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Over the past few decades the Arctic has warmed up more than the lower latitudes. Soil organic carbon (SOC) in the Arctic is vulnerable to climate change, and carbon dioxide (CO2) produced via SOC decomposition can amplify atmospheric temperature increase. Although SOC composition is relevant to decomposability, studies on its compositional changes with warming are scarce, particularly in the Arctic. Therefore, we investigated the responses of SOC and the bacterial community to climate manipulation under Cassiope and Salix heath vegetation communities in permafrost‐affected soil in Zackenberg, Greenland. After 8–9 years of experimental warming, we evaluated changes in SOC quantity and quality of three density fractions of soil: free light fraction (FLF), occluded light fraction (OLF) and heavy fraction (HF). The SOC content at 0–5‐cm depth was significantly reduced with warming under Cassiope, and it was accompanied by decreased FLF content, attributed to accelerated decomposition of the FLF by warming. However, SOC molecular composition and bacterial community composition were not affected by warming. By contrast, there was no warming effect on SOC under Salix, which could be partially due to smaller temperature increases caused by higher moisture levels associated with larger silt and clay contents, or to different responses of the dominant plant species to temperature. In both soils, more than 55% of SOC was associated with minerals, and its molecular composition indicated microbial decomposition. Our results suggested that long‐term warming in the high Arctic could induce the loss of SOC, particularly in the FLF; however, the response could vary with vegetation type and/or soil properties, that is, soil texture. Highlights: We show decreased SOC with long‐term (8‐year) warming of heath soils in the high ArcticParticularly, the free light fraction of SOC in topsoil decreased with warming in a Cassiope heath siteMineral‐associated SOC content was more than 55% and showed signs of microbial processingEffects of warming differed according to soil properties and/or plant community composition [ABSTRACT FROM AUTHOR]

Background and objective Development of CPE in CAP is associated with prolonged hospital stay and it may increase the morbidity and mortality. We aimed to identify microbiological and clinical factors that predicate a prolonged hospital admission in patients treated with a tube thoracostomy to control CPE. Methods This retrospective cohort included patients with CPE requiring chest tube drainage in a tertiary referral Korean hospital from 1 January 2004 to 30 July 2012. After dichotomous grouping according to the mean duration of hospital stay, clinical, laboratory and microbiological parameters were compared. Results The final analysis included 158 patients with CPE. The majority were male (130, 85.0%), and the mean age was 62.8 years. The mean duration of hospital stay was 17.7 (±10.2) days. The mean duration of chest tube drainage was 9.6 (±6.7) days. Streptococcus viridans (48.4%) was the most common pathogen. Intrapleural fibrinolysis was performed in 85 (53.8%); additional tube insertion was needed in 40 (25.3%) patients. In the multivariate analysis after adjusting for covariates, a prolonged hospital stay was associated with fever (aOR: 3.42, P = 0.02), lower PaO2 (a OR: 4.89, P = 0.007) and haemoglobin (aOR: 4.90, P = 0.003) levels, and an increased blood neutrophil fraction (a OR: 3.83, P = 0.01) on admission as well as the identification of microbes in CPE (a OR: 4.14, P = 0.03), and ineffective pleural drainage (a OR: 3.28, P = 0.03). Conclusions This study suggests that physicians should note the clinical symptoms and laboratory findings of severe infection and effectiveness of pleural drainage to predicate which patients with a CAP needing thoracostomy for CPE will have a prolonged hospital stay. [ABSTRACT FROM AUTHOR]

Background and objective Inhaled medications have been widely applied to patients with airflow limiting non-cystic fibrosis (non- CF) bronchiectasis. However, the association between the use of inhalers and the development of haemoptysis has rarely been explored. The objective of this study was to assess the association between the risk of haemoptysis and the use of inhalers in patients with non- CF bronchiectasis. Methods A nested case-control study was performed using a national claims database from 1 January 2009 to 31 December 2011. Inhalers including inhaled corticosteroids ( ICS), long-acting β2 agonists ( LABA), long-acting muscarinic antagonists ( LAMA), short-acting β2 agonists ( SABA), short-acting muscarinic antagonists ( SAMA) and their combinations were tested for the risk of clinically significant haemoptysis events. Results Among the 62 530 eligible new users of inhalers with non- CF bronchiectasis, 6180 patients with haemoptysis and 27 486 strictly matched controls were selected. In the unadjusted analyses, SAMA, LAMA, SABA and ICS/ LABA significantly increased the risk of haemoptysis. After adjustment for other inhaled respiratory medications, comorbidities, health-care utilization and concomitant medications, SAMA, SABA and LAMA consistently increased the risk of haemoptysis ( SAMA: odds ratio ( OR), 1.6; 95% confidence interval ( CI), 1.1-1.4; LAMA: OR, 1.2; 95% CI: 1.1-1.2; SABA: OR, 1.2; 95% CI: 1.1-1.2). The association between anticholinergics ( SAMA and LAMA) and risk of haemoptysis showed a dose-dependent trend ( P for trend, <0.001). Conclusions The use of SABA and inhaled anticholinergics in patients with non- CF bronchiectasis increased the risk of haemoptysis. The risk-benefit ratio of inhaled bronchodilators should be considered in the haemoptysis-susceptible population. [ABSTRACT FROM AUTHOR]

