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Respiratory medicine 81건

  1. [해외논문]   City housing atmospheric pollutant impact on emergency visit for asthma: A classification and regression tree approach   SCI SCIE

    Mazenq, Julie (Pediatric Pulmonology Department, Timone Children's Hospital, Aix-Marseille University, Marseille, France ) , Dubus, Jean-Christophe (Pediatric Pulmonology Department, Timone Children's Hospital, Aix-Marseille University, Marseille, France ) , Gaudart, Jean (Aix Marseille University, IRD, INSERM, SESSTIM, 13005 Marseille, France ) , Charpin, Denis (Pulmonology and Allergology Department, Hospital Nord, Marseille, France ) , Viudes, Gilles (Regional Emergencies Observatory, Provence-Alpes-Cote d'Azur Region (ORU PACA), France ) , Noel, Guilhem (Regional Emergencies Observatory, Provence-Alpes-Cote d'Azur Region (ORU PACA), France)
    Respiratory medicine v.132 ,pp. 1 - 8 , 2017 , 0954-6111 ,

    초록

    Abstract Introduction Particulate matter, nitrogen dioxide (NO 2 ) and ozone are recognized as the three pollutants that most significantly affect human health. Asthma is a multifactorial disease. However, the place of residence has rarely been investigated. We compared the impact of air pollution, measured near patients' homes, on emergency department (ED) visits for asthma or trauma (controls) within the Provence-Alpes-COte-d’Azur region. Methods Variables were selected using classification and regression trees on asthmatic and control population, 3–99 years, visiting ED from January 1 to December 31, 2013. Then in a nested case control study, randomization was based on the day of ED visit and on defined age groups. Pollution, meteorological, pollens and viral data measured that day were linked to the patient's ZIP code. Results A total of 794,884 visits were reported including 6250 for asthma and 278,192 for trauma. Factors associated with an excess risk of emergency visit for asthma included short-term exposure to NO 2 , female gender, high viral load and a combination of low temperature and high humidity. Conclusion Short-term exposures to high NO 2 concentrations, as assessed close to the homes of the patients, were significantly associated with asthma-related ED visits in children and adults. Highlights “What is new?” Keys findings: High concentration of NO 2 , measured near patients' homes, increased the risk for emergency department visit for asthma. What is known: A relationship between short-term exposure to air pollution and emergency room visits for asthma has been demonstrated. What does this add: Our study confirms the excess risk of asthma emergency visits linked to air pollution close to where the patients live. What is the implication: Emissions of NO 2 are linked to road traffic. Preventative strategies should be implemented to reduce and vehicles emissions.

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  2. [해외논문]   Toxicity risk from glucocorticoids in sarcoidosis patients   SCI SCIE

    Khan, Nauman A. (Department of Hospital Medicine, Cleveland Clinic, USA ) , Donatelli, Christopher V. (Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, Louis Stoke Cleveland VA Medical Center, Case Western Reserve University, USA ) , Tonelli, Adriano R. (Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, USA ) , Wiesen, Jonathan (Community Intensivists Group, Cleveland & Ben Gurion University, Israel ) , Ribeiro Neto, Manuel L. (Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, USA ) , Sahoo, Debasis (Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, USA ) , Culver, Daniel A. (Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, USA)
    Respiratory medicine v.132 ,pp. 9 - 14 , 2017 , 0954-6111 ,

    초록

    Abstract Background Glucocorticoids (GC) are considered first-line therapy for treating sarcoidosis, but there are few data about the adverse consequences of GC. Although there are several steroid-sparing medications available for treatment, a large proportion of patients are treated with prolonged courses of GC. The toxicities of GC in sarcoidosis populations have not been carefully evaluated. Methods We performed a retrospective cohort study of all newly diagnosed sarcoidosis patients who had the entirety of their medical care in a single health system. We analyzed the time to development of a composite toxicity end-point, including diabetes, hypertension, weight gain, hyperlipidemia, low bone density and ocular complications of GC using Cox proportional hazards analysis. Results One hundred and five patients were ever treated with GC, whereas 49 were not treated during a median follow-up of 101 months. GC-treated patients developed 1.3 ± 1.1 toxicities during therapy, versus 0.6 ± 1.0 in the non-treated group. After adjustment for age, gender, race and preexisting conditions, the hazard ratio for ever-treated patients was 2.37 (1.34–4.17) for the composite end-point. Age and the presence of preexisting conditions also were associated with reaching the end-point. Similar effects were seen when analyzed for cumulative GC dose and for duration of GC use. For individual end-points, weight gain (HR 2.04) and new hypertension (HR 3.36) were associated with any use of GC. Conclusions Our data suggest that GC are associated with clinically important toxicities in sarcoidosis patients, associated with both the cumulative dose and duration of treatment. Highlights Standard therapy of sarcoidosis includes steroids, often in prolonged courses. Long-term steroids for sarcoidosis are associated with significant comorbidity. Steroid therapy in sarcoidosis needs to be re-evaluated and minimized when possible.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

