Search

Background Lymphangioleiomyomatosis (LAM) is a progressive, cystic lung disease that causes an obstructive ventilatory impairment similar to chronic obstructive pulmonary disease (COPD) and impairs the health-related quality of life (HRQoL). Here, we extended the use of the COPD assessment test (CAT) to patients with chronic respiratory diseases other than COPD. Specifically, the CAT was administered to patients with LAM for the first time. Methods Using data from 25 patients with LAM at Juntendo University who participated in the Multicenter Lymphangioleiomyomatosis Sirolimus Trial for Safety (MLSTS), we evaluated changes in pulmonary function, responses to HRQoL questionnaires (the CAT, St. George׳s Respiratory Questionnaire [SGRQ], EuroQOL Visual Analogue Scale [EuroQOL-VAS], and Functional Performance Inventory [FPI]), and the association between pulmonary function and HRQoL during a 24-month period of sirolimus treatment. Results Forced expiratory volume in one second (FEV 1 ), forced vital capacity (FVC), and CAT total scores improved over the 24 months of sirolimus treatment (5.33 ± 1.20 ml/month, 2.61 ± 1.16 ml/month, and −0.127 ± 0.022 score/month, respectively), whereas SGRQ total score, EuroQOL-VAS score, and FPI score did not. Most pulmonary functions at baseline were associated with the CAT breathlessness score during the first year. Longitudinal changes in FEV 1 , FEV 1% predicted, or FEV 1 /FVC correlated significantly with the scores of CAT total, CAT breathlessness, and SGRQ activity. When analyzed by stepwise multivariate regression within a linear mixed-effects model, CAT breathlessness and confidence scores were significantly associated with a change in FEV 1 from the baseline value ( P = 0.0011, and P = 0.0441). Conclusion Our results suggest that the CAT is a useful instrument for assessing HRQoL in sirolimus-treated patients with LAM.

Most color simulators for color deficiencies are based on the tristimulus values and are intended to simulate the appearance of an image for dichromats. Statistics show that there are more anomalous trichromats than dichromats. Furthermore, the spectral sensitivities of anomalous cones are different from those of normal cones. Clinically, the types of color defects are characterized through Rayleigh color matching, where the observer matches a spectral yellow to a mixture of spectral red and green. The midpoints of the red/green ratios deviate from a normal trichromat. This means that any simulation based on the tristimulus values defined by a normal trichromat cannot predict the color appearance of anomalous Rayleigh matches. We propose a computerized simulation of the color appearance for anomalous trichromats using multispectral images. First, we assume that anomalous trichromats possess a protanomalous (green shifted) or deuteranomalous (red shifted) pigment instead of a normal (L or M) one. Second, we assume that the luminance will be given by L+M, and red/green and yellow/blue opponent color stimulus values are defined through L-M and (L+M)-S, respectively. Third, equal-energy white will look white for all observers. The spectral sensitivities of the luminance and the two opponent color channels are multiplied by the spectral radiance of each pixel of a multispectral image to give the luminance and opponent color stimulus values of the entire image. In the next stage of color reproduction for normal observers, the luminance and two opponent color channels are transformed into XYZ tristimulus values and then transformed into sRGB to reproduce a final image for anomalous trichromats. The proposed simulation can be used to predict the Rayleigh color matches for anomalous trichromats. We also conducted experiments to evaluate the appearance of simulated images by color deficient observers and verified the reliability of the simulation.

Background: Cigarette smoking remains a significant public health problem. However, current treatment programs have not yet succeeded in sufficiently reducing smoking rates. The study aimed to examine whether patients’ recognition of “spirometric-lung-age (SLA)” estimated from spirometry data prompts smoking cessation. Methods: From December 2010 to September 2011, participating smokers were prospectively enrolled into the standardized smoking cessation program (Visits 1–5 for 12 weeks) and assigned single-blindly to either SLA assessment or control groups. The SLA group was informed of the estimated age of their lungs from spirometry analysis and given an opportunity to recognize the difference from their actual chronological age, whereas the control group was not. The primary calculation of outcome was the smoking quit rate on Visit 5, whereas the secondary end-point was the proportion of patients who remained abstinent 1 year later. Results: One hundred and twenty-six Japanese smokers (88 males) participated and were randomly assigned to the SLA group (n=52) or the control group (n=74). The smoking quit rate on Visit 5 was similar in the SLA assessment group and control group (59.6% vs . 41.9%; P=0.0700). However, the proportion of patients who remained abstinent 1 year later was similar in both groups (78.6% vs . 69.0%; P=0.5497). Multivariate logistic regression analysis after adjusting baseline characteristics demonstrated that telling patients their SLA, the use of varenicline, and age were significantly associated with smoking quit rate on Visit 5 whereas only age was associated with remaining abstinent 1 year later. Conclusions: Telling patients their SLA can become a useful tool prompting smoking cessation among Japanese smokers although other factors such as pharmacotherapy and age also influence the cessation of smoking.

Bronchial‐pulmonary arterial fistula (BPAF) is a rare vascular malformation complicated with racemose hemangioma. We report a case of a 65‐year‐old male with BPAF with primary racemose hemangioma. Bronchial arteriography demonstrated convolution, dilation, and aneurysm connected with pulmonary artery, suggesting the presence of BPAF, in the left upper lobe. Since a 20‐mm sized aneurysm of bronchial artery and BPAF coexisted, he underwent ligation of bronchial arterial aneurysm and left upper lobectomy to prevent hemoptysis. As neither history of prior illness nor histopathologic findings of vascular inflammation was seen, the present case demonstrated BPAF with primary racemose hemangioma. Establishment of non‐invasive treatment strategy for BPAF is urgently required.