-
Seungtaek Lim,
Byoung Chul Cho,
Ji Ye Jung,
Gun Min Kim,
Se Hyun Kim,
Hye Ryun Kim,
Han Sang Kim,
Sun Min Lim,
Ji Soo Park,
Jun Ho Lee,
Darae Kim,
Eun Young Kim,
Moo Suk Park,
Young Sam Kim,
Se Kyu Kim, Joon Chang,
Joo Hang Kim
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to investigate the efficacy and safety of belotecan in combination with cisplatin in patients with previously non-treated extensive stage small cell lung cancer. A total of 42 patients were enrolled and treated with combination of belotecan 0.5mg/m(2) on daily basis throughout day 1-4 and cisplatin 60mg/m(2) on day 1 of a 3-week cycle, up to 6 cycles. Treatment was continued until the completion of 6 cycles of the chemotherapy, disease progression, detection of unacceptable toxicity, withdrawal of the consent, or death of the patient. Response was assessed every 2 cycles of chemotherapy by the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0. Toxicity was assessed by the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 3.0. The overall response rate was 73.8% in an intention to treat population and 83.9% in the evaluable patients. With the median follow up of 9.9 months, the median progression free survival was 6.9 months (95% CI, 6.6-7.2 months), and median overall survival was 11.2 months (95% CI, 9.9-12.5 months). The frequently reported grade≥3 toxicities were neutropenia (90.2%), thrombocytopenia (63.4%), and anemia (34.1%). Febrile neutropenia was reported in 16 patients (39.0%). Although most of non-hematologic toxicities were grade 1 or 2, there were 4 patient deaths caused by pneumonia complicated by septic shock. Belotecan and cisplatin combination chemotherapy demonstrated a promising efficacy in ED SCLC patients. But, the hematologic toxicity of this regimen requires considerable amount of attention.
Lung cancer (Amsterdam, Netherlands) 03/2013; · 3.14 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Asthma is one of the most common chronic conditions. Knowing the longitudinal trends of prevalence is important in developing health service planning and in assessing the impact of the disease. However, there have been no studies that examined current asthma prevalence trends in Korea through the analysis of nationwide surveys. METHODS: Data were acquired from patients aged 20-59 years who participated in the First Korean National Health and Nutritional Examination Surveys (KNHANES), which was conducted in 1998, and in the second year of the Fourth KNHANES, which was conducted in 2008. To estimate the prevalence of asthma with age and gender standardization, we used data from the Population and Housing Census, which was conducted by Statistics Korea in 2005. RESULTS: The prevalence of physician-diagnosed asthma increased from 1998 to 2008 (1998: 0.7 %, 2008: 2.0 %). The prevalence of asthma medication usage also increased from 1998 to 2008 (1998: 0.3 %, 2008: 0.7 %); however, the prevalence of wheezing decreased between 1998 and 2008 (1998: 13.7 %, 2008: 6.3 %). A similar trend was observed after estimating the prevalence of asthma with age and gender standardization. Allergic rhinitis might be the reason for the increased prevalence of physician-diagnosed asthma, while the observed decrease in wheezing may be related to the decrease in smoking or the increase in the use of asthma medication. CONCLUSIONS: The present study showed that the prevalence of both self-reported physician-diagnosed asthma and asthma medication usage increased from 1998 to 2008 in Korea, despite a possible changing pattern of diagnosing asthma.
Beiträge zur Klinik der Tuberkulose 03/2013; · 1.90 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Splenosis is defined as an autotransplantation of the splenic tissue after splenic rupture or splenectomy, and occurs most frequently in the peritoneal cavity. Splenosis is usually asymptomatic and is found incidentally. We report a case of combined intrathoracic and intraperitoneal splenosis in a 54-year-old male who worked as a miner for 10 years in his twenties, and was a current smoker. He was referred to our hospital for further evaluation of an incidental left diaphragmatic mass. Positron emission tomography-computed tomography and bronchoscopy were performed to evaluate the possibility of malignancy. There was no evidence of malignancy, but the spleen was not visualized. Reviewing his medical history revealed previous splenectomy, following a dynamite explosion injury. Therefore, splenosis was suspected and technetium-99m-labeled heat-damaged red blood cell scan confirmed the diagnosis. Radionuclide imaging is a useful diagnostic tool for splenosis, which could avoid unnecessary invasive procedures.
Tuberculosis and Respiratory Diseases 03/2013; 74(3):134-9.