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  3. [해외논문]   Annual progression of endothelial dysfunction in patients with COPD   SCI SCIE

    Clarenbach, Christian F. (Pulmonary Division, University Hospital Zurich, Zurich, Switzerland ) , Sievi, Noriane A. (Pulmonary Division, University Hospital Zurich, Zurich, Switzerland ) , Kohler, Malcolm (Pulmonary Division, University Hospital Zurich, Zurich, Switzerland)
    Respiratory medicine v.132 ,pp. 15 - 20 , 2017 , 0954-6111 ,

    초록

    Abstract Background The risk to die from cardiovascular disease is particularly high in patients with COPD. This longitudinal study aims to evaluate changes of endothelial function over time and identify underlying mechanisms in COPD patients. Methods In stable COPD patients we performed annual assessments of endothelial function by flow-mediated dilatation (FMD), lung function, systemic inflammation and cholesterol, sympathetic activation, oxygenation, physical activity and exercise capacity. Associations between annual changes of potential predictors and FMD were investigated in mixed analysis. Results 76 patients (41% GOLD stage 1/2, 30% 3, 29% 4) were included. Endothelial function significantly decreased annually by −0.14% (95%CI -0.25/-0.04), equal to a relative decrease of −5.6%. Yearly change in 6-min walking distance was significantly associated with FMD in univariable analysis (Coef. −0.00, p = 0.045). Progressive airway obstruction and increase in level of total cholesterol were borderline significant with a greater decrease in FMD (Coeff. −0.02, p = 0.097 and Coeff. −0.16, p = 0.080, respectively). In multivariable analysis a greater annual decline in FEV1 tends to be independently associated with a decrease in FMD (p = 0.085). Conclusion The findings of this study demonstrated that COPD patients experience a significant decrease in endothelial function over time. A greater annual decline in lung function tends to be associated with greater decrease in FMD. However, no other independent predictors for endothelial dysfunction could be identified. Clinical trial registration www.ClinicalTrials.gov, NCT01527773. Highlights The evolution of endothelial function in COPD is unknown. COPD patients experience a significant decrease in endothelial function over time. A greater annual decline in FEV1 showed a trend towards greater decrease in FMD.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

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  4. [해외논문]   A systematic review of school-based interventions that include inhaler technique education   SCI SCIE

    Geryk, Lorie L. (Center for Health Systems Effectiveness, Oregon Health & Sciences University, 3181 S.W. Sam Jackson Park Road, Mail Code: MDYCHSE, Portland, OR 97239, USA ) , Roberts, Courtney A. (Division of Pharmaceutical Outcomes and Policy, University of North Carolina, 301 Pharmacy Lane, CB#7355, Chapel Hill, NC 27599, USA ) , Carpenter, Delesha M. (Division of Pharmaceutical Outcomes and Policy, University of North Carolina, 301 Pharmacy Lane, CB#7355, Chapel Hill, NC 27599, USA)
    Respiratory medicine v.132 ,pp. 21 - 30 , 2017 , 0954-6111 ,

