Korean Guidelines for Diagnosis and Management of Interstitial Lung Diseases: Part 5. Connective Tissue Disease Associated Interstitial Lung Disease

Koo, So-My,Kim, Song Yee,Choi, Sun Mi,Lee, Hyun-Kyung,Korean Interstitial Lung Diseases Study Group The Korean Academy of Tuberculosis and Respiratory 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4

Connective tissue disease (CTD) is a collection of disorders characterized by various signs and symptoms such as circulation of autoantibodies in the entire system causing damage to internal organs. Interstitial lung disease (ILD) which is associated with CTD is referred to as CTD-ILD. Patients diagnosed with ILD should be thoroughly examined for the cooccurrence of CTD, since the treatment procedures and prognosis of CTD-ILD are vary from those of idiopathic interstitial pneumonia. The representative types of CTD which may accompany ILD include rheumatoid arthritis, systemic sclerosis (SSc), Sjogren's syndrome, mixed CTD, idiopathic inflammatory myopathies, and systemic lupus erythematous. Of these, ILD most frequently co-exists with SSc. If an ILD is observed in the chest, high resolution computed tomography and specific diagnostic criteria for any type of CTD are met, then a diagnosis of CTD-ILD is made. It is challenging to conduct a properly designed randomized study on CTD-ILD, due to low incidence. Therefore, CTD-ILD treatment approach is yet to been established in absence of randomized controlled clinical trials, with the exception of SSc-ILD. When a patient is presented with acute CTD-ILD or if symptoms occur due to progression of the disease, steroid and immunosuppressive therapy are generally considered.

CASE REPORT : p53 Expression in a Malignant Mesothelioma Patient during Seven-Year Follow-up

( So My Koo ),( Soo Taek Uh ),( Dong Won Kim ),( Ki Up Kim ),( Yang Ki Kim ) 대한결핵 및 호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.6

Malignant mesothelioma (MM) is the aggressive tumor of serosal surfaces. There are crude pathogenetic results regarding the biology of MM. Coordinated upregulations of p53 gene expression are shown in malignancies. We believed that there are changes in the p53 expression with transformation from reactive hyperplasia to MM. A 65-year-old male was admitted the hospital because of left pleuritic chest pains in 2004. Chest computed tomography (CT) results showed left pleural effusions with loculation and pleural thickening. Pathologic findings revealed reactive mesothelial hyperplasia. In 2008, the patient again felt left pleuritic chest pains. Chest CT showed progressive thickening of the left pleura. Pathologic diagnosis was atypical mesothelial hyperplasia. In 2011, chest CT showed progressive thickening of his left pleura. He was diagnosed with well-differentiated papillary mesothelioma. Serial change was analyzed by immunohistochemical staining for p53 of pleural tissues. There were no remarkable changes in p53 expressions during the transformation to MM.

p53 Expression in a Malignant Mesothelioma Patient during Seven-Year Follow-up

Koo, So-My,Uh, Soo-Taek,Kim, Dong Won,Kim, Ki-Up,Kim, Yang-Ki The Korean Academy of Tuberculosis and Respiratory 2014 Tuberculosis and Respiratory Diseases Vol.76 No.6

Malignant mesothelioma (MM) is the aggressive tumor of serosal surfaces. There are crude pathogenetic results regarding the biology of MM. Coordinated upregulations of p53 gene expression are shown in malignancies. We believed that there are changes in the p53 expression with transformation from reactive hyperplasia to MM. A 65-year-old male was admitted the hospital because of left pleuritic chest pains in 2004. Chest computed tomography (CT) results showed left pleural effusions with loculation and pleural thickening. Pathologic findings revealed reactive mesothelial hyperplasia. In 2008, the patient again felt left pleuritic chest pains. Chest CT showed progressive thickening of the left pleura. Pathologic diagnosis was atypical mesothelial hyperplasia. In 2011, chest CT showed progressive thickening of his left pleura. He was diagnosed with well-differentiated papillary mesothelioma. Serial change was analyzed by immunohistochemical staining for p53 of pleural tissues. There were no remarkable changes in p53 expressions during the transformation to MM.

