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BACKGROUND: Several researchers have reported that the amount of protein intake is associated with lung function and airflow obstruction. However, few studies have investigated the effect of low protein intake on acute exacerbations of chronic obstructive pulmonary disease. This study aimed to investigate the effect of low protein intake on exacerbations in mild to moderate chronic obstructive pulmonary disease. METHODS: We used data obtained from the Korean National Health and Nutrition Examination Survey (KNHANES) between 2007 and 2012, linked to the National Health Insurance claims data. The clinical outcomes and the rate of exacerbation were retrospectively compared between the low protein intake group and the non-low protein intake group which was stratified by quartile categories of protein intake in 2,069 patients with mild to moderate chronic obstructive pulmonary disease. RESULTS: The low protein intake group was significantly associated with older age, women, never smoker, low household income, and low education level, compared with the non-low protein intake group. The low protein intake group was significantly associated with increased hospitalization (18.0% vs. 10.5%, P

Abscisic acid (ABA) is a signaling molecule conserved in plants, bacteria, fungi and animals. Recently, ABA has gained attention for its pharmacological activities and its potential as a biomarker for the severity of chronic obstructive pulmonary disease (COPD) and glioma. This prompts the development of a reliable, sensitive, rapid, and cost-effective method to quantify ABA levels in mammalian cells and tissues. The previously described ABA biosensor system based on the ABA-dependent interaction between the plant ABA receptor PYL1 and co-receptor ABI1 is not sensitive enough for the low ABA levels seen in mammals. Therefore, we optimized this system by replacing PYL1 with other high-affinity plant PYL proteins. The optimized biosensor system engineered with the PYL8 receptor enabled the quantification of ABA at low concentrations in HEK293T cells.

Objective Although previous studies have reported impaired performance in the reading the mind in the eyes test (RMET), which measures complex emotion recognition abilities, in patients with schizophrenia, reports regarding individuals at clinical high risk (CHR) for psychosis have been inconsistent, mainly due to the interacting confounding effects of general cognitive abilities and age. We compared RMET performances across first-episode psychosis (FEP) patients, CHR individuals, and healthy controls (HCs) while controlling for the effects of both general cognitive abilities and age.Methods A total of 25 FEP, 41 CHR, and 44 HC subjects matched for age participated in this study. RMET performance scores were compared across the groups using analysis of variance with sex and intelligence quotient as covariates. Exploratory Pearson’s correlation analyses were performed to reveal the potential relationships of RMET scores with clinical symptom severity in the FEP and CHR groups.Results RMET performance scores were significantly lower among FEP and CHR participants than among HCs. FEP patients and CHR subjects showed comparable RMET performance scores. RMET scores were negatively correlated with Positive and Negative Syndrome Scale (PANSS) positive symptom subscale scores in the FEP patients. No significant correlation was identified between RMET scores and other clinical scale scores.Conclusion Impaired RMET performance is present from the risk stage of psychosis, which might be related to positive symptom severity in early psychosis. Longitudinal studies are necessary to confirm the stability of complex emotion recognition impairments and their relationship with social functioning in early psychosis patients.

Many studies have been conducted to improve economically important livestock traits such as feed efficiency and muscle growth. Genome editing technologies represent a major advancement for both basic research and agronomic biotechnology development. The clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 technical platform is a powerful tool used to engineer specific targeted loci. However, the potential occurrence of off-target effects, including the cleavage of unintended targets, limits the practical applications of Cas9-mediated genome editing. In this study, to minimize the off-target effects of this technology, we utilized D10A-Cas9 nickase to generate myostatin-knockout (MSTN KO) chickens via primordial germ cells. D10A-Cas9 nickase (Cas9n)-mediated MSTN KO chickens exhibited significantly larger skeletal muscles in the breast and leg. Degrees of skeletal muscle hypertrophy and hyperplasia induced by myostatin deletion differed by sex and muscle type. The abdominal fat deposition was dramatically lower in MSTN KO chickens than in wild-type chickens. Our results demonstrate that the D10A-Cas9 technical platform can facilitate precise and efficient targeted genome engineering and may broaden the range of applications for genome-edited chickens in practical industrialization and as animal models of human diseases.

