Clinical Factors Associated with Lung Function Decline and Mortality in Rheumatoid Arthritis-related Interstitial Lung Disease

( Kangjoon Kim ),( Ala Woo ),( Youngmok Park ),( Seung Hyun Yong ),( Su Hwan Lee ),( Sang Hoon Lee ),( Ah Young Leem ),( Song Yee Kim ),( Kyungsoo Chung ),( Eun Young Kim ),( Ji Ye Jung ),( Young Ae K 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Purpose Studies on risk and protective factors for lung function decline and mortality in rheumatoid arthritis-related interstitial lung disease (RA-ILD) are limited. Therefore, we aimed to investigate clinical factors and medication uses associated with lung function decline and mortality in patients with RA-ILD. Methods This retrospective cohort study examined patients with RA-ILD who visited Severance Hospital, a university-affiliated tertiary referral hospital in South Korea, between January 2006 and December 2019. From 3,946 consecutive RA patients, we selected 170 participants with RA-ILD with at least one spirometry (Figure 1). Absolute FVC decline ≥10% was defined as significant decline of pulmonary function. Valid medical treatment was defined as continuation of medication for at least 12 weeks in the period between diagnosis date of RA and the last follow-up. Data were retrieved from electronic medical records. Results Ninety patients (52.9%) were female; mean ± SD age was 64.0 ± 10.2 years. Multivariate logistic regression showed that high ESR at RA diagnosis (≥81.5 mm/hr) (OR 3.056; 95% CI 1.183-7.890) and history of methotrexate (MTX) use (OR 0.269; 95% CI 0.094-0.769) were identified as risk and protective factors for lung function decline, respectively. Multivariate cox regression analysis showed that age 65 years or older (OR 2.723; 95% CI 1.142-6.491), radiologic pattern of usual interstitial pneumonia (UIP) or probable UIP (OR 3.948; 95% CI 1.522-10.242, p=0.005), baseline FVC % predicted (OR 0.971; 95% CI 0.948-0.994), and history of MTX use (OR 0.284; 95% CI 0.091-0.880) predicted mortality in the cohort. Conclusions MTX use was associated with favorable outcome in terms of lung function and mortality in our cohort. A largersized, prospective study may be warranted to investigate beneficial effect of MTX on RA-ILD.

Serum CA 19-9 Level Correlates CT Severity Score in Patients with NTM-PD

( Kangjoon Kim ),( Hye-jeong Lee ),( Seung Hyun Yong ),( Su Hwan Lee ),( Sang Hoon Lee ),( Song Yee Kim ),( Kyungsoo Chung ),( Eun Young Kim ),( Ji Ye Jung ),( Moo Suk Park ),( Young Sam Kim ),( Joon 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Background Until now, there is no validated clinical biomarker of nontuberculous mycobacterial pulmonary disease (NTM-PD) in terms of evaluating disease severity or treatment response. Limited data suggests that elevated serum carbohydrate antigen 19-9 (CA 19-9) is observed in the patients with NTM-PD, and the level decreases following the successful NTM-PD treatment. Methods This retrospective study examined 79 NTM-PD patients who conducted both measurement of serum CA 19-9 level and chest computed tomography (CT) scan, less than a month apart. The NTM-PD disease severity were rated by the scoring system based on CT images. Correlation between the CT score and the serum level of CA 19-9 were evaluated by using Spearman’s correlation coefficient and Spearman’s partial correlation coefficient, and the latter was controlled for the variables of age, sex and body mass index (BMI). Results Serum CA 19-9 levels had a positive correlation with the CT score, especially for the score of total (rs=.416, p<0.01), and the sub-score of bronchiectasis (rs=.251, p<0.05), bronchiolitis (rs=.289, p<0.01), cavity (rs=.221, p<0.05), and consolidation (rs=.303, p<0.01). Patients’ BMI had a negative correlation with the CT score (rs=-.358, p<0.01), but had no significant correlation with serum CA 19-9 level itself. After controlling for the variables of age, sex and BMI, partial correlation analysis showed statistically significant positive correlation between serum CA 19-9 level and the CT score of bronchiectasis, bronchiolitis, cavity, consolidation, and total sum (Table 1). Conclusion Serum CA 19-9 levels had a positive correlation with the CT severity score of NTM-PD. Serum CA 19-9 may be a useful biological marker for evaluating disease activity or therapeutic response in the patients with NTM-PD, and further study is warranted.

