Ji-Yong Moon

Hanyang University Medical Center, Sŏul, Seoul, South Korea

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Publications (13)14.83 Total impact

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    ABSTRACT: Prone positioning for acute respiratory distress syndrome (ARDS) has no impact on mortality despite significant improvements in oxygenation. However, a recent trial demonstrated reduced mortality rates in the prone position for severe ARDS. We evaluated effects of prone position duration and protective lung strategies on mortality rates in ARDS. We extensively searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) reporting on prone positioning during acute respiratory failure in adults for inclusion in our meta-analysis. Eight trials met our inclusion criteria, Totals of 1,099 and 1,042 patients were randomized to the prone and supine ventilation positions. The mortality rates associated with the prone and supine positions were 41% and 47% [risk ratio (RR), 0.90; 95% confidence interval (CI), 0.82-0.98, P=0.02], but the heterogeneity was moderate (P=0.01, I(2)=61%). In a subgroup analysis, the mortality rates for lung protective ventilation (RR 0.73, 95% CI, 0.62-0.86, P=0.0002) and duration of prone positioning >12 h (RR 0.75, 95% CI, 0.65-0.87, P<0.0001) were reduced in the prone position. Prone positioning was not associated with an increased incidence of cardiac events (RR 1.01, 95% CI, 0.87-1.17) or ventilator associated pneumonia (RR 0.88, 95% CI, 0.71-1.09), but it was associated with an increased incidence of pressure sores (RR 1.23, 95% CI, 1.07-1.41) and endotracheal dislocation (RR 1.33, 95% CI, 1.02-1.74). Prone positioning tends to reduce the mortality rates in ARDS patients, especially when used in conjunction with a lung protective strategy and longer prone position durations. Prone positioning for ARDS patients should be prioritized over other invasive procedures because related life-threatening complications are rare. However, further additional randomized controlled design to study are required for confirm benefit of prone position in ARDS.
    03/2015; 7(3):356-67. DOI:10.3978/j.issn.2072-1439.2014.12.49
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    ABSTRACT: The Wnt signaling pathway has regulatory roles in cell proliferation, differentiation, and polarity. Aberrant Wnt pathway regulation can lead to abnormal cell proliferation and cancer, and loss of Wnt7a expression has been demonstrated in lung cancer cell lines. E-cadherin keeps intercellular integrity and prevents metastasis. Therefore, E-cadherin has been known as a prognostic factor in cancer. In the present study, we investigated the E-cadherin expression status by immunohistochemical stain and the Wnt7a promoter methylation status in human non-small cell lung carcinoma (NSCLC) by methylation-specific PCR. We also analyzed their correlations with clinicopathological factors. Methylation of the Wnt7a gene promoter was detected in the lung tissues of 32 of 121 (26.4%) patients with NSCLC. Wnt7a promoter methylation was correlated with advanced tumor stage (P = 0.036) and distant metastasis (P = 0.037). In addition, Wnt7a promoter methylation showed correlation with loss of E-cadherin expression (P < 0.001). However, Wnt7a promoter methylation was not closely related with gender, age, histological type, or smoking habit. Even though Wnt7a methylation could not show significant correlation with the long term survival of the patients with limited follow up data, these findings suggest that loss of the Wnt7a gene induced by promoter methylation might be another prognostic factor for NSCLC and that restoration of Wnt7a may be a promising treatment for NSCLC.
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    ABSTRACT: Invasive pulmonary aspergillosis (IPA) is rarely reported in patients who have normal immune function. Recently, IPA risk was reported in nonimmunocompromised hosts, such as patients with chronic obstructive pulmonary disease and critically ill patients in intensive care units. Moreover, influenza infection is also believed to be associated with IPA among immunocompetent patients. However, most reports on IPA with influenza A infection, including pandemic influenza H1N1, and IPA associated with influenza B infection were scarcely reported. Here, we report probable IPA with a fatal clinical course in an immunocompetent patient with influenza B infection. We demonstrate IPA as a possible complication in immunocompetent patients with influenza B infection. Early clinical suspicion of IPA and timely antifungal therapy are required for better outcomes in such cases.
