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A Case of Acute Fibrinous and Organizing Pneumonia
( Iseul Yu ),( Sang-ha Kim ),( Sung Min Ko ),( Soon-hee Jung ),( Ji-ho Lee ),( Seok Jeong Lee ),( Myoung Kyu Lee ),( Won-yeon Lee ),( Suk Joong Yong ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Background Acute fibrinous and organizing pneumonia (AFOP) is a rare type of acute lung injury. AFOP can be misdiagnosed with pneumonia or tuberculosis, because there is no characteristic clinical feature. Case presentation A 80-year-old man was hospitalized in May 2021 with exertional dyspnea for 14dyas. Before admission, he had taken levofloxacin at a local clinic for 10 days, but there was no benefit. On admission day, His blood pressure was 132/76 mmHg, heart rate was 82 beats/min, respiratory rate was 18 breaths/min, temperature was 37.0 °C and oxygen saturation 93% in room air. Initial laboratory data included a white blood cell count of 8.98 X /L, C-reactive protein 9.75 mg/dL, serum procalcitonin 0.13 ng/mL. Electrolytes, hepatorenal function, and respiratory virus ware normal. The blood cultures revealed no growth, besides sputum TB-PCR and acid-fast bacilli smear & culture were all negative. Autoimmune antibody profiles were within normal limits. A chest computed tomography (CT) scan showed consolidation and ground-glass opacity in the right lower lobe with small amount pleural effusion. We treated him with an empirical antibiotic therapy (cefoperazone/sulbactam plus levofloxacin) for community acquired pneumonia. But his symptoms and chest X-ray was getting worse, so we exchanged levofloxacin for clarithromycin. Despite of antibiotics change, his clinical status worsened with fever. CT guided transthoracic needle biopsy was done on day 12 and histologic examination revealed AFOP. On day 14, we started on intravenous methylprednisolone 1mg/kg (75mg) daily. His general conditions (fever, dyspnea) and chest X-ray were improved. The patient discharged on day 26 with oral methylprednisolone 32mg daily. He is on tapering dose of steroid in outpatient follow-up.
Iseul Yu,Suk Joong Yong,Won-Yeon Lee,Sang Ha Kim,Hyun Lee,Ju Ock Na,Deog Kyeom Kim,Yeon-Mok Oh,이지호 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.5
Background/Aims: Patients with bronchiectasis often present with respiratory symptoms caused by chronic rhinosinusitis (CRS). However, studies on the prevalence of CRS and its relationship with bronchiectasis are limited. Methods: The baseline characteristics of patients with bronchiectasis recruited from the Korean Multicenter Bronchiectasis Audit and Research Collaboration were analyzed. CRS diagnosis was determined by a physician, on the basis of medical records, upper airway symptoms, and/or radiologic abnormalities. Questionnaires for quality of life, fatigue, and depression were administered when patients were stable for a minimum of 4 weeks after the bronchiectasis exacerbation. Results: The prevalence of CRS was 7.1% (66/931). Patients with CRS were significantly younger than those without CRS (60.5 ± 10.7 years vs. 64.6 ± 9.3 years, p = 0.001). Idiopathic bronchiectasis was more common in patients with CRS compared to those without CRS (53.0% vs. 36.0%, p = 0.006). Lung function, inflammatory markers, exacerbations, bronchiectasis severity, and scores for quality of life, fatigue, and depression did not differ between the two groups. In a logistic regression analysis, CRS was associated with age of bronchiectasis diagnosis (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.94 to 0.99; p = 0.003) and idiopathic bronchiectasis (OR, 1.95; 95% CI, 1.12 to 3.34; p = 0.018). Conclusions: The prevalence of CRS was relatively low. CRS was not associated with the severity or clinical outcomes of bronchiectasis. Early diagnosis and idiopathic etiology were associated with CRS. Our findings reflect the low recognition of CRS in the clinical practice of bronchiectasis and highlight the need for awareness of CRS by adopting objective diagnostic criteria.
