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Thematic Poster : TP-40 ; A Case of Isoniazid Induced Lung Fibrosis : Case Report
( Chaeuk Chung ),( Dong Il Park ),( Sun Young Kim ),( Ju Ock Kim ),( Hee Sun Park ),( Jae Young Moon ),( Jeong Eun Lee ),( Choong Sik Lee ),( Sung Soo Jung ) 대한결핵 및 호흡기학회 2014 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.118 No.-
A 42-year-old man was diagnosed with tuberculous pleurisy. He was treated with isoniazid (INH), rifampicin (RFP), ethmbutol (EB) and pyrazinamide (PZA). After two weeks of treatment, he developed dyspnea on exercise and symptom got worsened. His arterial O2 saturation was 87% and physical examination revealed velcro rale on both lower lung fields. A chest imaging showed newly developed bilateral lung infiltrations including glass ground opacity (GGO), consolidation, and reticular opacity. Pulmonary function test showed severe restrictive pattern and markedly decreased diffusion lung capacity. Interstitial lung disease induced by anti-Tbc medication was mostly suspected, all drugs were discontinued. Open lung biopsy at right lower lobe revealed chronic interstitial inflammation with fibrosis. Among anti-Tbc medication, INH is most common cause of pneumonitis. At post-operation day 5, anti-Tbc medication except isoniazid was started with prednisolone (Pd) 60mg. After 2 weeks, Pd dose was decreased to 30mg and azathioprine 50mg was added. There are some case reports of INH induced pneumonitis. To our knowledge, this is the first case of INH-induced lung fibrosis occurring in a month of anti-Tbc medication.
Chung Chaeuk,Hyon YunKyong,Woo Seong-Dae,Lee Sunju,이송이,Ha Taeyoung,Yoonjoo Kim 대한결핵및호흡기학회 2023 Tuberculosis and Respiratory Diseases Vol.86 No.4
The stethoscope has long been used for the examination of patients, but the importance of auscultation has declined due to its several limitations and the development of other diagnostic tools. However, auscultation is still recognized as a primary diagnostic device because it is non-invasive and provides valuable information in real-time. To supplement the limitations of existing stethoscopes, digital stethoscopes with machine learning (ML) algorithms have been developed. Thus, now we can record and share respiratory sounds and artificial intelligence (AI)-assisted auscultation using ML algorithms distinguishes the type of sounds. Recently, the demands for remote care and non-face-to-face treatment diseases requiring isolation such as coronavirus disease 2019 (COVID-19) infection increased. To address these problems, wireless and wearable stethoscopes are being developed with the advances in battery technology and integrated sensors. This review provides the history of the stethoscope and classification of respiratory sounds, describes ML algorithms, and introduces new auscultation methods based on AI-assisted analysis and wireless or wearable stethoscopes.
Hippo-Foxa2 signaling pathway plays a role in peripheral lung maturation and surfactant homeostasis
Chung, Chaeuk,Kim, Tackhoon,Kim, Miju,Kim, Minchul,Song, Hoogeun,Kim, Tae-Shin,Seo, Eunjeong,Lee, Sang-Hee,Kim, Hanbyul,Kim, Sang Kyum,Yoo, Geon,Lee, Da-Hye,Hwang, Deog-Su,Kinashi, Tatsuo,Kim, Jin-Man National Academy of Sciences 2013 PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF Vol.110 No.19
<P>Respiratory distress syndrome (RDS), which is induced by insufficient production of surfactant, is the leading cause of mortality in preterm babies. Although several transcription factors are known to be involved in surfactant protein expression, the molecular mechanisms and signaling pathways upstream of these transcription factors have remained elusive. Here, using mammalian Hippo kinases (Mst1/2, mammalian sterile 20-like kinase 1/2) conditional knockout mice, we demonstrate that Mst1/2 kinases are critical for orchestration of transcription factors involved in surfactant protein homeostasis and prevention of RDS. Mice lacking Mst1/2 in the respiratory epithelium exhibited perinatal mortality with respiratory failure and their lungs contained fewer type I pneumocytes and more immature type II pneumocytes lacking microvilli, lamellar bodies, and surfactant protein expression, pointing to peripheral lung immaturity and RDS. In contrast to previous findings of YAP (Yes-associated protein)-mediated canonical Hippo signaling in the liver and intestine, loss of Mst1/2 kinases induced the defects in pneumocyte differentiation independently of YAP hyperactivity. We instead found that Mst1/2 kinases stabilized and phosphorylated the transcription factor Foxa2 (forkhead box A2), which regulates pneumocyte maturation and surfactant protein expression. Taken together, our results suggest that the mammalian Hippo kinases play crucial roles in surfactant homeostasis and coordination of peripheral lung differentiation through regulation of Foxa2 rather than of YAP.</P>
Poster Session : PS 1580 ; DILD : A Case of Isoniazid Induced Lung Fibrosis: Case Report
( Chaeuk Chung ),( Dong Il Park ),( Sun Young Kim ),( Ju Ock Kim ),( Hee Sun Park ),( Jae Young Moon ),( Jeong Eun Lee ),( Choong Sik Lee ),( Sung Soo Jung ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
A 42-year-old man was diagnosed with tuberculous pleurisy. He was treated with isoniazid (INH), rifampicin (RFP), ethmbutol (EB) and pyrazinamide (PZA). After two weeks of treatment, he developed dyspnea on exercise and symptom got worsened. His arterial O2 saturation was 87% and physical examination revealed velcro rale on both lower lung fi elds. A chest imaging showed newly developed bilateral lung infi ltrations including glass ground opacity (GGO), consolidation, and reticular opacity. Pulmonary function test showed severe restrictive pattern and markedly decreased diffusion lung capacity. Interstitial lung disease induced by anti-Tbc medication was mostly suspected, all drugs were discontinued. Open lung biopsy at right lower lobe revealed chronic interstitial infiammation with fibrosis. Among anti-Tbc medication, INH is most common cause of pneumonitis. At post-operation day 5, anti-Tbc medication except isoniazid was started with prednisolone (Pd) 60mg. After 2 weeks, Pd dose was decreased to 30mg and azathioprine 50mg was added. There are some case reports ofiNH induced pneumonitis. To our knowledge, this is the fi rst case of INH-induced lung fi brosis occurring in a month of anti-Tbc medication.