The value-added products in livestock industry is one of the key issues in order to maximize the revenue and to create a new business model. Numerous studies have suggested application of herbal plants as feed additives to increase health, productivity, and/or high-quality product in livestock. In this study, the first experiment was designed to develop in vitro evaluation system by using primary chicken myoblast (pCM) cells isolated from pectoralis major of 10-day-old male embryos. Subsequently, to evaluate effects of Korean Danggui Angelica gigas Nakai (AGN), we optimized the concentration of AGN root extract for treatment of primary pCM cells. After the treatment of AGN root extract, we compared proliferation and differentiation capacity, and also examined the gene expression. In the second experiment, the next generation sequencing analysis was performed to compare the different patterns of the global gene expression in pCM cells treated with AGN extract. Three up-regulated (pancreas beta cells, fatty acid metabolism and glycolysis) and one down-regulated (adipogenesis) gene sets were characterized suggesting that the AGN extract affected the metabolic pathways for the utilization of fat and glucose in chicken muscle cells. Furthermore, we validated the expression patterns of the up-regulated genes (GCLC, PTPN6, ISL1, SLC25A13, TGFBI, and YWHAH) in the AGN-treated pCM cells by quantitative RT-PCR. These results demonstrated that the treatment of AGN extract decreased proliferation and differentiation of pCM cells, and affected the metabolic pathways of glucose and fatty acids. Moreover, AGN extract derived from byproducts such as stem and leaf also showed the reduced proliferation patterns on AGN-treated pCM cells. Taken together, pCM cell-based in vitro assay system could be primarily and efficiently applied for evaluating the biofunctional efficacy of various feed additive candidates.

The circadian rhythm is a 24-h cycle in which cells control metabolic and physiological processes throughout the day. In this study, we compared the expression patterns of major circadian rhythm-related genes: from blood of Bmal1, Ror-α, Cry1, Per2, Per1, and Nr1d1. In addition, changes in patterns of melatonin levels were observed in 16 subjects, eight males rugby players and eight males who did not exercise regularly. Blood was collected at 6:00, 10:00, 18:00, and 22:00. Bmal1, Ror-α, Cry1, Per2 (p

Introduction Uwhangchungsimwon (UCW) is one of the most representative standardized herbal drugs for the treatment of central nervous system diseases, including mood disorders, and has been used for over 600 years in Korea and China. In spite of the long clinical application of UCW, no experimental evidence for its use against depressive disorders exists. Here, we performed an animal study to investigate the anti-depressive effect of UCW and the underlying mechanisms. Methods A social isolation-induced depressive-like model was produced using C57BL/6J male mice by housing the mice individually for 31 days, and the mice underwent daily oral administration of distilled water, UCW (100, 200, 400 mg/kg) or fluoxetine (20 mg/kg) during the final 17 days. A tail suspension test (TST), forced swimming test (FST), and open field test (OFT) were used to explore the effects of UCW on depressive-like behaviors. 5-Hydroxytryptamine (5-HT) was measured in the dorsal raphe nuclei (DRN) using immunofluorescence. The serum corticosterone level was measured with its receptor and catecholamine, along with cAMP response element-binding protein (CREB) and brain-derived neurotrophic factor (BDNF) in the hippocampus. Results Social isolation stress effectively induced depressive-like behaviors, and UCW treatment significantly improved the symptoms of depressive-like behavior in the FST, TST, and OFT. The isolation stress-induced depletion of 5-HT was significantly ameliorated by UCW treatment. UCW also attenuated the activation of the glucocorticoid receptor (GR) and the elevated serum corticosterone level, as well as the hippocampal levels of dopamine and norepinephrine. Dexametasone-derived translocation of GR was inhibited by UCW treatment in PC12 cells and HT22 cells. In addition, alterations of tryptophan hydroxylase 2 (TPH2), BDNF, and CREB in the protein analyses were notably regulated by UCW treatment. Conclusions These results provide animal-based evidence for the anti-depressive effect of UCW, and its underlying mechanisms may involve regulating the serotonergic system, the hypothalamic-pituitary-adrenal (HPA) axis, and neurotrophin.