    Tuberculosis and Respiratory Diseases 09/2014; 77(3):141-4. DOI:10.4046/trd.2014.77.3.141
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    ABSTRACT: Background/AimsSmoking is widely acknowledged as the single most important risk factor for chronic obstructive pulmonary disease (COPD). However, the risk of COPD in nonsmokers exposed to secondhand smoke remains controversial. In this study, we investigated the association of secondhand smoke exposure with COPD prevalence in nonsmokers who reported never smoking.MethodsThis study was based on data obtained from the Korean National Health and Nutrition Examination Surveys (KNHANES) conducted from 2008 to 2010. Using nationwide stratified random sampling, 8,596 participants aged ≥ 40 years of age with available spirometry results were recruited. After selecting participants who never smoked, the duration of exposure to secondhand smoke was assessed based on the KNHANES questionnaire.ResultsThe prevalence of COPD was 6.67% in participants who never smoked. We divided the participants who had never smoked into those with or without exposure to secondhand smoke. The group exposed to secondhand smoke was younger with less history of asthma and tuberculosis, higher income, and higher educational status. Multivariate logistic regression analysis determined that secondhand smoke did not increase the prevalence of COPD.ConclusionsThere was no significant difference in the prevalence of COPD between participants who had never smoked with or without exposure to secondhand smoke in our study. Thus, secondhand smoke may not be an important risk factor for the development of COPD in patients who have never smoked.
    The Korean Journal of Internal Medicine 09/2014; 29(5):613-9. DOI:10.3904/kjim.2014.29.5.613
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    ABSTRACT: Interstitial Lung Disease Global Case ReportsSESSION TYPE: Global Case ReportPRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PMINTRODUCTION: Macrolide have been proven to be beneficial in the treatment of chronic respiratory inflammatory diseases. Here we report a case of desquamative interstitial pneumonia (DIP) with recurrent spontaneous pneumothorax , in which treatment with corticosteroids was unsuccessful. Clinical and radiologic symptoms improved with a combination therapy with clarithromycin and prednisolone; However, tapering the dose of prednisolone decreased efficacy of clarithromycin, resulting in an unfavorable response. This finding supports the efficacy of combination therapy with macrolide and corticosteroid for cases of DIP refractory to corticosteroids.CASE PRESENTATION: A 34-year-old man was admitted with a 4-month history of dry cough and progressive dyspnea on exertion. He was a 15-pack-year smoker. In serologic tests, C-reactive protein, rheumatoid factor, antineuclear antiboby test were negative. Pulmonary function tests revealed a restrictive disease of moderate severity. A chest X-ray was normal; however, chest computed tomography (CT) scan showed diffuse ground-glass densities. Wedge resection via video-assisted thoracic surgery (VATS) was performed, and microscopic findings were mildly fibrotic and thickened alveolar septa with macrophages prominently accumulated in alveolar spaces, finally diagnosed as DIP. He was encouraged to quit smoking and started on prednisolone (1mg/kg/day) at discharge. The dose of prednisolone was tapered to 30 mg daily in outpatient clinic. Four months later, the patient returned complaining of sudden dyspnea and left chest wall pain. Chest radiograph revealed left tension pneumothorax, and tube thoracostomy was performed. However, the left lung failed to fully expand by the third hospital day; thus, wedge resection via VATS was performed. Moreover, right pneumothorax developed on the seventh hospital day, which failed to completely recover even after tube thoracostomy; therefore, right upper lobe lobectomy was performed. Histological analysis of the excised lung specimens was similar to the initial biopsy. The persistent ground-glass opacities on chest CT revealed that the patient was refractory to corticosteroid therapy. The patient was started the combination therapy with clarithromycin (500mg, twice daily) and prednisolone (30mg, daily). Within two weeks, the ground-glass opacities started to disappear on chest CT, and exertional dyspnea was getting improved. After 2 months of treatment, the patient reported considerable improvement in