Incidence and Risk Factors for Brain Metastasis in Patients with Presumed Early-stage Lung Cancer

( Kangjoon Kim ),( Ala Woo ),( Youngmok Park ),( Seung Hyun Yong ),( Su Hwan Lee ),( Ah Young Leem ),( Song Yee Kim ),( Kyungsoo Chung ),( Eun Young Kim ),( Ji Ye Jung ),( Young Ae Kang ),( Young Sam 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Purpose Regarding whether brain magnetic resonance imaging (MRI) should be routine in patients with presumed early-stage lung cancer, guideline recommendations are inconsistent. In this regard, we performed the study to evaluate the incidence and risk factors for brain metastasis (BM) in patients with presumed early-stage non-small cell lung cancer (NSCLC). Method A review of the medical charts of consecutive NSCLC patients diagnosed between January 2006 and May 2020 was performed. We identified 1,382 patients who were diagnosed with NSCLC with clinical stage of T1/2aN0M0 apart from brain MRI result (Figure 1). Firth’s bias-reduced logistic regression were used to assess predictors of BM. Fisher’s exact test with the minimum p-value approach was used to determine the optimal cut-off value in tumor size predicting BM. Result Six hundred fifty-one patients (47.1%) were female; mean ± SD age was 64.3 ± 10.4 years. Nine hundred forty-nine patients (68.7%) underwent brain MRI during staging, and 34 patients (3.6%) were shown to have BM. Firth’s bias-reduced logistic regression model showed that tumor size in millimeters (OR 1.056; 95% CI 1.009-1.106) was a single predictor for presence of BM. A cut-off value of 3.5 cm in tumor size was predictive for BM in our cohort (OR 4.538; CI 95% 1.977-9.650). The median overall survival of the participants with BM was 5.5 year and 5-year survival rate was 59.8%. Conclusions Given the incidence and favorable outcome of BM in patients with presumed early-stage NSCLC, routine screening of brain MRI might be considered, especially in patients with tumor size of ≥3.5 cm.

Efficacy of Standard Dexamethasone Therapy and Predictors for Nonresponsiveness to the Treatment in Patients with COVID-19

( Kangjoon Kim ),( Su Hwan Lee ),( Ah Young Leem ),( Kyungsoo Chung ),( Young Sam Kim ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Purpose Corticosteroid use is recommended in patients with coronavirus disease 2019 (COVID-19) requiring oxygen therapy. Current guidelines suggest typical daily doses of 6mg dexamethasone as the standard treatment, irrespective to the severity of respiratory failure. This study was aimed to investigate general efficacy of standard dexamethasone therapy and predictors for non-responsiveness to the treatment. Method This retrospective study reviewed patients with COVID-19 who were admitted Severance Hospital, between February 2020 and August 2021. We recruited 108 of consecutive participants who were initiated on 6mg daily dose of dexamethasone therapy during hospital stay. Patients who discontinued or tapered dexamethasone following the treatment were defined as responders. On the other hand, patients who increased the corticosteroid dose or expired during the therapy were defined as non-responders. Descriptive and inferential statistics were used to evaluate the treatment efficacy and predictors for nonresponsiveness to the treatment. Result Among the 108 participants, 71 (65.7%) were responders, and 37 (34.3%) were non-responders. In the non-responders, severe hypoxia requiring high-flow nasal cannula (HFNC) or mechanical ventilation (MV) was more common, lymphocyte count was lower at the baseline (p < 0.05). The 28-day mortality rate was higher in the non-responder group (10.8% vs. 1.4%, p = 0.046). Multivariate logistic regression showed that severe hypoxia requiring HFNC or MV, lower blood lymphocyte count, and higher serum CRP level at the baseline were the predictors for non-responsiveness to the treatment (p < 0.05). Among the non-responders without missing value (n = 32), 17 (53.1%) patients showed ≥50% improvement in PaO2/FiO2 ratio after the treatment with increased doses of corticosteroids (Figure 1). Conclusion About one-third of the participants showed non-responsiveness to the standard dexamethasone therapy and treated with higher doses of corticosteroids. Initial therapy with higher doses of corticosteroids might be considered in patients with predictors for non-responsiveness.