In poultry industry as well as livestock, the precise genetic information is being required for improving the economic traits. Thus, functional genomic studies are widely conducted to build the genetic and genomic information for faster, healthier and more-efficient animal production. Especially, chicken myoblast cells which are required to muscle development and regeneration are important because chicken growth performance is closely related to muscle mass. In this study, we induced expression of microRNA-146b (miR-146b) mediated by piggyBac transposon system in chicken myoblast (pCM cells). Subsequently, we analyzed and compared the proliferation and differentiation capacity, and also examined the expression patterns of related genes between regular pCM (rpCM) cells and miR-146b overexpressing pCM (pCM-146b OE) cells. The overexpression of miR-146b showed that the increased proliferation and up-regulated gene expression related to cell proliferation. In addition, the next generation sequencing (NGS) analysis were performed to compare the global gene expression patterns between rpCM cells and pCM-146b OE cells. We found that the higher proliferation rate of pCM-146b OE cells resulted from up-regulation of the cell cycle related gene sets. Moreover, miR-146b overexpression indicated that inhibitory effect of myotube differentiation in chicken myoblast cells. Collectively, these results demonstrated that miR-146b is closely related to proliferation and differentiation of chicken myogenic cells as a modulator of post-transcription.

Introduction: Pranlukast is a leukotriene receptor antagonist (LTRA) that is used as an additional controller of mild to moderate asthma. This study compared the efficacy and side effects of two bioequivalent preparations of pranlukast: original pranlukast (Onon®; Ono Pharmaceutical, Japan) and a modified formulation of pranlukast (Prakanon®; Yuhan Co, Korea) in patients with mild to moderate asthma. Methods: Of the 34 subjects screened, 30 patients who were using standard medication to control asthma and scored less than 20 points on the Asthma Control Test™ (ACT) were assigned randomly to one of the two groups in a prospective, open label, crossover study: group 1 received Prakanon® (150 mg/day) and group 2 received Onon® (450 mg/day) for 8 weeks each; after a 1-week rest period, the groups were switched to the alternative medication for further 8 weeks and monitored for 2 more weeks without study medication. Evaluation parameters included the ACT, quality of life questionnaire adult Korean asthmatics (QLQAKA), pulmonary function tests, peripheral blood tests, vital signs, and adverse events. Results: Thirty patients were enrolled and 21 completed the trial: 10 in group 1 and 11 in group 2. The baseline data of the two groups did not differ. No statistical significant differences were observed in efficacy and lung function at each time and in changes from baseline value between the two kinds of pranlukast. The final asthma control rate was 81% with Prakanon® and 76% with Onon®. There were no differences in vital signs and laboratory data at each time and in changes from baseline value between the two drugs. There were no differences in adverse events between the two drugs. The most common side effect was abdominal pain. Drug compliance was high, without differences between the two drugs. Conclusion: These findings suggest that Prakanon® which is an improved formulation of pranlukast at a lower dose than the original formulation, Onon®, has a similar efficacy and side effect profile in the control of persistent asthma.

