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Background/aims To use serological and multiplex polymerase chain reaction (PCR) assays to examine sputum samples from patients experiencing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) for the presence of atypical pathogens, including Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. Methods From September 2012 to February 2014, 341 patients with AECOPD attending outpatient clinics were enrolled as part of a randomized, double-blind, multicenter study. A commercial enzyme-linked immunosorbent assay was used to measure serum immunoglobulin M (IgM) and IgG antibody titers on the first day of the study and at 36 days post-enrollment. Multiplex PCR was used to test sputum samples for the presence of atypical pathogens. A urinary antigen test for L. pneumophila was performed on the first day. Results Nineteen patients (5.6%) showed serological evidence of acute infection with M. pneumoniae. Also, one and seven patients (2%) showed serological evidence of acute infection with C. pneumoniae and L. pneumophila, respectively. All DNA samples were negative for M. pneumoniae, C. pneumoniae, and L. pneumophila according to PCR. Only one urine sample was positive for L. pneumophila antigen, but serologic evidence was lacking. Conclusion Serological testing suggested that infection by atypical pathogens during AECOPD was relatively uncommon. In addition, PCR provided no direct evidence of infection by atypical pathogens. Thus, atypical pathogens may not be a major cause of AECOPD in South Korea.

Objectives：In the theory of Korean medicine, Pear has long been considered to protect throat, bronchus and lung. Pear has been believed to remove sputum in Korean people. This study was conducted to investigate the effect of pear ethanol extract (PEE) on asthma induced by ovalbumin in mice. Methods：We investigated the effects of PEE on airway hyperresponsiveness to methacholine, production levels of ovalbumin (OVA) specific total immunoglobulin G (IgG), IgG1, IgG2a and IgE in serum and histopathological changes of lung tissues in asthamtic mice. Results：PEE decreased airway hyperresponsiveness to methacholine significantly compared to non-treated asthmatic mice (P

There is little empirical research that examines the externality effects of adaptive reuse projects on the urban economy to support the theoretical positions of existing literature. Adaptive reuse projects positively stimulate the local economy through job creation, sustainability, and the preservation of the historic sense of the community. This study empirically tests for externality effects of a church reuse project on nearby housing sale prices in Cleveland, Ohio. Using a hedonic approach that accounts for the spatial dependence, regression results of 2001-2002 data are compared to regression results of 2006-2007 data. The regression analysis reveals that positive externality effects reached up to 0.25 mile from the reuse project location. The study features a cost/benefit analysis that determined the public subsidy provided by the Cuyahoga County government will be justified by the project in less than 10 years.

The purpose of this study was to investigate the differences of the visual image evaluation according to coloration of men's dress shirts and neckties, and perceiver's gender. Subjects were 336 males and females living in Seoul. Five dimensions of visual evaluation were derived by factor analysis: elegance/intelligence, sociability, potency/attractiveness, individuality, and manliness. White shirts were evaluated highly in elegance/intelligence, and blue shirts were shown the manliest. Women evaluated the blue shirts manlier than men did. Dark blue neckties were evaluated highly in elegance/intelligence and sociability, and red ties were perceived to be very distinctive. Black shirts and white shirts with silvery gray ties were perceived to be the most elegant and intelligent. Blue shirts with dark blue ties was evaluated highly in sociability and potency/attractiveness, and black shirts with yellow ties were evaluated the highest in individuality. The evaluations of elegance/intelligence, potency/attractiveness, and manliness had significant interaction effects between the color of shirts and neckties. White shirts and blue shirts with dark blue ties were perceived to be more elegant and intelligent, potent, attractive and manlier than with red ties.