단일 급발성 고탄산 호흡부전으로 발현한 중증근무력증

김원영 ( Won-young Kim ),박성진 ( Sung Jin Park ),백문성 ( Moon Seong Baek ),김강준 ( Kangjoon Kim ),이대근 ( Daegeun Lee ),최병휘 ( Byoung-whui Choi ) 대한내과학회 2023 대한내과학회지 Vol.98 No.2

Myasthenic crisis, which can be life-threatening due to severe respiratory failure, occurs in 15-20% of patients with myasthenia gravis. However, the crisis often develops within 1-2 years after diagnosis and is very rare as a first symptom of myasthenia gravis; isolated sudden-onset hypercapnic respiratory failure without other symptoms of myasthenia gravis is even rarer. A 63-year-old woman presented to the emergency department with fever and dizziness. Chest computed tomography showed multifocal peribronchial ground-glass opacities, and a diagnosis of pneumonia was made. Initially, the patient did not have dyspnea. However, she developed acute hypercapnic respiratory failure and was intubated. After mechanical ventilation, her hypercapnia improved initially, but worsened on initiation of weaning from the ventilator. As she had a high acetylcholine receptor antibody titer, myasthenia gravis was diagnosed. Her hypercapnia improved after treatment with pyridostigmine and methylprednisolone. (Korean J Med 2023;98:88-92)

Incidence and Course of Depression in Patients with Alzheimer’s Disease

SeungHo Ryu,HanYong Jung,KangJoon Lee,SeokWoo Moon,DongWoo Lee,Narei Hong,BaikSeok Kee,DoHoon Kim,Changsu Han,ChangUk Lee 대한신경정신의학회 2017 PSYCHIATRY INVESTIGATION Vol.14 No.3

Objective-Depressive symptoms are common in Alzheimer’s disease (AD) and they might influence the course and prognosis of AD. Depression could appear anytime in the course of the disease, and could either last considerably long or disappear easily. This study is intended to investigate the occurrence of depression in the course of AD and the risk factors of incidence. Methods-This study targeted 1,272 AD patients without depressive symptoms at the start of this study in Korea. A total of 775 subjects completed the study, and the occurrence of depression was assessed after 12 months. Demographic information of subjects was collected and cognitive functions, overall functions, and depression severity were assessed at the start of this study and after 12 months. Results-Among the 775 subjects, 103 subjects (13.29%) developed depression 12 months later. The MMSE-KC scores showed significant changes in both groups that developed depression and did not. In the univariate analysis, significant differences in the incidence of depression were found in terms of gender, the administration of the antidepressant at the baseline, the SGDS-K score, and the GDS score. The multiple logistic regression analysis showed that the increase in the incidence of depression was associated with a female, in the increase in SGDS-K score and the GDS score. Conclusion-The incidence of depression in the subjects who completed the 12-month follow-up observation was 13.29%. Moreover, in the multivariate analysis, a female gender and the severity of dementia, including the overall functions, seemed associated with the occurrence of depression.