Treatment of connective tissue disease-associated interstitial lung disease: the pulmonologist`s point of view

( So-my Koo ),( Soo-taek Uh ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.4

Interstitial lung disease (ILD) occurs in 15% of patients with collagen vascular disease (CVD), referred to as connective tissue disease (CTD). Despite advances in management strategies, ILD continues to be a significant cause of mortality in patients with CVD-associated ILD (CTD-ILD). There is a lack of randomized, clinical trials assessing pharmacological agents for CTD-ILD, except in cases of ILD-associated systemic sclerosis (SSc). This may be due to the lack of CTD cases available, the difficulty of histological confirmation of ILD, and the various types of CTD and ILD. As a result, evidence-based pharmacological treatment of CTD-ILD is not yet well established. CTD-ILD presents with varying degrees of histology, from inflammation to fibrosis, and a wide spectrum of clinical manifestations, from minimal symptoms to respiratory failure. This renders it difficult for clinicians to make decisions regarding treatment options, observational strategies, optimal timing for interventions, and the appropriateness of pharmacological agents for treatment. There is no specific treatment for reversing fibrosis-like idiopathic pulmonary fibrosis in a clinical setting. This review describes pharmacological interventions for SSc-ILD described in randomized control trials, and presents an overview of recent advances of CTD-ILD-dependent treatments based on the types of CTD.

Effect of Pregnancy on Quantitative Medication Use and Relation to Exacerbations in Asthma

Koo, So-My,Kim, Yunsun,Park, Chorong,Park, Gun Woo,Lee, MoonGyu,Won, Sungho,Yang, Hyeon-Jong Hindawi 2017 BioMed research international Vol.2017 No.-

<P><B>Background</B></P><P> The quantification of asthma medication reduction and its relation to an aggravation of asthma during pregnancy at an individual level are unclear.</P><P><B> Methods</B></P><P> We conducted a nationwide retrospective cohort study of asthmatic pregnant women in South Korea. All of the asthma medications were ranked from 1 to 4 according to the guideline-based stepwise approach. We assessed the daily sums of the ranks of the asthma medications and their association with exacerbations during three phases based on the individual's delivery date: before, during, and after pregnancy.</P><P><B> Results</B></P><P> The study cohort included 115,169 asthmatic pregnant women who gave birth between 2011 and 2013. The subjects were clustered into four groups according to the daily rank sums of their asthma medication. Asthma medications were rapidly reduced at the beginning of the pregnancy and then slowly increased after delivery. Exacerbations were more frequent in the group with higher rank-sum values than in the group with lower values. Overall exacerbations were reduced during pregnancy compared to before or after delivery.</P><P><B> Conclusions</B></P><P> Asthmatic pregnant women tended to reduce their asthma medication use during pregnancy. This led to a greater number of exacerbations in a small part of the study population.</P>

Characteristics of Device-Associated Cerebrospinal Fluid Infection in Adults

So My Koo,Eun Jung Lee,Se Yoon Park,Shi Nae Yu,Min Young Lee,Tae Hyong Kim,Eun Ju Choo,Min Huok Jeon 순천향대학교 순천향의학연구소 2013 Journal of Soonchunhyang Medical Science Vol.19 No.2