Background Pulmonary actinomycosis is a chronic pulmonary infection caused by Actinomyces. Both improving oral hygiene and early application of antibiotics to the case of suspicious pulmonary infections result in changes in incidences and presentations of pulmonary actinomycosis. However, there are little reports dealt with the recent clinical characteristics of pulmonary actinomycosis. This study aimed to review the characteristics of pulmonary actinomycosis occurred during the first decade of 21st century. Methods This retrospective study was performed on 94 subjects with pulmonary actinomycosis diagnosed pathologically from January 2000 to December 2010 in 13 hospitals in Korea. Results The data of the study showed that pulmonary actinomycosis occurs frequently in middle to old-aged males (mean age; 57.7 years old) and that the most common symptoms are cough, hemoptysis, and sputum production. Various radiologic features such as the consolidation with central low attenuation (74.5%) and no regional predominance were also observed. Most of patients recovered completely with medical and/or surgical treatment, reaching approximately 98% cure rate. Conclusions The results demonstrate that pulmonary actinomycosis is one of the cautious pulmonary diseases. More importantly, in cases of persistent hemoptysis or for differential diagnosis from lung malignancy, our data have revealed that surgical resection appears to be a useful intervention and that radiologic diagnosis may not provide decisive information. These findings indicate that it is important for the clinicians to include pulmonary actinomycosis as one of differential diagnoses for refractory pulmonary abnormal lesions to the current usual management.

Objective : This study was designed to investigate the effects of Angelicae Gigantis Radix (AGR) on Polycystic Ovary (PCO) induced by Estradiol valerate (EV) in female rats. Methods : We investigated the effects of AGR on Changes in body weights and food and water uptake for 5 weeks. In addition, we examined the effects on ovary weights. Finally, we also observed histopathological changes in PCO rats. Results : Treatment with AGR did not affect body weights, amount of food and water uptake. Administration group of AGR restored body/ovary weight ratio to normal levels, which were lowered by induction of PCO. In histopathological observation, formation of cysts was suppressed in AGR group compared with non-treated control group. Conclusion : These results suggest that AGR can be used for patients with PCO to prevent formation of cystic follicles and malfunction of ovary.

This study was conducted to determine whether meiotic maturation could be induced in ovarian oocytes from the American brown bear (Ursus arctos), a model for gamete "rescue" techniques for endangered ursids. The bears were euthanized, and their ovaries were transported to the laboratory within 4 h. The mean ovarian size was 2.4 x 1.8 cm (range: 2.0-3.3 x 1.5-2.2 cm). The ovaries obtained from the 2 brown bears yielded 97 oocytes (48.5/female), and 88 (90.7%) of them were morphologically classified as normal quality. Oocytes were in vitro matured at 38.5 C in 5% CO2 for 24 or 48 h in TCM-199 supplemented with 10% FBS, 1 microg/ml estradiol-17beta, and 10 microg/ml FSH. In Exp. 1, morphologic evaluation of matured oocytes was conducted by measuring the diameters of oocytes with a zona pellucida (ZP) or cytoplasm without a ZP. In Exp. 2, activation was induced by applying two 20 microsec DC pulses of 2.0 kV/cm delivered by an Electro Cell Fusion Generator. The activated oocytes were cultured in TCM-199 containing 2 mM of 6-dimethylaminopurine for 4 h, in Charles Rosenkrans (CR) 1 for 3 days and the in CR2 for another 4 days. The diameters of the matured bear oocytes with a ZP and with cytoplasm without a ZP (161.8 +/- 6.0 and 135.3 +/- 7.5 microm, respectively) were significantly (P0.05) larger than those of bovine oocytes (150.7 +/- 4.9 and 118.7 +/- 7.5 microm). The maturation rates of the bear oocytes were 17.6 and 59.4% at 24 and 48 h of in vitro maturation, the percentage of activated oocytes that developed to the 2 or 4-cell stage was 31.6%; however, no blastocysts were observed. These results indicate that bear oocytes can develop to metaphase II in an in vitro culture system and that activated oocytes can develop to the 2 or 4-cell stages.