Depression and Somatic Symptoms May Influence on Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Preliminary Study

JunSung Koh,HyoJung Ko,ShengMin Wang,KangJoon Cho,JoonChul Kim,SooJung Lee,ChiUn Pae 대한신경정신의학회 2014 PSYCHIATRY INVESTIGATION Vol.11 No.4

The present study is the first one to investigate the impacts of depression and somatization on the disease severity and quality of life (QoL) in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The Korean version of National Institutes of Health (NIH)- Chronic Prostatitis Symptom Index (CPSI) for severity of CP/CPPS. Korean version of Patient Health Questionnaire-9 (PHQ-9) for depression, Korean version of Patient Health Questionnaire-15 (PHQ-15) for somatization, and Korean version of EuroQol Questionnaire-5 Dimensions (EQ-5D)- [(EQ-5D utility index and visual analog scale (EQ-5D VAS)] for QoL, were administered. Eighty patients were enrolled. The NIH-CPSI total scores were significantly higher in those with depression (25.3%, p=0.01) or somatization (23.2%, p=0.03) than in those without. These trends toward significantly negative influence of depression and somatic symptoms on QoL were also observed. Our preliminary results indicate that depression and somatization may have negative influence on the symptom severity and QoL in patients with CP/CPPS. However, adequately-powered and more well-designed studies are mandatory to prove our results.

The Relationship between Depression, Anxiety, Somatization, Personality and Symptoms of Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia

JunSung Koh,HyoJung Ko,ShengMin Wang,KangJoon Cho,JoonChul Kim,SooJung Lee,ChiUn Pae 대한신경정신의학회 2015 PSYCHIATRY INVESTIGATION Vol.12 No.2

This study investigated the relationship of personality, depression, somatization, anxiety with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). The LUTS/BPH patients were evaluated with the International Prostate Symptom Score (IPSS), 44-item Big Five Inventory (BFI), the Patient Health Questionnaire-9 (PHQ-9), the PHQ-15, and 7-item Generalized Anxiety Disorder Scale (GAD-7). The LUTS/BPH symptoms were more severe in patients with depression (p=0.046) and somatization (p=0.024), respectively. Neurotic patients were associated with greater levels of depression, anxiety and somatisation (p=0.0059, p=0.004 and p=0.0095, respectively). Patients with high extraversion showed significantly low depression (p=0.00481) and anxiety (p=0.035) than those with low extraversion. Our exploratory results suggest patients with LUTS/BPH may need careful evaluation of psychiatric problem including depression, anxiety and somatization. Additional studies with adequate power and improved designs are necessary to support the present exploratory findings.

Quantitative Electroencephalography and Low Resolution Electromagnetic Tomography Imaging of Alzheimer’s Disease

HyungTae Jung,SeungHwan Lee,JongNam Kim,KangJoon Lee,YoungCho Chung 대한신경정신의학회 2007 PSYCHIATRY INVESTIGATION Vol.4 No.1

Objective-The EEG abnormalities of Alzheimer’s disease (AD) patients are characterized by increased slow wave activities and reduced asymmetry between the two hemispheres. We attempted to find the specific spatio-temporal EEG pattern of AD through quantitative EEG (qEEG) and the source localization of specific frequency bands. Methods-The AD group consisted of 22 patients who fulfilled the DSM-IV criteria of AD with no space occupying lesions confirmed by brain CT or MRI. The normal control (NC) group consisted of 27 subjects with no personal history of psychiatric or neurological abnormalities. We performed qEEG, compared the hemispheric asymmetry between the AD and NC groups, and tried to obtain source imaging of each frequency band using low resolution electromagnetic tomography (LORETA). Results-Compared with the NC group, the AD patients had significantly increased slow wave activities of the theta (4-7 Hz) and delta waves (1-3 Hz) over all of the electrodes. There was no statistically significant asymmetric difference between the AD and NC groups. The slow waves of the AD patients were dominant in the right hemisphere compared to the NC subjects. Increased theta wave activity was observed, especially in Brodmann area 40 (inferior parietal lobule) in the AD patients compared with the NC subjects. Increased delta wave activity was observed especially in Brodmann area 7 (postcentral gyrus) in the AD patients compared with the NC subjects. The MMSE score had a significant negative correlation with the theta waves and a positive correlation with the alpha waves in the AD patients. There was a positive correlation between the duration of illness and the theta waves in the AD patients. Conclusions-Our results showed that AD patients had increased theta and delta wave activity in the right parietal areas, which reflect their decreased brain function in these regions. Our results suggest that qEEG and LORETA imaging are useful tools for detecting and evaluating AD.