( Iseul Yu ),( Ji-ho Lee ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.0
Background Patients with bronchiectasis often present with symptoms as a result of comorbidities. Respiratory symptoms caused by chronic rhinosinusitis (CRS) are commonly seen in patients with bronchiectasis. However, a study on prevalence of CRS and its relationship with bronchiectasis is scarce. Methods Baseline characteristics of patients with non-cystic bronchiectasis recruited from the Korean Multicenter Bronchiectasis Audit and Research Collaboration were analyzed. Diagnosis of CRS was determined by physician based on the medical record, upper airway symptoms, and/or radiologic abnormality. Questionnaires for quality of life, fatigue, and depression were inquired when patients were stable at least 4 weeks after the exacerbation of bronchiectasis. Pulmonary function test and history of exacerbations within 1 year of enrollment were collected. Results A total of 931 patients with bronchiectasis were included. Onset age of bronchiectasis was 57.5 ± 11.1 for patients with CRS, which was significantly lower than 61.4 ± 9.4 years for patients without CRS (p=0.002). Idiopathic bronchiectasis was higher for patients with CRS compared to patients without CRS (53.0% versus 36.0%, p=0.006). Predicted FEV1% did not differ between two groups: 68.3 ± 21.1 % for patients with CRS and 66.8 ± 19.1 % for patients without CRS (p=0.589). Exacerbation frequency, bronchiectasis severity and scores for quality of life, fatigue, and depression did not differ significantly between two groups. In a binary logistic regression, CRS was associated with onset age (OR 0.97, 95% CI: 0.94-0.99, p=0.020) and idiopathic bronchiectasis (OR 2.30, 95% CI: 1.25-4.23, p=0.007). Conclusions Prevalence of CRS was relatively low. Early onset age and idiopathic bronchiectasis were factors associated with CRS. Further study for the prevalence of CRS and its impact on bronchiectasis is warranted.
Respiratory Viral Infection and Prognosis of Patients with Pneumonia in Intensive Care Unit
( Keun Bae Jeong ),( Seok Jeong Lee ),( Iseul Yu ),( Ji-ho Lee ),( Sang-ha Kim ),( Won-yeon Lee ),( Suk Joong Yong ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Background Respiratory viral infection is usually associated with upper respiratory infection and mild symptoms. However, some lower respiratory infections develop by viruses or their complications. The knowledge of viral contribution to pneumonia is limited. Especially in patients with pneumonia admitted in intensive care unit (ICU), impact of viral infection on the prognosis is not much investigated. We investigated to reveal the association of viral infection and ICU prognosis of pneumonia. Methods Following a retrospective review of the medical records of a single medical center from 2012 to 2017, we included adults who had pneumonia and performed respiratory viral PCR test in ICU. Results The mean age of the patients was 67 years and 62% (n = 65) was male. Of total 105 patients, 16 patients (15.2%) showed positive respiratory viral PCR. There are eight influenza, three parainfluenza, two rhinovirus, an adenovirus, a metapneumovirus, and a coronavirus. The group of positive viral PCR showed higher level of C-reactive protein (22.28±10.73 vs 14.98±10.47 mg/ dL, p=0.012), more severe disease presented by APACHE II score (21.56±9.44 vs 17.31±7.28, p=0.043), and shorter ventilator free day at 28 day (8.4±11.0 vs 14.9±12.5 days, p=0.044). In simple univariable study, ICU mortality and hospital mortality are not related with viral PCR Results. There is only trend of higher hospital mortality in the group of PCR-positive patients. In multiple logistic regression model including variables of age, sex, APACHE II score, CRP, and respiratory viral PCR, CRP (OR, 1.085; 95% CI 1.033-1.139) is associated with ICU mortality. Conclusions The result of respiratory viral PCR is not associated with ICU mortality in patient with pneumonia. However, patients admitted in ICU with pneumonia and positive viral PCR may have more severe disease and shorter ventilator-free day compared to those with pneumonia and negative viral PCR.
( Jae-hwa Choi ),( Keun-bae Jeong ),( You Hyun Park ),( Iseul Yu ),( Seok Jeong Lee ),( Myoung Kyu Lee ),( Sang-ha Kim ),( Won-yeon Lee ),( Suk Joong Yong ),( Ji-ho Lee ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Background Inhaled corticosteroids (ICSs) play an important role in lowering the risk of acute exacerbation of chronic obstructive pulmonary disease (COPD). However, ICSs are known to increase the risk of pneumonia. Moreover, previous studies have shown that the incidence rate of pneumonia varies depending on the type of ICS. In this study, the risk of pneumonia according to the type of ICS was investigated in a population-based cohort. Methods A retrospective cohort study was conducted using claims data of the entire population from the Korean National Health Insurance Service. Patients who were newly diagnosed with COPD and prescribed fluticasone or budesonide were enrolled as study subjects. Cumulative and daily doses of ICSs were classified into categorical variables to analyze the risk of pneumonia within identical ICS doses. Results A total of 47,473 subjects were identified and allocated as 14,518 fluticasone and 14,518 budesonide users through 1:1 propensity score matching. Fluticasone users were more likely to develop pneumonia than budesonide users (14.22% vs. 10.66%, p<0.0001). The incidence rate per 100,000 person-years was 2,914.77 for fluticasone users and 2,102.90 for budesonide users. The hazard ratio (HR) of pneumonia in fluticasone compared to budesonide was 1.34 (95% CI 1.26-1.43, p<0.0001). The risk of pneumonia for fluticasone compared to budesonide increased with higher ICS cumulative doses: 1.06 (0.93-1.21), 1.41 (1.19-1.66), 1.41 (1.23-1.63), and 1.49 (1.33-1.66) from the lowest to highest quartiles, respectively. In addition, the risk of pneumonia for fluticasone compared to budesonide was higher as daily ICS doses increased: 1.33 (1.24-1.42) for low doses, 1.51 (1.21-1.89) for medium doses, and 1.72 (1.06-2.78) for high doses. Conclusion ICS types and doses need to be carefully considered during treatment with ICSs in patients with COPD.