Objective: Device-associated infections in the central nervous system are serious complications of procedures involving indwelling devices among neurosurgical patients. In this study, the clinical characteristics and outcome of microbiologically confirmed deviceassociated cerebrospinal fluid (CSF) infection were evaluated. Methods: We performed a retrospective analysis of adult patients found to have a positive CSF culture result during a hospital admission between 1 January 2005 through 2 October 2010 in Soonchunhyang University Hospital. Results: During the study period, all episodes (n=161 CSF specimens, 87 patients) involving a culture-positive CSF were enrolled. Thirty-two episodes of device-associated CSF infection were included in the analysis among the study group. Most device-associated infections were ventriculo-peritoneal shunt infections (14/32, 44%). Fever (>38°C) was present in 17 episodes (53%). Overall, the most common microorganism was coagulase-negative staphylococcus (7/32 [22%]). Gram-negative rods (Pseudomonas aeruginosa 6/32 [19%], Acinetobacter baumannii/haemolyticus 5/32 [16%]) were identified in culture in 16/32 (50%). Device was removed for the control of device-associated infection in 30/32 (94%). Cure rate was 69% (22/32). All patients with treatment failure (10/32, 34%) expired. Conclusion: It is difficult to diagnosis device-associated CSF infections early since those are frequently presented with nonspecific clinical signs and symptoms. In our study, gram-negative infections accounted for 50% of cases and the empiric antibiotics initially chosen were found to not be effective against the final identified pathogen in many cases. Device-associated CSF infections should be strongly considered a serious risk factor associated with CSF infections, and prompt initiation of broad coverage antibiotics should be started after appropriate assessment.

Korean Guidelines for Diagnosis and Management of Interstitial Lung Diseases: Part 5. Connective Tissue Disease Associated Interstitial Lung Disease

( So-my Koo ),( Song Yee Kim ),( Sun Mi Choi ),( Hyun-kyung Lee ) 대한결핵 및 호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.4

Connective tissue disease (CTD) is a collection of disorders characterized by various signs and symptoms such as circulation of autoantibodies in the entire system causing damage to internal organs. Interstitial lung disease (ILD) which is associated with CTD is referred to as CTD-ILD. Patients diagnosed with ILD should be thoroughly examined for the co-occurrence of CTD, since the treatment procedures and prognosis of CTD-ILD are vary from those of idiopathic interstitial pneumonia. The representative types of CTD which may accompany ILD include rheumatoid arthritis, systemic sclerosis (SSc), Sjögren’s syndrome, mixed CTD, idiopathic inflammatory myopathies, and systemic lupus erythematous. Of these, ILD most frequently co-exists with SSc. If an ILD is observed in the chest, high resolution computed tomography and specific diagnostic criteria for any type of CTD are met, then a diagnosis of CTD-ILD is made. It is challenging to conduct a properly designed randomized study on CTD-ILD, due to low incidence. Therefore, CTD-ILD treatment approach is yet to been established in absence of randomized controlled clinical trials, with the exception of SSc-ILD. When a patient is presented with acute CTD-ILD or if symptoms occur due to progression of the disease, steroid and immunosuppressive therapy are generally considered.

전이성 암종으로 오인된 철폐증 증례

구소미 ( So My Koo ),박성우 ( Sung Woo Park ),박종숙 ( Jong Sook Park ),이준혁 ( June Hyuk Lee ),장안수 ( An Soo Jang ),김도진 ( Do Jin Kim ),박춘식 ( Choon Sik Park ),박상현 ( Sang Hyun Paik ),고은석 ( Eun Suk Koh ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.1

Pulmonary siderosis is a pneumoconiosis caused by chronic iron inhalation. A diagnosis of pulmonary siderosis is based on a patient history of iron inhalation, on chest radiographic findings, and on accumulation of iron oxide in macrophages within the lung. A typical radiographic finding of pulmonary siderosis includes ill-defined micronodules that are diffusely distributed in the lung. We experienced a 52-year-woman with a 1.3×1.5-cm mass in the left upper lobe with multiple nodules in both lungs. Because the radiographic findings were atypical, we conducted a video-assisted thorascopic lung biopsy procedure to exclude the diagnosis of metastatic lung cancer. After confirming iron deposition in the lung tissue and knowing the patient`s occupational history of welding iron, we concluded that this was a case of pulmonary siderosis.