Metabolic syndrome is characterized by the co-occurrence of diverse symptoms initiating the development of type 2 diabetes, cardiovascular diseases, and a variety of comorbid diseases. The complex constellation of numerous comorbidities makes it difficult to develop common therapeutic approaches that ameliorate these pathological features simultaneously. The plant hormones abscisic acid, salicylic acid, auxin, and cytokinins, have shown promising anti-inflammatory and pro-metabolic effects that could mitigate several disorders relevant to metabolic syndrome. Intriguingly, besides plants, human cells and gut microbes also endogenously produce these molecules, indicating a role in the complex interplay between inflammatory responses associated with metabolic syndrome, the gut microbiome, and nutrition. Here, we introduce how bioactive phytohormones can be generated endogenously and through the gut microbiome. These molecules subsequently influence immune responses and metabolism. We also elaborate on how phytohormones can beneficially modulate metabolic syndrome comorbidities, and propose them as nutraceuticals.

Objective In the poultry industry, the most important economic traits are meat quality and carcass yield. Thus, many studies were conducted to investigate the regulatory pathways during muscle differentiation. To gain insight of muscle differentiation mechanism during growth period, we identified and validated calcium-related genes which were highly expressed during muscle differentiation through mRNA sequencing analysis. Methods We conducted next-generation-sequencing (NGS) analysis of mRNA from undifferentiated QM7 cells and differentiated QM7 cells (day 1 to day 3 of differentiation periods). Subsequently, we obtained calcium related genes related to muscle differentiation process and examined the expression patterns by quantitative reverse-transcription polymerase chain reaction (qRT-PCR). Results Through RNA sequencing analysis, we found that the transcription levels of six genes (troponin C1, slow skeletal and cardiac type [TNNC1], myosin light chain 1 [MYL1], MYL3, phospholamban [PLN], caveolin 3 [CAV3], and calsequestrin 2 [CASQ2]) particularly related to calcium regulation were gradually increased according to days of myotube differentiation. Subsequently, we validated the expression patterns of calcium-related genes in quail myoblasts. These results indicated that TNNC1, MYL1, MYL3, PLN, CAV3, CASQ2 responded to differentiation and growth performance in quail muscle. Conclusion These results indicated that calcium regulation might play a critical role in muscle differentiation. Thus, these findings suggest that further studies would be warranted to investigate the role of calcium ion in muscle differentiation and could provide a useful biomarker for muscle differentiation and growth.

The detrimental effect of high salinity on crop production is a serious problem. However, the number of genes with known functions relating to salinity tolerance is very limited in rice. To effectively address this limitation, selection of useful candidate genes and identification of major regulatory factors through global approaches are necessary. To this end, we used three data series of affymetrix array data produced with salt-treated samples from NCBI Gene Expression Omnibus ( http://www.ncbi.nlm.nih.gov/geo/ ) and identified 653 rice genes commonly differentially expressed under three salt-stress conditions. While evaluating the quality of selected candidate genes for salt-stress responses, Gene ontology enrichment analysis revealed that responses to salt and water stresses of biological process category are highly overrepresented in salt-stress conditions. In addition, the major salt stress-responsive metabolism process and regulatory gene modules are classified through MapMan analysis, and detailed elements for further studies are suggested. Based on this, we proposed a salt stress-responsive signaling pathway in rice. The functional analysis of the main signal transduction and transcription regulation factors identified in this pathway will shed light on a novel regulatory metabolism process that can be manipulated to develop crops with enhanced salinity tolerance.

The aim of this study was to characterize the prognosis and identify factors that contribute to rebleeding after bronchial artery embolization (BAE) in patients with active or inactive pulmonary tuberculosis (PTB).Following a retrospective review, 190 patients had hemoptysis requiring BAE due to PTB in one hospital between 2006 and 2013.The median age at the time of diagnosis of PTB was 37 years and 54 years at the time of first episode of hemoptysis. Among 47 patients (24.7 %) who experienced rebleeding after BAE during the median follow-up period of 13.9 months [interquartile range (IQR) 2.3-36.0 months], bleeding recurred in 12 patients (6.3 %) within 1 month and in 15 patients (7.9 %) after 1 year. The median non-recurrence time was 8.6 months (IQR 1.2-27.6 months). Independent predictors of rebleeding after BAE were tuberculous-destroyed lung [hazard ratio (HR) 3.0; 95 % confidence interval (CI) 1.5-6.2; p = 0.003], the use of anticoagulant agents and/or antiplatelet agents (HR 2.6; 95 % CI 1.1-5.8; p = 0.022), underlying chronic liver disease (HR 2.7; 95 % CI 1.1-4-6.9; p = 0.033), elevated pre-BAE C-reactive protein (CRP) (mg/dL) (HR 2.4; 95 % CI 1.0-5.5; p = 0.048), and the existence of fungal ball (HR 2.1; 95 % CI 1.0-4.3; p = 0.050).The risk of rebleeding after BAE in active or inactive PTB was high, particularly in patients with tuberculous-destroyed lung, chronic liver disease, the use of anticoagulant agents and/or antiplatelet agents, elevated pre-BAE CRP, and the existence of fungal ball.