the symptoms. He continued with the combination therapy and the dose of prednisolone was tapered to 15 mg daily over two months. However, progressive dyspnea returned with no evidence of infection. Chest radiograph revealed moderate amount of left pneumothorax and tube thoracostomy was performed. His symptoms improved upon treatment with an increased dose of prednisolone with clarithromycin. The patient has maintained this improved state; and has been receiving prednisolone (20mg daily) and clarithromycin (500mg twice daily) in an outpatient clinic for 2 months.DISCUSSION: The presented case report supports the combination therapy with macrolide and corticosteroid based on clinical and radiological findings. The use of macrolide antibiotic is supported by a recent case reporting the beneficial effect of clarithromycin in a patient with DIP refractory to corticosteroids. The presented report clearly shows that macrolide efficacy requires co-administration of corticosteroids.CONCLUSIONS: This report proposes the combination therapy with macrolide and corticosteroid for cases of DIP refractory to corticosteroid monotherapy.Reference #1: Hartman TE, Primack SL, Kang EY, et al. Disease progression in usual interstitial pneumonia compared with desquamative interstitial pneumonia. Assessment with serial CT. Chest 1996; 110:378-382Reference #2: Ryu JH, Myers JL, Capizzi SA, et al. Desquamative interstitial pneumonia and respiratory bronchiolitis-associated interstitial lung disease. Chest 2005; 127:178-184Reference #3: Knyazhitskiy A, Masson RG, Corkey R, et al. Beneficial response to macrolide antibiotic in a patient with desquamative interstitial pneumonia refractory to corticosteroid therapy. Chest 2008; 134:185-187DISCLOSURE: The following authors have nothing to disclose: Dong Won Park, Hyun Jung Kwak, Ji-Yong Moon, Sang-Heon Kim, Tae-Hyung Kim, Jang Won Sohn, Dong Ho Shin, Ho Joo Yoon, Sung Soo ParkNo Product/Research Disclosure Information.
    Chest 10/2013; 144(4_MeetingAbstracts):443A. DOI:10.1378/chest.1703440 · 7.13 Impact Factor
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    ABSTRACT: Pigtail catheter drainage is a common procedure for the treatment of pleural effusion and pneumothorax. The most common complications of pigtail catheter insertion are pneumothorax, hemorrhage and chest pains. Cerebral air embolism is rare, but often fatal. In this paper, we report a case of cerebral air embolism in association with the insertion of a pigtail catheter for the drainage of a pleural effusion. A 67-year-old man is being presented with dyspnea, cough and right-side chest pains and was administered antibiotics for the treatment of pneumonia. The pneumonia failed to resolve and a loculated parapneumonic pleural effusion developed. A pigtail catheter was inserted in order to drain the pleural effusion, which resulted in cerebral air embolism. The patient was administered high-flow oxygen therapy and recovered without any neurologic complications.
    Tuberculosis and Respiratory Diseases 06/2013; 74(6):286-90. DOI:10.4046/trd.2013.74.6.286
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    ABSTRACT: In uncontrolled hemoptysis patient, bronchial arteriography and bronchial artery embolization (BAE) is a important procedure in diagnosis and treatment. The aim of this study is to assess the incidence of contrast-induced nephropathy and the risk factors of contrast-induced nephropathy (CIN) after bronchial arteriography and BAE. We retrospectively reviewed the medical records of the patients who underwent bronchial arteriography and BAE in two university hospitals from January 2003 to December 2011. CIN was defined as rise of serum creatinine more than 25% of baseline value or 0.5 mg/dL at between 48 hours and 96 hours after bronchial arteriography and BAE. We excluded patients who already had severe renal insufficiency (serum creatinine≥4.0) or had been receiving dialysis. Of the total 100 screened patients, 88 patients met the enrollment criteria. CIN developed in 7 patients (8.0%). The mean duration between the exposure and development of CIN was 2.35±0.81 days. By using multivariate analysis, serum albumin level was found to be significantly associated with the development of CIN (p=0.0219). These findings suggest that the incidence of CIN was higher than expected and patients with hypoalbuminemia should be monitored more carefully to prevent the development of CIN after bronchial arteriography and BAE.