    초록

    Abstract Background Proper use of inhaled medication is essential for the successful treatment of childhood asthma; yet, improper inhaler technique among school-aged children is common. There are many schoolbased asthma education programs, but the extent to which these programs teach inhaler technique is unknown. Methods We systematically reviewed the literature to identify schoolbased asthma interventions that included inhaler technique instruction. We searched several databases, including PubMed, for relevant articles. Studies were included if they were asthma interventions of any type (programs, curriculums, education) conducted at kindergarten through twelfth grade schools that taught inhaler technique and included inhaler technique as an outcome measure. Of the 285 citations identified, the final nine studies (selected from 71 full-text articles) met the inclusion criteria. Results Findings from this systematic review identified a very small number of school-based interventions that evaluated improvements in students' inhaler technique. Two of the nine studies (22%) used a validated measure of inhaler technique. Inhaler technique instruction varied in length, from 15 min to 1 h and nurses implemented inhaler technique instruction in six of the nine (67%) interventions. Existing studies offer mixed evidence for sustained technique improvements up to a 12-month follow-up period. Conclusions Evidence suggests that students benefit from school-based inhaler technique education; however, inconsistencies in how technique was measured limit our ability to draw firm conclusions regarding the effectiveness of inhaler technique education on student outcomes. Future studies are needed to identify the most appropriate and feasible inhaler technique education components for use in comprehensive asthma self management interventions. Highlights Few school-based interventions evaluate improvements in students' inhaler technique. Two of the nine studies (22%) reviewed used a validated measure of inhaler technique. Mixed evidence found for sustained technique improvements up to a year.

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  5. [해외논문]   Effect of budesonide/formoterol pressurized metered-dose inhaler on exacerbations versus formoterol in chronic obstructive pulmonary disease: The 6-month, randomized RISE (Revealing the Impact of Symbicort in reducing Exacerbations in COPD) study   SCI SCIE

    Ferguson, Gary T. (Pulmonary Research Institute of Southeast Michigan, Farmington Hills, MI, USA ) , Tashkin, Donald P. (University of California, Los Angeles, CA, USA ) , Skä (AstraZeneca R&D, Gothenburg, Sweden ) , rby, Tor (AstraZeneca R&D, Gothenburg, Sweden ) , Jorup, Carin (AstraZeneca R&D, Gothenburg, Sweden ) , Sandin, Kristina (AstraZeneca R&D, Alderley Park, Cheshire, UK ) , Greenwood, Michael (AstraZeneca R&D, Alderley Park, Cheshire, UK ) , Pemberton, Kristine (AstraZeneca LP, Wilmington, DE, USA) , Trudo, Frank
    Respiratory medicine v.132 ,pp. 31 - 41 , 2017 , 0954-6111 ,

    초록

    Abstract Background Prevention of exacerbations is a primary goal for chronic obstructive pulmonary disease (COPD) therapy. This randomized, double-blind, double-dummy, parallel-group, multicenter study evaluated the effect of budesonide/formoterol pressurized metered-dose inhaler (pMDI) versus formoterol dry powder inhaler (DPI) on reducing COPD exacerbations. Methods 1219 patients aged ≥40 years with moderate-to-very-severe COPD (per lung function) and a history of ≥1 COPD exacerbation received budesonide/formoterol pMDI 320/9 μg twice daily (BID) during a 4-week run-in. Patients were then randomized 1:1 to receive budesonide/formoterol pMDI 320/9 μg BID (n = 606) or formoterol DPI 9 μg BID (n = 613) for 26 weeks. Exacerbations were identified using predefined criteria for symptom worsening and treatment with systemic corticosteroids and/or antibiotics and/or hospitalization. The primary endpoint was annual rate of exacerbations. Results Budesonide/formoterol pMDI resulted in a 24% reduction in annual rate of exacerbations (0.85 vs 1.12; rate ratio: 0.76 [95% CI: 0.62, 0.92]; P = 0.006), and a significant risk reduction for time to first exacerbation (hazard ratio: 0.78 [95% CI: 0.64, 0.96]; P = 0.016) versus formoterol DPI. The most commonly reported adverse events (AEs; ≥3%) in budesonide/formoterol and formoterol groups were COPD (4.5% vs 8.6%) and nasopharyngitis (5.0% vs 5.2%). Pneumonia AEs were reported in 0.5% and 1.0% of budesonide/formoterol-treated and formoterol-treated patients, respectively. Conclusions Budesonide/formoterol pMDI is an effective treatment option for reducing exacerbation rates in COPD patients with moderate-to-very-severe airflow limitation and history of exacerbations. No increase in pneumonia was observed with budesonide/formoterol; safety data were consistent with its established profile. Highlights Chronic obstructive pulmonary disease (COPD) therapy aims to prevent exacerbations. RISE evaluated the impact of BUD/FM pMDI on reducing the rate of COPD exacerbations. BUD/FM pMDI significantly reduced the annual exacerbation rate by 24% vs FM alone. Safety data were consistent with the established profile of BUD/FM pMDI. BUD/FM pMDI is an effective treatment option for preventing COPD exacerbations.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  6. [해외논문]   Heart rate and risk of death among patients with Pulmonary Hypertension: A 12-lead ECG analysis   SCI SCIE