Background The development of other primary cancers in patients with lung cancer is unfortunate and uncommon, although the frequency is increasing. The aim of this study was to determine the clinical features and prognosis in patients with multiple primary cancers (MPC) involving lung cancer. Methods After a retrospective review of 1644 patients who were newly diagnosed with primary lung cancer between 1998 and August 2012 at a tertiary hospital, 105 patients were included. Results The median age at the time of lung cancer diagnosis was 67 years, and 68 patients were male. Synchronous primary cancers occurred in 47% of the study population (49/105). Among those with metachronous cancer (56/105), the median interval between the diagnosis of lung cancer and another malignancy was 47.1 months; 21 patients were diagnosed with lung cancer as the first primary tumor. The most frequent type of other malignancy was urogenital (30%), followed by gastrointestinal (30%) and thyroid malignancies (16%). Advanced stage of lung cancer (hazard ratio (HR), 3.2; 95% confidence interval (CI), 1.8–5.7; P < 0.001), supportive care only as treatment for lung cancer (HR, 2.8; 95% CI, 1.3–6.0; P = 0.006), and head and neck cancer as another malignancy (HR, 3.9; 95% CI, 1.4–10.8; P = 0.010) were independent predictors of shorter survival from the time of diagnosis of the second primary cancer. Conclusion Advanced lung cancer stage, symptomatic supportive care only without antitumor therapy for lung cancer, and head and neck cancer as another primary malignancy were poor prognostic factors in patients with MPC involving primary lung cancer.

Plants retain rhythmic physiological responses when adapting to environmental challenges. However, possible integrations between drought conditions and those responses have not received much focus, especially regarding crop plants, and the relationship between abiotic stress and the diurnal cycle is generally not considered. Therefore, we conducted a genome-wide analysis to identify genes showing both diurnal regulation and water-deficiency response in rice (Oryza sativa). Among the 712 drought-responsive genes primary identified, 56.6% are diurnally expressed while 47.6% of the 761 that are down-regulated by drought are also diurnal. Using the β-glucuronidase reporter system and qRT-PCR analyses, we validated expression patterns of two candidate genes, thereby supporting the reliability of our transcriptome data. MapMan analysis indicated that diurnal genes up-regulated by drought are closely associated with the starch-sucrose pathway while those that are down-regulated are involved in photosynthesis. We then confirmed that starch-sucrose contents and chlorophyll fluorescence are altered in a diurnal manner under drought stress, suggesting these metabolic diurnal alterations as a novel indicator to evaluate the drought response in rice leaves. We constructed a functional gene network associated with the starch-sucrose KEGG metabolic pathway for further functional studies, and also developed a regulatory pathway model that includes OsbZIP23 transcription factor.

