for early detection and prognosis of lung cancer. We evaluated the serial changes in genome-wide DNA methylation patterns in blood samples of lung cancer patients. METHODS: Blood samples were obtained for three consecutive years from three patients (2 years before, 1 year before, and after lung cancer detection) and from three control subjects (without lung cancer). We used the MethylationEPIC BeadChip method, which covers the 850,000 bp cytosine-phosphate-guanine (CpG) site, to conduct an epigenome-wide analysis. Significant differentially methylated regions (DMRs) were identified using p-values <0.05 in a correlation test identifying serial methylation changes and serial increase or decrease in β value above 0.1 for three consecutive years. RESULTS: We found three significant CpG sites with differentially methylated β values and 7,105 CpG sites with significant correlation from control patients without lung cancer. However, there were no significant DMRs. In contrast, we found 11 significant CpG sites with differentially methylated β values and 10,562 CpG sites with significant correlation from patients with lung cancer. There were two significant DMRs: cg21126229 (RNF212) and cg27098574 (BCAR1). CONCLUSION This study revealed DNA methylation changes that might be implicated in lung cancer development. The DNA methylation changes may be the possible candidate target regions for the early detection and prevention of lung cancer.

BACKGROUND: Although physical activity is known to be beneficial to lung function, few studies have been conducted to investigate the correlation between physical activity and lung function in dusty areas. Therefore, the purpose of this study is to investigate the correlation between physical activity and lung function in a Korean cohort including normal and COPD-diagnosed participants. METHODS: Data obtained from the COPD in dusty areas (CODA) cohort was analyzed for the following factors: lung function, symptoms, and information about physical activity. Information on physical activity was valuated using questionnaires, and participants were categorized into two groups: active and inactive. The evaluation of the mean lung function, modified Medical Research Council dyspnea grade scores, and COPD assessment test scores was done based on the participant physical activity using a general linear model after adjusting for age, sex, smoking status, pack-years, height, and weight. In addition, a stratification analysis was performed based on the smoking status and COPD. RESULTS: Physical activity had a correlation with high forced expiratory volume in 1 second (FEV₁) among CODA cohort (p=0.03). While the active group exhibited significantly higher FEV₁ compared to one exhibited by the inactive group among past smokers (p=0.02), no such correlation existed among current smokers. There was no significant difference observed in lung function after it was stratified by COPD. CONCLUSION This study established a positive correlation between regular physical activity in dusty areas and lung function in participants.