    Bouchery-Bardet, Helene (Department of Cardiology, CHU de Caen, Caen F-14000, France ) , Creveuil, Christian (Department of Biostatistics and Clinical Research, CHU de Caen, Caen F-14000, France ) , Bauer, Fabrice (Department of Cardiology, CHU Rouen, Rouen F-76000, France ) , Beygui, Farzin (Department of Cardiology, CHU de Caen, Caen F-14000, France ) , Champ-Rigot, Laure (Department of Cardiology, CHU de Caen, Caen F-14000, France ) , Saloux, Eric (Department of Cardiology, CHU de Caen, Caen F-14000, France ) , Labombarda, Fabien (Department of Cardiology, CHU de Caen, Caen F-14000, France ) , Roule, Vincent (Department of Cardiology, CHU de Caen, Caen F-14000, France ) , Sabatier, Ré (Department of Cardiology, CHU de Caen, Caen F-14000, France ) , mi (Department of Cardiology, CHU de Caen, Caen F-14000, France ) , Legallois, Damien (Department of Pneumology and Thoracic Oncology, CHU de Caen, Caen F-14000, France ) , Zalcman, Gé (Department of Pneumology and Thoracic Oncology, CHU de Caen, Caen F-14000, France ) , rard (Department of Cardiology, CHU de Caen, Caen F-14000, France) , Bergot, Emmanuel , Milliez, Paul
    Respiratory medicine v.132 ,pp. 42 - 49 , 2017 , 0954-6111 ,

    초록

    Abstract Background Despite the emergence of new therapies, Pulmonary Hypertension (PH) still has a high mortality. Several clinical, echocardiographic, biological or hemodynamic prognostic factors have been identified but are of limited predictive value for survival. We aimed to assess whether heart rate (HR) and all ECG abnormalities measured on a 12-lead ECG may help to better identify patients at high risk of death in this population. Methods and results 296 patients followed in a registry were included with all types of PH, except group 2 of the WHO clinical classification. After a median follow-up of 10 years, age, male sex, NYHA III/IV status and, among all ECG parameters, HR and corrected QT interval were associated with mortality. In multivariate analysis, HR, age and male sex remained significant independent predictors of mortality. HR has a higher predictive value in the 238 patients in sinus rhythm. In addition, only HR was significantly correlated with clinical and hemodynamic PH prognostic factors. Conclusion HR measured on a 12-lead ECG at the time of the diagnosis is a strong independent predictor of mortality in PH patients. Highlights Heart rate is aimed to be assessed as an independent predictor of mortality in Pulmonary Hypertension patients. All groups except group 2 of the WHO classification have been included in the analysis. Heart rate was compared to all ECG abnormalities and to clinical and hemodynamic parameters. Heart rate is a strong independent predictor of mortality in sinus rhythm patients over a median of 10-year follow-up.

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  7. [해외논문]   Pulmonary function and diffusion capacity are associated with pulmonary arterial systolic pressure in the general population: The Rotterdam Study   SCI SCIE

    Loth, Daan W. (Department of Epidemiology, Erasmus MC –) , Lahousse, Lies (University Medical Center Rotterdam, Rotterdam, The Netherlands ) , Leening, Maarten J.G. (Department of Epidemiology, Erasmus MC –) , Krijthe, Bouwe P. (University Medical Center Rotterdam, Rotterdam, The Netherlands ) , Felix, Janine F. (Department of Epidemiology, Erasmus MC –) , Gall, Henning (University Medical Center Rotterdam, Rotterdam, The Netherlands ) , Hofman, Albert (Department of Epidemiology, Erasmus MC –) , Ghofrani, H. Ardeschir (University Medical Center Rotterdam, Rotterdam, The Netherlands ) , Franco, Oscar H. (Department of Epidemiology, Erasmus MC –) , Stricker, Bruno H. (University Medical Center Rotterdam, Rotterdam, The Netherlands ) , Brusselle, Guy G. (Universities of Giessen and Marburg Lung Center (UGMLC) –)
    Respiratory medicine v.132 ,pp. 50 - 55 , 2017 , 0954-6111 ,