Han-Hee Park,Seung-Won Choi,Gwang Jin Lee,김영대,Hyun-Jin Noh,Seung-Jae Oh,Iseul Yoo,Yu-Jin Ha,Gi-Bang Koo,Soon-Sun Hong,SungWonKwon,김유선 고려인삼학회 2019 Journal of Ginseng Research Vol.43 No.1
Background: Ginseng is believed to have antitumor activity. Autophagy is largely a prosurvival cellular process that is activated in response to cellular stressors, including cytotoxic chemotherapy; therefore, agents that inhibit autophagy can be used as chemosensitizers in cancer treatment. We examined the ability of Korean Red Ginseng extract (RGE) to prevent autophagic flux and to make hepatocellular carcinoma (HCC) cells become more sensitive to doxorubicin. Methods: The cytotoxic effects of total RGE or its saponin fraction (RGS) on HCC cells were examined by the lactate dehydrogenase assay in a dose- or time-dependent manner. The effect of RGE or RGS on autophagy was measured by analyzing microtubule-associated protein 1A/1B-light chain (LC)3-II expression and LC3 puncta formation in HCC cells. Late-stage autophagy suppression was tested using tandem-labeled green fluorescent protein (GFP)emonomeric red fluorescent protein (mRFP)eLC3. Results: RGE markedly increased the amount of LC3-II, but green and red puncta in tandem-labeled GFPemRFPeLC3 remained colocalized over time, indicating that RGE inhibited autophagy at a late stage. Suppression of autophagy through knockdown of key ATG genes increased doxorubicin-induced cell death, suggesting that autophagy induced by doxorubicin has a protective function in HCC. Finally, RGE and RGS markedly sensitized HCC cells, (but not normal liver cells), to doxorubicin-induced cell death. Conclusion: Our data suggest that inhibition of late-stage autophagic flux by RGE is important for its potentiation of doxorubicin-induced cancer cell death. Therapy combining RGE with doxorubicin could serve as an effective strategy in the treatment of HCC.
Park, Han-Hee,Choi, Seung-Won,Lee, Gwang Jin,Kim, Young-Dae,Noh, Hyun-Jin,Oh, Seung-Jae,Yoo, Iseul,Ha, Yu-Jin,Koo, Gi-Bang,Hong, Soon-Sun,Kwon, Sung Won,Kim, You-Sun The Korean Society of Ginseng 2019 Journal of Ginseng Research Vol.43 No.1
Background: Ginseng is believed to have antitumor activity. Autophagy is largely a prosurvival cellular process that is activated in response to cellular stressors, including cytotoxic chemotherapy; therefore, agents that inhibit autophagy can be used as chemosensitizers in cancer treatment. We examined the ability of Korean Red Ginseng extract (RGE) to prevent autophagic flux and to make hepatocellular carcinoma (HCC) cells become more sensitive to doxorubicin. Methods: The cytotoxic effects of total RGE or its saponin fraction (RGS) on HCC cells were examined by the lactate dehydrogenase assay in a dose- or time-dependent manner. The effect of RGE or RGS on autophagy was measured by analyzing microtubule-associated protein 1A/1B-light chain (LC)3-II expression and LC3 puncta formation in HCC cells. Late-stage autophagy suppression was tested using tandem-labeled green fluorescent protein (GFP)-monomeric red fluorescent protein (mRFP)-LC3. Results: RGE markedly increased the amount of LC3-II, but green and red puncta in tandem-labeled GFP-mRFP-LC3 remained colocalized over time, indicating that RGE inhibited autophagy at a late stage. Suppression of autophagy through knockdown of key ATG genes increased doxorubicin-induced cell death, suggesting that autophagy induced by doxorubicin has a protective function in HCC. Finally, RGE and RGS markedly sensitized HCC cells, (but not normal liver cells), to doxorubicin-induced cell death. Conclusion: Our data suggest that inhibition of late-stage autophagic flux by RGE is important for its potentiation of doxorubicin-induced cancer cell death. Therapy combining RGE with doxorubicin could serve as an effective strategy in the treatment of HCC.