Analysis of First-line Target Therapy on EGFR Mutant NSCLC Patients with Brain Metastasis Using Common Data Model

( Junyong Jang ),( So-my Koo ),( Ki-up Kim ),( Hyeon-jong Yang ),( Suyeon Park ),( Sangyoung Kim ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background There is limited head-to-head comparative studies on the effects of EGFR-TKIs used in advanced EGFR mutant non-small cell lung cancer (NSCLC). The purpose of this study is to analyze the real-world clinical data of the target therapies (afatinib, erlotinib, gefitinib, and osimertinib) as a first-line treatment in patients with NSCLC with brain metastasis. Method The data were retrospectively collected from patients who were diagnosed with advanced NSCLC within 60 days prior to receiving EGFR-TKIs using common data model (CDM) from four Soonchunhyang University hospital. Primary outcome was the time to treatment failure, and secondary outcome was overall survival and adverse drug reaction (ADR) : leukopenia, neutropenia, anemia, thrombocytopenia, hepatitis, and kidney injury. The time to treatment failure was defined as the duration of EGFR-TKI treatment as first-line treatment. Result In total of 437 patients were included (afatinib, 88 [20.1%]; erlotinib, 80 [18.3%]; gefitinib, 245 [56.0%]; Osimertinib, 24 [5.5%]). The median time to treatment failure was 164.0 days (interquartile range [IQR], 52.5 to 382.5 days) in afatinib group, 83.5 days (IQR, 24.5 to 279.8 days) in erlotinib group, 171.0 days (IQR, 42.0 to 411.0 days) in gefitinib group, and 139.5 days (IQR, 59.8 to 212.0 days) in Osimertinib group. Of the 437 patients, 104 patients had brain metastasis. Among patients with brain metastasis, gefitinib also showed the longest median time to treatment failure (201.0 days [IQR, 42.0 to 420.0 days]). Anemia was more common in the gefitinib group (n = 89, 40.3%). Thrombocytopenia is more common in erlotinib group (n=28, 35%) and osimertinib (n=9, 37.5%). Creatinine increase was more common in gefitinib (n=67, 27.4%) and osimertinib (n=6, 25.0%). Conclusion As the first-line treatment for advanced EGFR mutant NSCLC, gefitinib showed the longest treatment duration. There are limitations to analyzing survival of patients with CDM, and further studies are needed.

Inhibition of Vitamin D Receptor Translocation by Cigarette Smoking Extracts

어수택,박춘식,So-My Koo,김양기,장안수,김도진,김용훈,박성우,김기업 대한결핵및호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.73 No.5

Background: Vitamin D can translocate a vitamin D receptor (VDR) from the nucleus to the cell membranes. The meaning of this translocation is not elucidated in terms of a role in pathogenesis of chronic obstructive pulmonary disease (COPD) till now. VDR deficient mice are prone to develop emphysema, suggesting that abnormal function of VDR might influence a generation of COPD. The blood levels of vitamin D have known to be well correlated with that of lung function in patients with COPD, and smoking is the most important risk factor in development of COPD. This study was performed to investigate whether cigarette smoke extracts (CSE) can inhibit the translocation of VDR and whether mitogen activated protein kinases (MAPKs) are involved in this inhibition. Methods: Human alveolar basal epithelial cell line (A549) was used in this study. 1,25-(OH2)D3 and/or MAPKs inhibitors and antioxidants were pre-incubated before stimulation with 10% CSE, and then nucleus and microsomal proteins were extracted for a Western blot of VDR. Results: Five minutes treatment of 1,25-(OH2)D3 induced translocation of VDR from nucleus to microsomes by a dose-dependent manner. CSE inhibited 1,25-(OH2)D3-induced translocation of VDR in both concentrations of 10% and 20%. All MAPKs inhibitors did not suppress the inhibitory effects of CSE on the 1,25-(OH2)D3-induced translocation of VDR. Quercetin suppressed the inhibitory effects of CSE on the 1,25-(OH2)D3-induced translocation of VDR, but not in n-acetylcysteine. Conclusion: CSE has an ability to inhibit vitamin D-induced VDR translocation, but MAPKs are not involved in this inhibition.