Chin Kook Rhee,1 Jung Hyun Chang,2 Eu gene Choi,3 Hyun kuk Kim,4 Yong-Soo Kwon,5 Sun Young Kyung,6 Ji-Hyun Lee,7 Myung Jae Park,8 Kwang Ha Yoo,9 Yeon Mok Oh10 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University Medical Center, Seoul, 3Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Daejeon Hankook Hospital, Daejeon, 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, 6Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, 7Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, CHA Bundang Medical Center of CHA University, Seongnam, 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, KyungHee University Hospital, Seoul, 9Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine, 10Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Abstract: A new quinolone, zabofloxacin, has now been developed; hence, a non-inferiority trial is needed to compare this new compound with another widely used quinolone to examine its efficacy and safety for the treatment of chronic obstructive pulmonary disease (COPD) exacerbations. This was a prospective, multicenter, double-blind, double-dummy, randomized, controlled, parallel-group, Phase III, non-inferiority clinical trial designed to compare oral zabofloxacin (367 mg once daily for 5 days) with moxifloxacin (400 mg once daily for 7 days) for the treatment of patients with COPD exacerbation. In all, 345 COPD patients with a moderate COPD exacerbation were enrolled in the study via the outpatient clinics at 31 university hospitals. Clinical per protocol analysis revealed that the clinical cure rate for zabofloxacin was 86.7% and that for moxifloxacin was 86.3% (the rate difference, 0.4%; 95% confidence interval,–7.7%–8.6%). Intention-to-treat analysis revealed clinical cure rates of 77.1% and 77.3% (difference,–0.2%; 95% confidence interval,–9.0%–8.8%), respectively. These results confirm that zabofloxacin is not inferior to moxifloxacin. The favorable microbiological response rate for zabofloxacin was 67.4% and that for moxifloxacin was 79.5% (P=0.22). Patients in the zabofloxacin group showed better patient-oriented outcomes, as measured by EXAcerbations of Chronic Pulmonary Disease Tool-Patient-Reported Outcome and the COPD assessment test scores, than patients in the moxifloxacin group. Adverse drug reactions related to zabofloxacin occurred in 9.7% of cases and those related to moxifloxacin occurred in 9.6% of cases (P=0.97). The dropout rate due to adverse events was 0% (0/175) in the zabofloxacin group and 1.8% (3/167) in the moxifloxacin group (P=0.12). Oral zabofloxacin (367 mg once daily for 5 days) was not inferior to oral moxifloxacin (400 mg once daily for 7 days) for the treatment of patients with COPD exacerbation. Keywords: chronic obstructive pulmonary disease, exacerbation, zabofloxacin, quinolone, EXACT-PRO, CAT

Background: Patients with ventilator-associated pneumonia (VAP) in intensive care unit (ICU) have a high mortality rate. The routine surveillance cultures obtained previously or an ATS guideline for hospital-acquired pneumonia was used in selecting initial antimicrobials. The object of this study was to compare the respiratory samples before VAP and bronchoalveolar lavage (BAL) culture. Methods: 54 patients underwent fiberoptic bronchoscopy to obtain BAL samples. We reviewed microbiologic specimen results of prior respiratory specimens (pre-VAP) and BAL. Results: Among 51 patients with 54 VAP episodes, 52 microorganisms of pre-VAP and 56 BAL samples were isolated. Pre-VAP included 21.2% of MRSA, and 32.6% of multidrug resistant-Acinetobacter baumannii (MDR-AB). BAL samples comprised 25.0% of MRSA, 26.7% of MDR-AB, 14.3% of Stenotrophomonas maltophilia and 3.6% of Klebsiella pneumonia in order. In pre-VAP samples compared to BAL samples, only 35.2% were identical. In BAL samples compared to pre-VAP samples obtained in 5 days before the onset of VAP, only 43.6% were identical. However, among BAL samples compared to pre-VAP samples obtained after more than 5 days, 13.3% were identical (p=0.037). Conclusion: Based on these data, pre-VAP samples obtained prior to 5 day o nset of VAP may help to predict the causative microorganisms and to select appropriate initial antimicrobials.

Background: MicroRNAs (miRNAs) have demonstrated their potential as biomarkers for lung cancer diagnosis. In recent years, miRNAs have been found in body fluids such as serum, plasma, urine and saliva. Circulating miRNAs are highly stable and resistant to RNase activity along with, extreme pH and temperatures in serum and plasma. In this study, we investigated serum miRNA profiles that can be used as a diagnostic biomarker of non-small cell lung cancer (NSCLC). Methods: We compared the expression profile of miRNAs in the plasma of patients diagnosed with lung cancer using an miRNA microarray. The data from this assay were validated by quantitative real-time PCR (qRT-PCR). Results: Six miRNAs were overexpressed and three miRNAs were underexpressed in both tissue and serum from squamous cell carcinoma (SCC) patients. Sixteen miRNAs were overexpressed and twenty two miRNAs were underexpressed in both tissue and serum from adenocarcinoma (AC) patients. Of the four miRNAs chosen for qRT-PCR analysis, the expression of miR-23a was consistent with microarray results from AC patients. Receiver operating characteristic (ROC) curve analyses were done and revealed that the level of serum miR-23a was a potential marker for discriminating AC patients from chronic obstructive pulmonary disease (COPD) patients. Conclusion: Although a small number of patients were examined, the results from our study suggest that serum miR-23a can be used in the diagnosis of AC.