Background and objective A handful of studies have reported that bronchoscopies influence the clinical outcome of mechanically ventilated patients with aspiration pneumonia. The purpose of the present study is to elucidate the therapeutic role of early bronchoscopy in patients with aspiration who are mechanically ventilated. Methods A retrospective cohort study was conducted via medical record review from 2003 through 2013 in a tertiary hospital. All the diagnoses of pneumonia were supported by the probability of aspiration and consolidation of dependent areas confirmed by computed tomography. Patients who underwent bronchoscopy within 24 h after intubation were categorized as the early bronchoscopy group and the others as the late bronchoscopy group. We compared the demographics, clinical parameters and outcomes between the two groups. Results Of the 154 patients who were included, the early bronchoscopy group ( n = 93) showed significantly lower in-intensive care unit ( ICU) mortality and 90-day mortality (in- ICU: 4.9% vs 24.6%; 90-day: 11.8 vs 32.8%) regardless of the initial empirical antibiotics. In addition, their sequential organ failure assessment score on day 7 tended to decrease more rapidly. Among the survivors, patients in the early bronchoscopy group were extubated earlier with a higher success rate, had a shorter length of mechanical ventilation and had a shorter ICU stay. The early bronchoscopy was associated with lower 90-day mortality in multivariate analysis (odds ratio: 0.412; 95% confidence interval: 0.192-0.883). Conclusions Early bronchoscopy could benefit the clinical outcomes of mechanically ventilated patients with aspiration pneumonia. [ABSTRACT FROM AUTHOR]

Background and objective There is limited data on size change during natural progression of pulmonary aspergilloma. We aimed at elucidating the clinical course and prognosis of aspergilloma according to its size change. Methods A multicentre retrospective observational study was performed in 143 adult pulmonary aspergilloma patients with serial chest computed tomography images. The clinical course and risk of haemoptysis according to the size change of the cavity or mass of aspergillomas was evaluated. Results Median follow-up duration was 5.1 years. The size of aspergillomas changed in 39.2% of study subjects. Decreased and increased volumes of aspergilloma were observed in 13.3% and 25.9%, respectively. Patients with decreased volume had significantly higher C-reactive protein, and more severe bronchiectasis and tuberculosis-destroyed lung. Clinically significant haemoptysis occurred in 50.3% of patients and was significantly associated with the cavity and mass volume of aspergilloma, but not the extent of volume change. A mean cavity diameter of more than 22 mm and a mass diameter of more than 18 mm increased the risk of clinically significant haemoptysis. Conclusions A significant portion of pulmonary aspergilloma changed size in our population. The prevalence of clinically significant haemoptysis was associated with absolute size of cavity and mass of aspergilloma. [ABSTRACT FROM AUTHOR]