    초록

    Abstract Background Pulmonary hypertension is a progressive heterogeneous syndrome, characterized by elevated pulmonary arterial pressure which can lead to right ventricular failure. Although the presence of elevated pulmonary arterial systolic pressure (PASP) in patients with a lung disease is a well-known occurrence, little is known about the association between pulmonary function and PASP in the general population. We hypothesized that pulmonary function and PASP are associated, irrespective of airflow limitation. Methods This study was performed within the Rotterdam Study, a prospective population-based cohort. We included 1660 participants with spirometry, performed and interpreted according to ATS/ERS-guidelines, and echocardiography performed according to the ASE/EAE/CSE-guidelines. We analyzed the association of Forced Expiratory Volume in 1 s (FEV 1 ), Forced Vital Capacity (FVC), FEV 1 /FVC and diffusion capacity (DL CO ) with estimated PASP (ePASP). Furthermore, we investigated the association between spirometry measures, COPD, and echocardiographic pulmonary hypertension. Results A 10% absolute decrease in FEV 1 was associated with an ePASP increase of 0.46 mmHg (95%CI: 0.31; 0.61). Similarly, per absolute 10% decrease, FVC was significantly associated with an increased ePASP of 0.42 mmHg (95%CI: 0.25; 0.59). FEV 1 /FVC showed an association of 1.01 mmHg (95%CI: 0.58; 1.45) increase in ePASP per 10% absolute decrease. A decrease in DL CO (in mL/min/kPa) was associated with an increased ePASP (0.46 mmHg, 95%CI: 0.17; 0.76). We found significant associations for FEV 1 and FVC with echocardiographic pulmonary hypertension. Importantly, an increased ePASP was significantly associated with mortality (Hazard Ratio: 1.042 per mmHg [95%CI: 1.023–1.062; p Conclusion We observed a clearly graded association between pulmonary function and ePASP and pulmonary hypertension, even in individuals without airflow limitation. Highlights Pulmonary artery systolic pressure is associated with spirometry in the general population. Pulmonary artery pressure is associated with diffusion capacity. This association remains irrespective of the presence of airflow obstruction. Effect sizes are small, but provide insight in pulmonary artery pressure in an aging population.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  8. [해외논문]   Cardiovascular benefits from standard pulmonary rehabilitation are related to baseline exercise tolerance levels in chronic obstructive pulmonary disease   SCI SCIE

    Moore, Linn E. (Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada ) , Byers, Bradley W. (Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada ) , Fuhr, Desi P. (Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada ) , Wong, Eric (Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada ) , Bhutani, Mohit (Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada ) , Stickland, Michael K. (Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada)
    Respiratory medicine v.132 ,pp. 56 - 61 , 2017 , 0954-6111 ,

    초록

    Abstract Background Heightened arterial stiffness is a marker of cardiovascular risk and is elevated in chronic obstructive pulmonary disease (COPD). Physical activity has been shown to reduce arterial stiffness, and our previous work has shown that arterial stiffness is related to physical activity and exercise tolerance in COPD. The purpose of this study was to evaluate whether baseline physical activity and exercise tolerance influence the cardiovascular benefits associated with standard COPD outpatient pulmonary rehabilitation (PR). Methods A total of 66 patients with COPD were recruited from the G.F. MacDonald Centre for Lung Health, Edmonton, Alberta, prior to entering PR. Another 23 COPD patients not attending the PR program were recruited as time controls (TC). Arterial stiffness (carotid-radial pulse wave velocity, PWV), physical activity (steps taken over three days), and 6-min walk distance (6MWD) were assessed before and after PR, or before and after six weeks of standard care. Results Thirty-nine PR and 11 TC completed all parts of the study. Following PR, there was no overall change in PWV. However, changes in arterial stiffness with PR were dependent on baseline exercise tolerance, with those patients with a 6MWD 350 m: 8.2 ± 1.6 to 8.5 ± 1.7 versus 6MWD p Conclusion COPD patients with low exercise tolerance appear to derive the greatest cardiovascular benefits from PR. Highlights CV risk in COPD is linked to exercise tolerance and physical activity levels. CV benefits with PR are dependent on baseline exercise tolerance in COPD. Baseline physical activity levels do not determine CV improvements with PR.

