<i>Background:</i> Asthma is characterized by airway hyperresponsiveness (AHR), inflammation and remodeling. Peroxisome proliferator-activated receptors (PPARs) were reported to regulate inflammatory responses in many cells. In this study we examined the effect of a PPAR-γ agonist on the airway smooth muscle and the production of transforming growth factor (TGF)-β1 and vascular endothelial growth factor (VEGF). <i>Methods:</i> We developed a mouse model of airway remodeling including smooth muscle thickening in which ovalbumin (OVA)-sensitized mice were repeatedly exposed to intranasal OVA administration twice a week for 3 months. Mice were treated intranasally with ciglitazone during OVA challenge. <i>Results:</i> Mice chronically exposed to OVA developed sustained eosinophilic airway inflammation and AHR to methacholine compared with control mice. In addition, the mice chronically exposed to OVA developed features of airway remodeling, including thickening of the peribronchial smooth muscle layer. Administration of ciglitazone intranasally significantly inhibited the development of AHR, eosinophilic inflammation, and importantly, airway smooth muscle remodeling in mice chronically exposed to OVA. However, intranasal ciglitazone treatment did not reduce the level of TGF-β1 and VEGF in bronchoalveolar lavage fluid. <i>Conclusions:</i> These results suggest that intranasal administration of ciglitazone can prevent not only airway inflammation, but also airway remodeling associated with chronic allergen challenge. The mechanism might not be related to VEGF and TGF production. Further study is needed.
The aim of this study was to analyze clinical situations requiring rigid bronchoscopy and evaluate usefulness of rigid bronchoscopic intervention in benign or malignant airway disorders.We retrospectively reviewed 29 patients who underwent rigid bronchoscopy from November 2007 to February 2011 at St. Paul's Hospital, The Catholic University of Korea School of Medicine.Of the 29 patients, the most frequent underlying etiology was benign stenosis of trachea (n=20). Of those 20 patients, 16 had post-intubation tracheal stenosis (PITS), 2 had tracheal stenosis due to inhalation burn (IBTS) and other 2 had obstructive fibrinous tracheal pseudomembrane (OFTP). Other etiologies were airway malignancy (n=6), endobronchial stenosis due to tuberculosis (n=2), and foreign body (n=1). For treatment, silicone stent insertion was done in 16 cases of PITS and IBTS and mechanical removal was performed in 2 cases of OFTP. In 6 cases of malignant airway obstruction mechanical debulking was performed and silicone stents were inserted additionally in 2 cases. Balloon dilatation and electrocautery were used in 2 cases of endobronchial stenosis due to tuberculosis. In all cases of stent, airway obstructive symptom improved immediately. Granulation tissue formation was the most common complication.Tracheal stenosis was most common indication and silicone stenting was most common procedure of rigid bronchoscopy in our center. Rigid bronchoscopic procedures, at least tracheal silicone stenting, should be included in pulmonary medicine fellowship programs because it is a very effective and indispensable method to relieve critical airway obstruction which needs training to learn.
Gout is a chronic inflammatory disease of which the development is associated with metabolic abnormality caused by obesity. However, there are a substantial number of non-obese patients (body mass index (BMI) <25 kg/m2) who develop gout in Korea. As it has been suggested that accumulation of visceral fat, rather than subcutaneous fat is associated with metabolic abnormality and hyperuricemia in patients with gout, we hypothesized that visceral fat accumulation was increased in non-obese gout patients.
Objectives
In the present study, we characterized the components of metabolic syndrome, and examined the association of visceral fat obesity and gout, especially focused on non-obese population.
Methods
One hundred and three male patients with primary gout and 204 age - matched healthy controls who attended health check-up examination were recruited by medical chart review. Visceral fat area (VFA) was measured by bioelectrical impedance analysis (BIA), and VFA>100cm2 was defined as visceral fat obesity (VFO). The frequency of VFO was compared in patients and control groups. The frequency of metabolic syndrome as well as its components was investigated.
Results
The prevalence of metabolic syndrome in patients with gout was 31.7% (33/104) according to modified ATP III criteria. BMI (26.3±3.8 vs. 23.4±2.4 kg/m2, P<0.001), waist circumference (91.2±9.7 vs. 82.3±7.5 cm, P<0.001), total fat mass (20.8±7.6 vs. 15.1±4.4 kg) the serum triglyceride level (178.6±99.7 vs. 89.9±38.3 mg/dL), the serum glucose level (101.2±21.3 vs. 89.8±6.8) were significantly greater in patients than controls. VFA was increased in gout patients compared to controls (115.8±27.0 vs. 97.7±20.2 cm2, P<0.001) and the prevalence of VFO was also higher in patients group (71.8% vs. 41.2%, P<0.001). There were significant correlations between VFA and the serum triglyceride level (Spearman9s rho =0.274, P<0.001) and the serum glucose level (rho =0.324, P<0.001). In non-obese subgroup analysis (gout patients =38, healthy controls =150), VFA (98.7±19.3 vs. 91.0±16.7, P=0.016) and the frequency of VFO (47.4 vs. 27.3%, P=0.017) remained significantly higher in patients group. There was no difference in either BMI or the total fat mass between patients and controls in the non obese subgroup.