The late Quaternary glacial history of the Nun- Kun massif, located on the boundary between the Greater Himalaya and the Zanskar range in northwestern India, was reconstructed. On the basis of morphostratigraphy and 10Be dating of glacial landforms (moraines and glacial trimlines), five glacial stages were recognized and defined, namely: (i) the Achambur glacial stage dated to Marine Oxygen Isotope Stage 3 to 4 (38.7-62.7 ka); (ii) the Tongul glacial stage dated to the early part of the Lateglacial (16.7-17.4 ka); (iii) the Amantick glacial stage dated to the later part of the Lateglacial (14.3 ka, 11.7-12.4 ka); (iv) the Lomp glacial stage dated to the Little Ice Age; and (v) the Tanak glacial stage, which has the youngest moraines, probably dating to the last few decades or so. Present and former equilibrium-line altitudes ( ELAs) were calculated using the standard area accumulation ratio method. The average present-day ELA of ∼4790 m above sea level in the Greater Himalaya is lower than those in the Ladakh and Zanskar ranges, namely 5380 and ∼5900 m a.s.l., respectively. The ELA in the Zanskar range is higher than in the Ladakh range, possibly due to the higher peaks in the Ladakh range that are able to more effectively capture and store snow and ice. ELA depressions decrease towards the Ladakh range (i.e. inner Plateau). Peat beds interbedded with aeolian deposits that cap the terminal moraine of Tarangoz Glacier suggest millennial-time-scale climate change throughout the Holocene, with soil formation times at c. 1.5, c. 3.4 and c. 5.2 ka, probably coinciding with Holocene abrupt climate change events. Given the style and timing of glaciation in the study area, it is likely that climate in the Nun- Kun region is linked to Northern Hemisphere climate oscillations with teleconnections via the mid-latitude westerlies. [ABSTRACT FROM AUTHOR]

ABSTRACT A 5.88-m-long core taken from Lake Ulaan was studied for high-resolution paleoclimatic changes during the last 17 000 years. The core sediments are divided into three units based on grain-size distribution: unit 1 (top to 392 cm depth, covering the last 11 200 years), unit 2 (392-530 cm, 11.2-15 ka) and unit 3 (530-588 cm, 15.0-16.7 ka). These sediments were transported by local westerly winds (units 1 and 3) and fluvial processes (unit 2). Based on major element compositions and geological setting of adjacent areas, provenance of unit 1 sediments was interpreted to be the Lake terrane, and that of unit 2 to be the Idermeg terrane. Unit 3 sediments were derived from the Gobi Altai terrane. The records of total organic carbon, C/N ratio and weathering intensity suggest that paleoclimate in the source area of Lake Ulaan sediment was most humid during the Early Holocene, humid during the mid-Holocene and dry in the Late Holocene. The decrease of humidity through the Holocene is a typical characteristic of the East Asian monsoon region. Comparison with lacustrine records of other Mongolia regions suggests that the northern boundary of East Asian summer-monsoon influence could have been located further north than previously assumed. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Many approaches have been suggested as anti-tumor therapy for targeting insulin-like growth factor 1 receptor (IGF-1R), such as monoclonal antibodies and tyrosine kinase inhibitor. We introduced recombinant adenoviruses expressing antisense, dominant negative or short hairpin RNA to IGF-1R. Moreover, we demonstrated that histone deacetylase inhibitor (vorinostat) can increase the transduction efficiency of adenoviruses by increasing CAR-induced transduction and by enhancing the transcription of the adenoviral transgene. In the present study, we showed that the combination of ad-sh (short hairpin) IGF-1R with vorinostat leads to a synergistic enhancement of IGF-1R blockade. Methods We measured the change in IGF-1R upon cotreatment with vorinostat and ad-shIGF-1R. Changes in transduction efficiency of ad-shIGF-1R were measured by fluorescent microscopy. Changes in apoptotic proportion and cell survival after the cotreatment were measured by the sub-G1 assay and cell counts. The effect of nuclear factor (NF)-κB activation was also measured by NF-κB p65 activation enzyme-linked immunosorbent assay. Drug interactions were analyzed upon cotreatment with ad-shIGF-1R, vorinostat and cisplatin. Results Combined treatment of ad-shIGF-1R and vorinostat synergistically suppressed the IGF-1R expression in lung cancer cell lines and also increased the transduction efficiency of ad-shIGF-1R. Ad-shIGF-1R and vorinostat cotreatment increased apoptotic cell death and synergistically suppressed cell growth compared to ad-shIGF-1R or vorinostat treatment alone. Vorinostat suppressed NF-κB activation, which was activated by ad-shIGF-1R. Moreover, triple combination of ad-shIGF-1R, vorinostat and cisplatin demonstrated synergistic cytotoxicity on lung cancer cells. Conclusions Vorinostat enhanced the blocking capability of ad-shIGF-1R. The combined treatment of vorinostat and ad-sh-IGF-1R appears to have promising potential as a new therapeutic approach for lung cancer. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary Background: Patients with chronic obstructive pulmonary disease (COPD) show different spirometric response patterns to bronchodilator, such that some patients show improvement principally in expiratory flow (forced expiratory volume in 1 s; FEV1), whereas others respond by improvement of lung volume (forced vital capacity; FVC). The mechanisms of these different response patterns to bronchodilator remain unclear. We investigated the associations between bronchodilator responsiveness and quantitative computed tomography (CT) indices in patients with COPD. Methods: Data on a total of 101 patients with stable COPD were retrospectively analysed. Volume and flow responses to bronchodilator were assessed by FVC and FEV1 changes before and after inhalation of salbutamol (400 μg). Volumetric CT was performed to quantify emphysema, air trapping and large airway thickness. Emphysema was assessed by the volume fraction of the lung under −950 Hounsfield units (HU; V950) at full inspiration and air trapping by the ratio of mean lung density (MLD) at full expiration and inspiration. Airway wall thickness and wall area percentage (WA%; defined as wall area/[wall area + lumen area] × 100), were measured near the origin of right apical and left apico-posterior bronchus. Results: Among quantitative CT indices, the CT emphysema index ( V950 insp) showed a significant negative correlation with postbronchodilator FEV1 change ( R = −0·213, P = 0·004), and the CT air-trapping index correlated positively with postbronchodilator FVC change( R = 0·286, P≤0·001). Multiple linear regression analysis showed that CT emphysema index had independent association with postbronchodilator FEV1 change and CT air-trapping index with postbronchodilator FVC change. Conclusion: The degrees of emphysema and air trapping may contribute to the different response patterns to bronchodilator in patients with COPD. [ABSTRACT FROM AUTHOR]