Miliary tuberculosis is quite a rare but serious cause of acute respiratory distress syndrome (ARDS). Therefore, the early detection of military tuberculosis as the underlying cause of ARDS is very important for the prognosis and survival of the patient. We report a case of military tuberculosis mimicking ARDS. A female patient was admitted due to repeated fever and dyspnea. The initial chest CT scan showed diffuse ground glass opacity, without a miliary pattern. The case was considered to be ARDS caused by pneumonia. She showed improvement after being treated with levofloxacin. However, she was re-admitted with fever seven days after discharge. The follow up chest CT scan showed micronodules in both lungs. An open lung biopsy confirmed the diagnosis of military tuberculosis.

연구배경: 메티실린 내성 황색포도알균은 의료기관 관련 감염 뿐 아니라 지역사회 감염에서도 나타나 이에 저자들은 한 대학병원 중환자실에 입원한 환자의 비강 도말 배양을 통해 MRSA의 의료기관 관련 감염 및 지역사회 감염의 빈도와 분자 역학 및 항생제 내성을 연구하였다. 방법: 2006년 6월에서 9월까지 건양대학교 병원 중환자실 환자 353명을 대상으로 입실 첫날 비강 도말 배양을 시행하여 MRSA 획득 위험인자에 따라 HA-MRSA와CA-MRSA로 나누어 Pulsed-Field Gel Electrophorosis(PFGE)로 분류하여 각각의 항생제 내성 검사를 시행하였다. 결과: 353명 중 비강 도말 배양에서 동정된 MRSA는 42명(11.9%)이며, 동정된 MRSA 중 HA-MRSA는 33명(78.6%), CA-MRSA는 9명(21.4%)이다. PFGE에서 type A에서 type K까지 11형으로 구분하였고 HA-MRSA는 type A (n=9), B (n=7)가, CA-MRSA는 type A (n=2), B (n=2)가 주로 나타났다. 항생제 내성률은 erythromycin, ciprofloxacin에서 HA-MRSA가 CA-MRSA보다 높게 나타났다. 결론: MRSA의 집락률은 11.9%이며 HA-MRSA의 균주가 CA-MRSA보다 많고, CA-MRSA는 9예로 적은 예지만 PFGE type에서 대부분의 type이 HA-MRSA에서 동정된 type과 같은 경향을 보여 지역사회전파를 시사한다.

Background: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy. Methods: Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes. Results: The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05). Conclusions: Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy.

Purpose: Anti-cancer chemotherapeutic agents act by inhibiting tumor cell proliferation through cytotoxic action, therefore the generally tolerated maximum dose is administered to patients. However, this often results in the production of undesirable toxicities, such as bone marrow suppression, and a long interruption of treatment is necessary for recovery to occur before additional cycles of treatment are administered. Paclitaxel and cisplatin are well known effective chemotherapeutic agents used for the treatment of Non-Small Cell Lung Cancer (NCSLC), however, they have substantial toxicities. To evaluate efficacy and safety of a therapy consisting of a weekly low dose of paclitaxel and therapy in elderly patients with advanced NSCLC. Materials and Methods: Thirteen treatment-naive, elderly patients over 65 years old who were diagnosed with stage IV NSCLC at Konyang University from April 2005 to October 2006 were enrolled in the present study. Paclitaxel at a dose of 55 mg/m2 in combination with cisplatin at a dose of 20 mg/m 2 was administered intravenously on day 1, 8, and 15 with 1 week of interruption for a total of six cycles of chemotherapy. Results: The mean age of the ten patients included in this study was 69.5 years. Following treatment, 50 % of the patients exhibited a partial response to treatment, whereas the disease remained stable in 40% of the patients, and progressed in 10% of the patients. The median survival time (Kaplan-Meier method) was 15 months (4 ∼24 months), and the 6-month, 1-year, and 2-year survival rates were 80%, 50%, and 10%, respectively. The median progression survival time was 8 months (2 ∼14 months) and the 6- and 12-month progression free survival rates were 60% and 10%, respectively. Grade 3 neutropenia occurred in only 1 case (10%). Conclusion: The results of this study indicated that chemotherapy consisting of a weekly low dose of paclitaxel and cisplatin could be more effective and have lesser toxicity when administered to elderly patients with advanced NSCLC. In addition, this treatment regimen showed a promising response rate. (J Lung Cancer 2007;6(2):85�� 90)