The conventional treatment for community-acquired pneumonia (CAP) involves combination therapy consisting of a β-lactam penicillin or a cephalosporin with a macrolide. Alternatively, high-dose levofloxacin treatment has been used as single-agent therapy for treating CAP, covering atypical pathogens.This study compared the clinical efficacy and safety of high-dose levofloxacin with combined ceftriaxone and azithromycin for the treatment of CAP.This phase IV, prospective, randomized, open-label trial enrolled patients admitted to a tertiary referral hospital for CAP treatment from 2010 to 2011. Hospital admission was decided based on clinical judgement and the pneumonia severity index. Forty subjects were enrolled and assigned to two treatment arms using a random numbers table. The 20 subjects in the experimental group were given levofloxacin 750 mg intravenously once daily, followed by the same dose of oral levofloxacin at discharge when clinically improved and the 20 subjects in the control group were given ceftriaxone 2.0 g intravenously once daily plus oral azithromycin 500 mg for 3 consecutive days, followed by oral cefpodoxime 200 mg per day at discharge after clinical improvement. The primary outcome was the clinical success rate. Secondary outcomes were the microbiological success rate and adverse events during the study.Of the 40 subjects enrolled, 36 completed the study: 17 in the experimental group and 19 in the control group. The groups did not differ in terms of demographic factors or clinical findings at baseline. The clinical success rate (cured + improved) was 94% in the experimental (levofloxacin) group and 84% in the control group (p0.05). The microbiological success rate and overall adverse events were also similar in both groups.Single-agent, high-dose levofloxacin treatment exhibited excellent clinical and microbiological efficacy with a safety profile comparable to that of ceftriaxone plus azithromycin therapy. Large-scale clinical trials are required to verify these results.WHO International Clinical Trials Registry: KCT0000374; Daiichi-Sankyo Korea study code: T11-13-V1.

Thank you for the recent comments1 for the topic of real-time polymerase chain reaction (RT-PCR) assay2. We propose that positivity in RT-PCR using any respiratory specimens suggests the possibility of active tuberculosis (TB) in clinically suspected cases, guiding to start anti-TB medication, and RT-PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination2. Wiwanitkit1 mentioned that "There are some concerns on this assay. False-positive of the test can be seen in cases with treated or old lesion from pulmonary TB and the low sensitivity of the test can be seen." As a response to the issues of false-positivity raised by Wiwanitkit1, it was mentioned in our paper2 that "In our study, the false-positive rate was 0.5% in sputum and 2.0% in bronchoscopic aspirates. False-positivity in PCR has been reported to be due to carry-over contamination between specimens, cross-reactions with isolated nontuberculous mycobacteria, or dead tissue debris from previous TB scarring in highly endemic areas." Low sensitivity of this test was also discussed in our paper2 that "Most reports have evaluated PCR using known acid-fast bacilli-positive samples. In smear-positive specimens, the sensitivity and specificity of polymerase chain reaction are in the range 90%-100%, with a positive predictive value of >95%, whereas in smear-negative specimens, the sensitivity of PCR is reduced to

Eun Mi Chun, Seo Woo Kim, So Yeon Lim Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea Background: Colorectal adenomatous polyps are precancerous lesions of colorectal cancer. The aim of this study was to assess the prevalence of colorectal adenomatous polyps in chronic obstructive pulmonary disease (COPD) patients and determine whether COPD is associated with colorectal malignant potential.Methods: Subjects who had undergone post-bronchodilator spirometry and colonoscopy and were 40 years or older were selected from the hospital database. COPD was defined as a spirometry in which the ratio of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) is