Background and objective: The need for routine use of bronchial washing in addition to forceps biopsy has been debated in the diagnosis of endoscopically visible lung tumours. Moreover, the optimal sequence for obtaining bronchial washing and forceps biopsy specimens from endoscopically visible tumours through a flexible bronchoscope has not been well established. Methods: A multicentre 13-month prospective randomized study was performed. Two hundred and thirty consecutive patients with endoscopically visible tumours were randomly assigned into a bronchial washing before forceps biopsy (pre-biopsy) group and a bronchial washing after forceps biopsy (post-biopsy) group. Bronchial washing and forceps biopsy were performed according to the assigned sequence. Results: Two hundred and seven patients with a definite cytological or histological diagnosis of lung cancer were included in the analyses. One hundred and three were in the pre-biopsy group and 104 were in the post-biopsy group. The diagnostic yield of bronchial washing was 57.3% (59/103) in the pre-biopsy group and 55.8% (58/104) in the post-biopsy group ( P = 0.88). In addition, bronchial washing provided the diagnosis in six patients without definite diagnosis from forceps biopsy, and its addition to forceps biopsy significantly increased the overall diagnostic yield of bronchoscopy from 93.7% to 96.6% ( P = 0.03). Conclusion: The sequence for performing bronchial washing before or after forceps biopsy did not affect the diagnostic yield of bronchial washing in patients with endoscopically visible lung cancers. However, bronchial washing led to a significant increase in the overall diagnostic yield of bronchoscopy in patients with lung cancers. [ABSTRACT FROM AUTHOR]

Background and objective Non-cystic fibrosis (CF) bronchiectasis is a chronic airway inflammatory disease, exhibiting a diverse array of clinical courses. The purpose of this study was to determine the factors that predict radiologic progression of non-CF bronchiectasis during a long-term follow-up. Methods We reviewed the electronic medical records that included pulmonary function test data from non-CF bronchiectasis patients, who were older than 18 years of age with a follow-up of computerized tomography for more than 5 years. The original Bhalla score was used to determine the radiologic severity of non-CF bronchiectasis. Results A total of 155 patients (mean age, 59.6 years; male, 45.2%) were included for the final analysis. The mean follow up time was 7.11 ± 1.42 (5-10) years. The baseline Bhalla score was 9.52 ± 3.14 (4-19), and the change of Bhalla score was 0.55 ± 1.14 (−2 to 5). The Bhalla score was increased in 56 patients (36.1%) but not in 99 patients (63.9%). The Bhalla score change was significantly associated with the age at diagnosis ( p = 0.037), body mass index (BMI, p = 0.012), chronic infection of Pseudomonas aeruginosa ( p = 0.005) or isolation of nontuberculous mycobacterium ( p = 0.042) in respiratory specimens. In a multivariate analysis, BMI and isolation of P. aeruginosa were significantly related with the Bhalla score change. Conclusion The radiologic progression of non-CF bronchiectasis was associated with lower BMI and isolation of P. aeruginosa in respiratory specimens. [ABSTRACT FROM AUTHOR]