    Tuberculosis and Respiratory Diseases 04/2013; 74(4):163-8. DOI:10.4046/trd.2013.74.4.163
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    ABSTRACT: BACKGROUND: Aspirin-intolerant asthma is a unique clinical syndrome characterized by acute bronchoconstriction following the administration of aspirin and/or non-steroidal anti-inflammatory drugs. OBJECTIVE: We assessed the prevalence and investigated the demographic and clinical characteristics of adult patients with aspirin-intolerant asthma in Korea. METHODS: Using an adult asthma cohort (COREA) from 11 university hospitals in Korea, we analyzed the prevalence of aspirin-intolerant asthma, defined as a positive response to the question: "Have you ever experienced dyspnea and cough after taking an aspirin or any NSAID (cold medicine)?" Demographic and clinical characteristics were compared between patients with aspirin-intolerant asthma and aspirin-tolerant asthma. RESULTS: Aspirin-intolerant asthma was reported in 68 (5.8%) of 1173 adult asthmatics (age 15-84). Patients with aspirin-intolerant asthma had a lower mean age (43.9 ± 13.4 vs. 49.0 ± 15.6, P = 0.003) and a higher prevalence of rhinosinusitis (77.9% vs. 61.7%, P = 0.012) and atopic dermatitis (16.2% vs. 5.7%, P = 0.001) than aspirin-tolerant asthma patients. There were no significant differences in lung function, asthma severity or the use of asthma controllers. However, aspirin-intolerant asthma was associated with greater use of healthcare services over a lifetime and over the past 12 months. Aspirin-intolerant asthma was significantly associated with emergency room visits over the past 12 months (P = 0.029, OR 2.19, 95% CI 1.08-4.42). CONCLUSION: Based on histories, the prevalence of aspirin-intolerant asthma is 5.8% among adult asthma patients in Korea. Aspirin-intolerant asthma is associated with lower age, higher prevalence of rhinosinusitis and atopic dermatitis, and more frequent exacerbations.
    Respiratory medicine 11/2012; 107(2). DOI:10.1016/j.rmed.2012.10.020 · 2.92 Impact Factor
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    ABSTRACT: Congenital cystic adenomatoid malformation (CCAM) is an uncommon, nonhereditary anomaly caused by arrest of lung. Patients with CCAM may present with respiratory distress as newborns, or may remain asymptomatic until later in life. CCAM type I is rarely found in association with bronchial atresia (BA) in adults; we present such a case. CASE: A 54-year-old female presented with chronic cough and blood-tinged sputum. Physical examination and laboratory tests were unremarkable. Chest radiographs and a CT scan of the chest showed multiple large air-filled cysts consistent with a CCAM in the right lower lobe, and an oval-shaped opacity in the distal right middle lobal bronchus. Based on the radiologic findings, right middle lobectomy and a medial basal segmentectomy of the right lower lobe were performed via a thoracotomy. These lesions were consistent with Stocker's Type I CCAM and BA in the different lobes.