Seok Jeong Lee,1 Seo Woo Kim,1 Kyoung Ae Kong,2 Yon Ju Ryu,1 Jin Hwa Lee,1 Jung Hyun Chang1 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, 2Department of Clinical Trial Center, School of Medicine, Ewha Womans University, Seoul, Republic of Korea Background: Chronic obstructive pulmonary disease (COPD) patients include those who have never smoked. However, risk factors other than smoking in never-smokers have not been elucidated sufficiently. This study investigated the risk factors for COPD among never-smokers in Korea using population-based data. Methods: The data were retrieved from the Korean National Health and Nutrition Survey IV conducted from 2007 to 2009. Among subjects aged 40 years or older who underwent appropriate pulmonary function tests, never-smokers not diagnosed with asthma and not showing a restrictive pattern on pulmonary function tests were enrolled. Risk factors of COPD in never-smokers were analyzed using logistic regression models. Results: Among 24,871 participants in the representative Korean cohort, 3,473 never-smokers were enrolled. COPD patients accounted for 7.6% of the never-smokers. In the logistic regression analysis, low education status (odds ratio [OR]: 2.0; 95% confidence interval [CI]: 1.2–3.2), occupational exposure (OR: 2.6; 95% CI: 1.3–5.3), a history of tuberculosis (OR: 4.5; 95% CI: 2.3–8.7), bronchiectasis (OR: 6.0; 95% CI: 1.4–25.4), male sex (OR: 4.2; 95% CI: 2.6–6.7), advanced age (60–69 years vs 40–49 years; OR: 3.8; 95% CI: 2.0–7.0), and being underweight (body mass index

Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, KoreaBackground: The incidence of tuberculosis (TB) in Korea is relatively high compared to the other Organisation for Economic Co-operation and Development (OECD) countries, with a prevalence of 71 per 100,000 in 2012, although the incidence is declining. Real-time polymerase chain reaction (PCR) has been introduced for the rapid diagnosis of TB. Recently, its advantage lies in higher sensitivity and specificity for the diagnosis of TB. This study evaluated the clinical accuracy of real-time PCR using respiratory specimens in a clinical setting.Methods: Real-time PCR assays using sputum specimens and/or bronchoscopic aspirates from 2,877 subjects were reviewed retrospectively; 2,859 subjects were enrolled. The diagnosis of TB was determined by positive microbiology, pathological findings of TB in the lung and pleura, or clinical suspicion of active TB following anti-TB medication for more than 6 months with a favorable response.Results: Sensitivity, specificity, and accuracy were 44%, 99%, and 86% from sputum, and 65%, 97%, and 87% from bronchoscopic aspirates, respectively. For overall respiratory specimens, sensitivity was 59%, specificity was 98%, and accuracy increased to 89%.Conclusion: Positivity in real-time PCR using any respiratory specimens suggests the possibility of active TB in clinically suspected cases, guiding to start anti-TB medication. Real-time PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination.Keywords: Diagnosis; Sputum; Bronchoscopy; Real-Time Polymerase Chain Reaction; Tuberculosis, Pulmonary

Background: More than half of cases for advanced non-small-cell lung cancer (NSCLC) occur in elderly patients with a median age at diagnosis of 70 years. The aim of our study was to examine the clinical features and prognostic factors contributing to mortality in elderly patients with advanced NSCLC. Methods: Following a retrospective review of clinical data, 122 patients aged 70 years and over with a histopathological diagnosis of locally advanced (stage IIIB, n=32) and metastatic (stage IV, n=90) NSCLC between 2005 and 2011 were enrolled. Results: The median age was 76 years (interquartile range, [IQR], 72−80 years), and 85 (70%) patients were male. Fiftyseven (46%) patients had never smoked, and 17 (19%) were in a malnourished state with a body mass index (BMI) of

Background/Aims: Gastroesophageal reflux disease is one of the most common causes of chronic cough and is a potential risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors for reflux esophagitis (RE) in COPD patients. Methods: From our hospital database, between September 2006 and April 2010, we searched for subjects who were 40 years old or older and had undergone both postbronchodilator spirometry and esophagogastroduodenoscopy (EGD). COPD was defined as having a ratio of forced expiratory volume in 1 second to forced vital capacity < 0.7 in postbronchodilator spirometry and no abnormality causing airway obstruction, except emphysematous changes, on a chest X-ray. The diagnosis of RE was based on a mucosal break surrounding the distal esophageal sphincter through EGD. Results: In total, 253 patients with COPD were enrolled. The prevalence of RE in COPD was 30% (76/253). Multiple logistic regression analyses revealed that age (odds ratio [OR], 0.950; 95% confidence interval [CI], 0.918 to 0.983; p = 0.003), smoking pack-years (OR, 1.015; 95% CI, 1.004 to 1.025; p = 0.006), and inhaled anticholinergics (OR, 0.516; 95% CI, 0.271 to 0.982; p = 0.044) were independently associated with RE in COPD patients. Conclusions: The prevalence of RE in our COPD patients was higher than that reported previously in the Korean general population. In COPD, smoking increased the risk of RE, whereas inhaled anticholinergics may be associated with a reduced risk of RE.