Behcet’s disease is a systemic vasculitis of an unknown etiology involving the arteries and veins of all sizes. There are reports showing that a pulmonary artery aneurysm or thromboembolism and superior vena cava thrombosis are present in 5-10% of patients with Behcet's disease and that lung parenchymal lesions are mainly airway consolidations resulting from hemorrhage or infarction. We encountered a patient with increasing pulmonary cavitary changes and localized aspergilloma. The patient was a 43-year-old man diagnosed with Behcet’s disease with a history of recurrent oro-genital ulceration and uveitis, and who was administered methotrexate, colchicines, prednisolone. During the follow up he developed progressive dyspnea upon exertion and finger clubbing. Therefore further evaluations were performed. Chest computed tomography showed more advanced consolidations and cavitations than the previous film with the previously known aspergilloma still observable. An open lung biopsy was carried out to determine the presence of malignant changes, which revealed nonspecific vasculitis. Azathioprine was added resultion in an improvement of symptoms. (Tuberc Respir Dis 2006; 61: 65-69)

Background : Acute drug intoxication has recently become an important issue in the social and clinical areas. There are various complications associated with acute drug intoxication such as pneumonia, but the process is was not fully understood. The aim of this study was to analyze our cases of pneumonia associated with acute drug intoxication and to determine the associated risk factors. Methods : Forty four cases out of 237 patients, who were acute drug intoxicated from May 2000 to Feb. 2005, were diagnosed with pneumonia at the Konyang University hospital. These cases were analyzed by a retrospective review of their medical records. Results : The incidence of pneumonia in acute drug intoxication was 18.6%. There was no gender difference in terms of the incidence, but the age group with the highest incidence was in the decade (22.5%) followed by the decade (17.9%). Most common drug of associated with pneumonia was organophosphate insecticides, and the others were herbicides. Suicidal attempts were the most common motive of intoxication. The incidence of pneumonia was increased in old age (, p, p=0.006). A longer hospital duration was also a risk factor for pneumonia (, p

Background : An insertion-deletion polymorphism of angiotensin converting enzyme (ACE) gene has been shown to be associated with enzyme activity levels of ACE. Reported results that have been mutually contradictory about asthmatic hypersensitiveness and occurrence according to ACE gene insertion (I)/deletion (D) polymorphism. Also, the involvement of the ACE genes as the genetic basis of bronchial asthma is currently controversy. We investigated whether there was any association between polymorphisms of the ACE genes and airway hyper-responsiveness in chronic obstructive pulmonary disease (COPD). Methods : A total of 100 patients with COPD were enrolled in this study. The ACE genotypes were determined in all subjects by polymerase chain reaction. Pulmonary function test including bronchodilator response (BDR), methacholine bronchial provocation test (MBPT) were done in those patients. Airway hyper-responsiveness include any findings of positive BDR or MBPT. Results : In COPD patients, the ACE genotype distribution did not differ significantly among groups of patients with severities of COPD, and with or without airway hyper-responsiveness. Conclusions : These results suggest that polymorphisms of the ACE gene may not be associated with airway hyper-responsiveness, development and severity of COPD.

Internal myiasis is a rare disease, which has not been reported in Korea, yet. This case report describes a patient with pneumonia associated with internal myiasis. She was 84-year old female who was admitted to the emergency department, Konyang University Hospital as a result of dyspnea and fever and a drowsy mental state. Approximately twenty fly maggots continuously crawled out from the nose at the third hospital day in the intensive care unit. These maggots were almost 7.2mm long and were identified as the genus lucilia belonging to the family Calliphoridae. In addition, a bronchial washing study showed eggs of the dipterous larvae. A lesion of this myiasis case might have been located in the respiratory system of patient. This case is the first internal myiasis of the respiratory system reported in Korea. This cases is discussed with a review of the relevant literature.