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  9. [해외논문]   Clinical characterization of 52 patients with immunoglobulin G4-related disease in a single tertiary center in Japan: Special reference to lung disease in thoracic high-resolution computed tomography   SCI SCIE

    Saraya, Takeshi (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo, Japan ) , Ohkuma, Kosuke (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo, Japan ) , Fujiwara, Masachika (Kyorin University School of Medicine, Department of Pathology, Mitaka City, Tokyo, Japan ) , Miyaoka, Chika (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo, Japan ) , Wada, Shoko (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo, Japan ) , Watanabe, Takayasu (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo, Japan ) , Mikura, Sunao (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo, Japan ) , Inoue, Manami (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo, Japan ) , Oda, Miku (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo, Japan ) , Sada, Mitsuru (Kyorin University School of Medicine, Department of Respiratory Medicine, Mitaka City, Tokyo,) , Ogawa, Yukari , Honda, Kojiro , Tamura, Masaki , Yokoyama, Takuma , Kurai, Daisuke , Ishii, Haruyuki , Takizawa, Hajime
    Respiratory medicine v.132 ,pp. 62 - 67 , 2017 , 0954-6111 ,

    초록

    Abstract Background Immunoglobulin G4-related disease (IgG4-RD) is a rare multi-organ disorder. Physicians rarely encounter patients with IgG4-RD and its range of symptoms. Methods To elucidate the clinical characterization of IgG4-RD, along with the clinical significance of lung involvement, we retrospectively reviewed the medical records of patients who satisfied the comprehensive diagnostic criteria for IgG4-RD. Results We identified 52 patients with IgG4-RD. Of these, 32 patients underwent tissue biopsies, resulting in categorization as definite (n = 23) or possible (n = 9) IgG4-RD cases. Among the 23 definite IgG4-RD cases, those with positive lung involvement (n = 8) had significantly higher values of serum LDH (median 220 IU/L, interquartile range (IQR) 175–378 vs. median 184, IQR 136–249, p = 0.039), IgG (median 2769 mg/dL, IQR 2028–7807 vs. median 2048, IQR 1168–4376, p = 0.009), and soluble interleukin-2 receptors (median 1620 U/mL, IQR 871–2250 vs. median 733, IQR 271–1600, p = 0.003) than those with negative lung involvement (n = 15). Similarly, a significant number of patients with positive lung involvement were positive for rheumatoid factor (71.4% vs. 23.1%, p = 0.041) or hypocomplementemia (50% vs. 0%, p = 0.036). Sixteen patients also showed lung involvement (definite n = 8, possible n = 8); thoracic computed tomography (CT) of these patients revealed mediastinal lymphadenopathies (n = 14, 87.5%), ground glass opacity (n = 11, 68.8%), consolidation (n = 8, 50%), thickening of the bronchovascular bundles (n = 7, 43.8%), small nodules (n = 5, 31.3%), bronchiectasis (n = 4, 25%), and reticular shadows (n = 4, 25%), and pulmonary function tests, using a standard technique involving a single breath, revealed decreased diffusion capacity for carbon monoxide. Conclusions IgG4-RD is associated with diverse thoracic CT findings and a decreased diffusion capacity, and careful multidisciplinary assessment is needed to enable differentiation of IgG4-RD from lymphoproliferative disorders. Highlights Serum levels of LDH, IgG, and soluble IL-2R are significantly higher in positive lung involvement than in negative patients. The lung involvement in IgG4-related disease might be linked to a more intense inflammatory reaction. The lung involvement patients have high occurrences of positive RF or hypocomplementemia. IgG4-RD is associated with diverse thoracic CT findings and a decreased diffusion capacity. Decreased diffusion capacity might reflect the activation of lymphocytes and/or plasma cells that accumulate in interstitium.