Background: Distal airway bacterial colonization occurs more frequently in patients with endotracheal tubes or tracheostomy of intensive care units (ICU) care. In general, bronchoscopic samples are considered more accurate than transtracheal aspirates. In this study, we evaluated the consistency and clinical significance between bronchoscopic samples and transtracheal aspirates (TTA) in severe pneumonia under mechanical ventilation. Methods: We investigated the consistency between bronchoscopic samples and transtracheal aspirates among patients with endotracheal tubes or tracheostomy, retrospectively. Fiberoptic bronchoscopy was performed in 212 patients with mechanical ventilation via endotracheal tube or tracheostomy between January 1st, 2004 and December 31th, 2008 in ICU at Ewha Womans University Hospital. We evaluated consistency in terms of true pathogen according to the arbitrary ICU days progress. Results: Among the 212 enrolled patients, 113 (53%) had consistency between bronchoscopic samples and transtracheal aspirates. When evaluated alteration trends in consist ency according to ICU stay, the consistency was maintained for 5 to 9 ICU days with statistical significance (p ＜ 0.05) since adjusting for age, sex, and combined risk factors. Consistency in sampling status between the endotracheal tube and tracheostomy was also evaluated, however, there was no statistical significance (OR 1.9 vs. 1, 95% CI = 0.997−3.582, p = 0.051). Conclusions: Shorter hospital stay (within 9 d ays of ICU stay) had higher probability of consistency between bronchoscopic samples and TTA samples. TTA may be as confident as bronchoscopic samples in patients of pneumonia under mechanical ventilation with shorter ICU stays, especially less than 10 days.

Blockers of renin-angiotensin system(RAS) including ACE inhibitor or ARB are one of the most frequently prescribed medications for the treatment of hypertension, heart failure and proteinuria. One of the major side effects of these RAS blockers is the deterioration of renal function, mainly due to a reduction of intraglomerular pressure. Therefore, close monitoring of renal function is recommended when RAS blockers are initially prescribed, especially for the patients with impaired renal function. We report a patient who was transferred to our hospital due to the sudden development of oliguria and dyspnea after treatment for hypertension with ACEi and ARB. She was finally diagnosed as RAS blocker-induced acute renal failure with pulmonary edema complicated on congenital solitary kidney. After hemodialysis and conservative treatment, her renal function was recovered with maintenance of normal urine output. Conclusion:This case highlights the necessity of the functional and structural evaluation of kidney to prevent the serious complication such as acute renal failure before the administration of ACEi and/or ARB.

Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.

Mixed hepatocellular-cholangiocarcinoma accounts for about 1% of all hepatocellular carci- noma. In many cases, mixed hepatocellular-cholangiocarcinoma has been misdiagnosed as hepa- tocellular carcinoma or cholangiocarcinoma because of the indistinctive clinical course and radi- ologic findings. The clinical course and the pathologic characters are not known well, but it resem- bles the characteristics of hepatocellularcarcinoma rather than cholangiocarcinoma. So mixed hepa- tocellular-cholangiocarcinoma was classified as a kind of hepatocellular carcinoma. But the gr- owth and dissemination rate is faster than that of hepatocellular carcinoma and the prognosis more poor. So the exact diagnosis is important. Authors experienced a patient who has the mixed hepa- tocellular-cholangiocarcinoma diagnosed by liver and neck node biopsy in patient who complain-ed abdominal discomfort and palpable mass, so we report the case.