Transthoracic Needle Biopsy: How to Maximize Diagnostic Accuracy and Minimize Complications
( Chaeuk Chung ),( Yoonjoo Kim ),( Dongil Park ) 대한결핵 및 호흡기학회 2020 Tuberculosis and Respiratory Diseases Vol.83 No.-
Although transthoracic needle biopsy (TTNB) was introduced for lung biopsy about 40 years ago, it is still mainstay of pathologic diagnosis in lung cancer, because it is relatively inexpensive and can obtain tissue regardless of the tumor-bronchus relationship. With several technological advances, proceduralists can perform TTNB more safely and accurately. Utilizing ultrasound-guided biopsy for peripheral lesions in contact with the pleura and rapid onsite evaluation during the procedure are expected to make up the weakness of TTNB. However, due to the inherent limitations of the percutaneous approach, the incidence of complications such as pneumothorax or bleeding is inevitably higher than that of other lung biopsy techniques. Thorough understating of each biopsy modality and additional technique are fundamental for maximizing diagnostic accuracy and minimizing the complications.
( Chaeuk Chung ),( Da Hye Lee ),( Da Hyun Kang ),( Hee Sun Park ),( Dongil Park ),( Jeong Eun Lee ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Purpose: The efficacy of EGFR-TKIs in lung cancer is limited by various resistance mechanisms. YAP is involved in EGFR-TKI resistance and regulation of PD-L1 transcription. Autophagy is important survival mechanism of cancer cells as a cytoprotective mechanism. The adaptor protein sequestosome 1 (p62/SQSTM1) plays a key role in the autophagic process. p62 also confers genomic instability and functions as signaling hub connecting to mTOR, c-MYC and NRF2. Recently, combination of EGFR-TKI and autophagic blockers such as chloroquine was tried to overcome the resistance of EGFR-TKI, but the result was not satisfactory. Accumulation of oncogenic p62 by chloroquine may have affected the result. So, we tried to find out how inhibit autophagy without p62 accumulation and overcome EGFR-TKI resistance. Method: We investigated the relationship between p62 and YAP by knockdown using specific siRNA or overexpression in the EGFR-TKI resistant lung adenocarcinoma (PC-9/GR cells). Wound-healing assay, transwell migration, and invasion assay were performed to study the effect of targeting YAP and p62. Result: When we knocked down YAP by siRNA in PC9/GR, the protein and mRNA level of p62 were significantly decreased. Consistent with this, YAP overexpression causes the upregulation of p62. We treated YAP siRNA and chloroquine in PC9/GR together, the p62 level remained decreased. We found YAP regulates the expression of p62 via ERK signaling independently of autophagic degradation of p62. Then we used verteporfin which is known as YAP inhibitor to check the effect of blocking autophagy without p62 accumulation. Verteporfin markedly decreased the expressions of YAP, PD-L1 and p62 simultaneously. The combination of EGFR-TKI and verteporfin overcame the EGFR-TKI resistance more effectively than the combination of EGFR-TKI and chloroquine in PC9/GR cells. Conclusion: Our findings suggest Co-targeting YAP/PD-L1 signaling and p62 to overcome EGFR-TKI resistance in lung cancer (Figure 1).
( Da Hyun Kang ),( Chaeuk Chung ),( Ju Ock Kim ),( Sung Soo Jung ),( Hee Sun Park ),( Dongil Park ),( Jeong Eun Lee ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Purpose: Various studies are underway as a factor for predicting the effects of immunotherapy, but only PD-L1 expression of tumor cells is routinely used, and there is no easy and convenient biomarker that can be used in clinical practice. The aim of this study was to identify predictive factors of PD-1/PD-L1 blockade efficacy in the immune cell population of peripheral blood. Method: This study included 20 patients with advanced NSCLC who received PD-1/PD-L1 inhibitors between February 2018 and August 2018 in Chungnam National University Hospital. We prospectively collected pre-treatment peripheral blood mononuclear cells (PBMCs) and analyzed by flow cytometry. Result: Of the 20 patients, the response to treatment was 5 partial response (PR), 4 stable disease (SD), and 11 progression disease (PD). The average duration of administration was 4.6 months. Six patients had treatment duration of 6 months or more, and these patients were assigned to the long lasting group. The proportion of T lymphocytes in the total PBMCs was significantly higher in the PR/SD group than in the PD group. The fractions of CD4+ and CD8+ lymphocytes were also significantly higher in the PR/SD group than PD group. In the PR/SD group, the proportion of Th1 cells in the CD4+ T cells was significantly higher and the proportion of Th17 cells was significantly lower than in the PD group. In addition, the Th1/Th2 ratio and Th1/Th17 ratio were significantly higher in the PR/SD group than in the PD group, and higher in the long lasting group than in the short lasting group. Conclusion: The population of CD4+ T cells is closely related to the clinical benefit of PD-1/PDL1 inhibitors. In particular, the high fraction of Th1 cells is associated with better response. Th1/Th2 ratio and Th1/Th17 ratio may be useful predicting markers for efficacy of immune checkpoint blockade.