    06/2012; 72(6):501-6. DOI:10.4046/trd.2012.72.6.501
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012
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    ABSTRACT: Measurement of the fraction of nitric oxide (FeNO) in exhaled air is useful in the management of asthma. A new hand-held nitric oxide (NO) analyzer, the NIOX MINO, is simple and easy to use in clinical practice. In this study, FeNO values measured using the NIOX MINO were compared with those obtained using a stationary chemiluminescence analyzer, the Sievers NOA280i. FeNO was measured in 100 adults, using both the NIOX MINO and the NOA280i. Nine (9.0%) of these subjects had asthma. The first acceptable measurement with the NIOX MINO and the mean of two acceptable measurements with the NOA280i were compared. There was a significant correlation between FeNO concentrations measured with the two devices (r = 0.876, P < 0.001). A Bland-Altman plot showed a high degree of agreement between the two devices: the mean inter-device difference was 3.3 parts per billion (ppb), and the 95% limits of agreement were -7.0 and 13.6 ppb. In addition, the mean relative difference was 14.5%, with the 95% limits of agreement being -33.7 and 62.7%. The mean value (± standard error of the mean) for FeNO as measured with the NIOX MINO (18.8 ± 0.9 ppb) was significantly lower than that measured with the NOA280i (22.1 ± 1.2 ppb, P < 0.001). There was a significant correlation, but only moderate agreement, between FeNO values measured with the NIOX MINO and those measured with the NOA280i, with the NIOX MINO values being significantly lower than the NOA280i values. Significant differences in FeNO values obtained with these two NO analyzers should be considered when interpreting the results of FeNO measurements.
    Respirology 03/2012; 17(5):830-4. DOI:10.1111/j.1440-1843.2012.02163.x · 3.50 Impact Factor
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    ABSTRACT: Trousseau's syndrome is an unexplained thrombotic event that precedes the diagnosis of an occult visceral malignancy or appears concomitantly with the tumor. Upper extremity deep vein thrombosis is prevalent in patients with a central venous catheter. Furthermore, a peripheral intravenous injection may cause upper extremity deep vein thrombosis as well. However, a deep vein thrombosis has not been reported in the form of Trousseau's syndrome with a catastrophic clinical course triggered by a single peripheral intravenous injection. A 48-year-old man presented with a swollen left arm on which he was given intravenous fluid at a local clinic due to flu symptoms. Contrast computed tomgraphy scans showed thromboses from the left distal brachial to the innominate vein. The patient developed multiple cerebral infarctions despite anticoagulation treatment. He was diagnosed with stomach cancer by endoscopic biopsy to evaluate melena and had a persistently positive lupus anticoagulant. After recurrent and multiple thromboembolic events occurred with treatment, he died on day 20.
    Tuberculosis and Respiratory Diseases 01/2011; 71(2). DOI:10.4046/trd.2011.71.2.134
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    ABSTRACT: Bronchiectasis is one of the common chronic respiratory diseases and associated with respiratory morbidity and mortality. However, neither its prevalence nor its etiology is well-defined. We aimed to estimate the prevalence and risk factors of bronchiectasis in adults. In a retrospective study, we analyzed radiologic findings on chest computed tomography (CT) images performed as part of a health-screening program. From January to December 2008, 1,409 (24.6%) of 5,727 participants in the screening program of a health promotion center at a university hospital underwent chest CT scans based on the subject's decision. Bronchiectasis was diagnosed, if there was abnormal bronchial dilatation in any area of both lungs on chest CT. Respiratory symptoms, smoking status, and past medical history were also analyzed to define clinical characteristics and risk factors of bronchiectasis. Of 1,409 patients (aged 23-86 years), who were screened for respiratory diseases using chest CT for one year in a health promotion center, 129 patients (9.1%) were diagnosed with bronchiectasis. The prevalence of bronchiectasis was higher in females than in males (11.5% vs. 7.9%, p = 0.022) and increased with age. Respiratory symptoms were reported in 53.7% of subjects. Previous history of tuberculosis (TB) (OR 4.61, 95% CI 2.39-8.88, p = 0.001) and age (OR 2.49, 95% CI 1.56-3.98, p = 0.001) were significantly associated with bronchiectasis. This retrospective analysis of chest CT findings in health screening examinees revealed a very high prevalence of bronchiectasis in adults. Previous TB infection is one of the major causes of bronchiectasis.
    The Tohoku Journal of Experimental Medicine 01/2010; 222(4):237-42. DOI:10.1620/tjem.222.237 · 1.28 Impact Factor