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  10. [해외논문]   Infection control, genetic assessment of drug resistance and drug susceptibility testing in the current management of multidrug/extensively-resistant tuberculosis (M/XDR-TB) in Europe: A tuberculosis network European Trialsgroup (TBNET) study   SCI SCIE

    Bothamley, Graham H. (Sunderby Sjukhus, 97180 Luleå, Sweden ) , Lange, Christoph (Completo Hospitalario de Pontevedra, Spain ) , Albrecht, Dirk (Unidad de Tratamiento Directamente Observado Serveis Clinics, Barcelona, Spain ) , Anibarro, Luis (Righospitalet, Copenhagen, Denmark ) , Gomez, Neus Altet (Asklepios Fachklinik, München-Gauting, Germany ) , Andersen, Aase Bengaard (Saint Petersburg Research Institute of Phthesiopulmonology, St. Petersburg, Russia ) , Avsar, Korkut (Lewisham and Greenwich NHS Trust, London UK ) , Balasanyants, Goar (Servei Pneumologia, Hospital Universitari, Vall d'Hebron, Barcelona, Spain ) , Belton, Moerida (Wilhelminspital, Wien, Austria ) , Garcí (Karolinska University Hospital, Stockholm, Sweden ) , a, Cristina Berastegui (Hospital General Gran Canaria “Dr. Negrin”, Las Palmas, Spain ) , Bogyi, Matthias (USMPh Nicolae Testemitanu, Republic of Moldova ) , Bruchfeld, Judith (Meyer University Hospital, Florence, Italy ) , Caminero, Jose (Pulmonology Department, University Hospital of Trieste, Italy ) , Chesov, Dumitru (Heart of England NHS Foundation Trust, Birmingham, UK ) , Chiappini, Elena (Unitat de Tuberculosis, Vall d'Hebron-Drassanes, Spain ) , Confalonieri, Marco (Pneumolgy Department, Centro Hospitalar Vila Nova de Gaia and ISPUP-EPIunit, Faculty of Medicine, Uni) , Dedicoat, Martin , Luiza de Souza Galvao, Maria , Duarte, Raquel , Dudnyk, Andrii , Dyrhol-Riise, Anne Ma , Eisenhut, Michael , Esteban, Jaime , Fløe, Andreas , Garcí , a-Garcí , a, José , -Marí , a , Giacomet, Vania , Gomez-Pastrana, David , Gyorfy, Zsuzsanna , Holmoka, Jiri , Jachym, Mathilde Fré , chet , Janssens, Jean-Paul , Jonsson, Jerker , Kaluzhenina, Anna , Konstantynovska, Olha , Kruczak, Katarzyna , Ladeira, Inê , s , Kuksa, Liga , Kulcitkaia, Stela , Lillebæk, Troels , Magis-Escurra, Cecile , Manika, Katerina , Joan-Pau, Millet , Muylle, Inge , Palmieri, Fabrizio , Pesut, Dragica , Polanova, Monika , Pontali, Emanuele , Popa,
    Respiratory medicine v.132 ,pp. 68 - 75 , 2017 , 0954-6111 ,

    초록

    Abstract Aim Europe has the highest documented caseload and greatest increase in multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) of all World Health Organization (WHO) regions. This survey examines how recommendations for M/XDR-TB management are being implemented. Methods TBNET is a pan-European clinical research collaboration for tuberculosis. An email survey of TBNET members collected data in relation to infection control, access to molecular tests and basic microbiology with drug sensitivity testing. Results 68/105 responses gave valid information and were from countries within the WHO European Region. Inpatient beds matched demand, but single rooms with negative pressure were only available in low incidence countries; ultraviolet decontamination was used in 5 sites, all with >10 patients with M/XDR-TB per year. Molecular tests for mutations associated with rifampicin resistance were widely available (88%), even in lower income and especially in high incidence countries. Molecular tests for other first line and second line drugs were less accessible (76 and 52% respectively). A third of physicians considered that drug susceptibility results were delayed by > 2 months. Conclusion Infection control for inpatients with M/XDR-TB remains a problem in high incidence countries. Rifampicin resistance is readily detected, but tests to plan regimens tailored to the drug susceptibilities of the strain of Mycobacterium tuberculosis are significantly delayed, allowing for further drug resistance to develop. Highlights M/XDR-TB poses a serious threat to TB control in Europe. Isolation rooms are insufficient for safe diagnosis. Drug susceptibility testing results are frequently delayed. A positive test for rifampicin resistance should lead automatically to tests for other first- and second-line drug resistance.

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