Conclusions
VFO determined by BIA is more frequently observed in patients with primary gout compared to healthy controls, even in non-obese subgroup analysis and VFA correlated well with components of metabolic syndrome. Thus, it seems that VFO may properly represent metabolic derangement in both obese and non-obese patients with gout.
Pulmonary capillary hemangiomatosis (PCH) is a progressive and refractory vascular disease in the lung. Pulmonary hypertension is frequently combined with PCH when capillary proliferation invades to nearby pulmonary vascular systems. It is difficult to differentiate PCH from other diseases such as pulmonary venoocclusive disease and pulmonary arterial hypertension that cause pulmonary hypertension as they frequently overlap. A 29-year-old female who had worked at a bathtub factory presented with progressive exertional dyspnea for the past 2 years. Computed tomography revealed centrilobular, diffusely spreading ground-glass opacities sparing subpleural parenchyma with some cystic lesions and air-trapping in both lungs, suggesting a peculiar pattern of interstitial lung disease with airway involvement. There was not any evidence of right heart failure or pulmonary hypertension on echocardiogram, as well as radiography. Microscopic examination of the lung by thoracoscopic resection showed atypical proliferation of capillary channels within alveolar walls and interlobar septa, without invasion of large vessels. We experienced a pathologically diagnosed PCH in a young female complaining progressive dyspnea with prior exposure to occupational silica or organic solvent without elevated right ventricular systolic pressure (RVSP) who showed atypical pattern of radiologic findings.
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems and endangered the control and prevention of tuberculosis (TB). We investigated the nationwide effects of COVID-19 on the national Public-Private Mix (PPM) TB control project in Korea, using monitoring indicators from the Korean PPM monitoring database. METHODS: The Korean PPM monitoring database includes data from patients registered at PPM hospitals throughout the country. Data of six monitoring indicators for active TB cases updated between July 2019 and June 2020 were collected. The data of each cohort throughout the country and in Daegu-Gyeongbuk, Seoul Metropolitan Area, and Jeonnam-Jeonbuk were collated to provide nationwide data. The data were compared using the χ² test for trend to evaluate quarterly trends of each monitoring indicator at the national level and in the prespecified regions. RESULTS: Test coverages of sputum smear (P = 0.622) and culture (P = 0.815), drug susceptibility test (P = 0.750), and adherence rate to initial standard treatment (P = 0.901) at the national level were not significantly different during the study period. The rate of loss to follow-up among TB cases at the national level was not significantly different (P = 0.088); however, the treatment success rate among the smear-positive drug-susceptible pulmonary TB cohort at the national level significantly decreased, from 90.6% to 84.1% (P < 0.001). Treatment success rate in the Seoul metropolitan area also significantly decreased during the study period, from 89.4% to 84.5% (P = 0.006). CONCLUSION: Our study showed that initial TB management during the COVID-19 pandemic was properly administered under the PPM project in Korea. However, our study cannot confirm or conclude a decreased treatment success rate after the COVID-19 pandemic due to limited data.
Purpose : The purpose of this study is to apply the standardized BLS education program provided by the Korean Cardiopulmonary Resuscitation Association and to verify its effectiveness to help increase the intention of CPR. Methods : This study is a quasi-experimental study of the nonquivalent control group pretest-posttest design. The subjects were first and second grade students, who were attending D university in Daegu, 67 in experimental group and 70 in control group. The data were analyzed using a statistical program(SPSS 22.0). Results : As a result of the homogeneity test on the attitude, subjective norm, and self-efficacy of CPR, the two groups were homogeneous. There was a statistically significant difference in the attitudes toward CPR in the experimental group from 69.0 points to 72.7 points(t＝-2.39, p＝.020). In addition, self-efficacy was significantly different from 74.3 points to 89.8 points(t＝-4.00, p＜.001). After educating in the experimental group, the number of students who answered “Definitely I will do CPR” increased from 20.9% to 28.4%. Conclusion : There is a need for a standardized educational program that enhances self-efficacy that affects CPR intention and behavior in college students.
Background: There is very limited data present on smoking cessation rates in outpatient departments of pulmonology.In this study, we aimed to investigate the effectiveness of a brief smoking cessation intervention program in an outpatient department of pulmonology and identify predictors of smoking cessation failure.Methods: After a brief recommendation of smoking cessation from pulmonologists, smokers willing to quit smoking were given individual counseling and supplement drugs.Fifty smokers were included in this study and baseline characteristics, smoking history and success rate were reviewed at 3 months.Results: The mean age of the patients was 58.3±14.6 years and the total group of patients included 3 women.The rate of smoking cessation success was 74% at 3 months, and there were no differences in age, spirometric indexes and associated diseases between the smoking cessation success and failure group.The rate of supplement drug usage was not different in both groups either.However, body weight, mean number of cigarette usage per day and nicotine dependence scores in the failure group were significantly higher than in the success group.In multivariate analysis, body weight and mean number of cigarette usage per day were significant.Two smokers with a depressive disorder failed the smoking cessation.Conclusion: A smoking cessation intervention program in the outpatient department of pulmonology showed a favorable success rate.More intensive interventions are needed to unfavorable groups which include the obese and heavy smokers.
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