-
Sang Hoon Lee,
Ji Ye Jung,
Do Hoon Kim,
Sang Kook Lee,
Song Yee Kim,
Eun Young Kim,
Young Ae Kang,
Moo Suk Park,
Young Sam Kim, Joon Chang,
Se Kyu Kim
[show abstract]
[hide abstract]
ABSTRACT: Purpose: Endobronchial metastasis is defined as documented extrathoracic malignancies metastatic to the endobronchus within a bronchoscopically visible range. Although the clinical and radiologic findings of endobronchial metastasis are similar to primary lung cancer, treatment and prognosis may be different. We hereby investigated the clinical, radiologic and bronchoscopic aspects of endobronchial metastases (EBM) in Korean patients. Materials and Methods: A total of 43 patients with EBM who underwent bronchoscopic biopsies from June 1991 to December 2009 at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea, were analyzed retrospectively. We evaluated clinical, radiologic and bronchoscopic characteristics of EBM. Results: The patients consisted of 27 males and 16 females and their ages ranged from 18 to 77 years. The common primary cancers related to EBM were rectal (16.3%), colon (11.6%), breast (9.3%) and uterine (9.3%) cancers. The mean interval from diagnosis of primary cancer to EBM was 36 months, and the mean survival duration from diagnosis of EBM was 16.1 months in 33 deceased patients. Conclusion: EBM develop in various types of malignancies at various times with unremarkable manifestations. Therefore, physicians should consider the possibility of EBM, especially if a patient has a history of any malignancy, regardless of respiratory symptoms. Respiratory symptoms related with EBM can be treated by various safe procedures.
Yonsei medical journal 03/2013; 54(2):403-9. · 0.77 Impact Factor
-
Ji Young Son,
Song Yee Kim,
Sang Ho Cho,
Hyo Sub Shim,
Ji-Ye Jung,
Eun Young Kim,
Ju Eun Lim,
Byung Hoon Park,
Young Ae Kang,
Young Sam Kim,
Se Kyu Kim, Joon Chang,
Moo Suk Park
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Transforming growth factor-β(1) (TGF-β(1)) is a key cytokine that plays a critical role in idiopathic pulmonary fibrosis (IPF). The genotypes of T869C polymorphism may be associated with the susceptibility to fibrotic lung disease. METHODS: We investigated a single-nucleotide polymorphism at exon 1 nucleotide position 29 (T → C) of the TGF-β(1) gene. Eighty-five healthy controls and 85 subjects with surgically confirmed IPF were investigated using polymerase chain reaction and restriction enzyme fragment length polymorphism techniques. RESULTS: The IPF patients consisted of 55 men and 30 women. The mean age was 61 ± 8 years. Fifty-one (60 %) of the 85 IPF patients were smokers and 34 were nonsmokers. The distribution of genotypes between IPF patients and controls was significantly different (IPF: TT 43.5 % and TC or CC 56.5 %; controls: TT 27.1 % and TC or CC 72.9 %, p = 0.037). TT genotype was significantly associated with decreased PaO(2) and increased D(A-a)O(2) upon initial diagnosis (p = 0.006 and 0.009, respectively). There was a positive association between TT genotype and IPF development (odds ratio [OR] = 2.1, 95 % confidence interval [CI] = 1.1-4.0, p = 0.028). CONCLUSIONS: This study suggests that the TGF-β(1) gene T869C polymorphism may affect susceptibility to IPF in Koreans. Larger studies are required to confirm the genetic association of TGF-β(1) gene polymorphism and IPF.
Beiträge zur Klinik der Tuberkulose 01/2013; · 1.90 Impact Factor
-
In Seon Lee,
Sae Byul Kim,
Chan Soo Moon,
Sung Mo Jung,
Song Yee Kim,
Eun Young Kim,
Ji Ye Jung,
Young Ae Kang,
Young Sam Kim,
Se Kyu Kim, Joon Chang,
Moo Suk Park
[show abstract]
[hide abstract]
ABSTRACT: A 55-year-old woman was admitted for an elevated serum carbohydrate antigen-125 (CA-125) level, and a left pleural effusion, which were detected at a routine health examination. Computed tomography of the chest was performed upon admission, revealing extensive bilateral paratracheal and mediastinal lymph node enlargement with a massive left-sided pleural effusion. Subsequent analysis of the pleural fluid demonstrated consistency with an exudate, no evidence of malignant cells, and a normal adenosine deaminase. However, the pleural fluid and serum CA-125 levels were 2,846.8 U/mL and 229.5 U/mL, respectively. A positron emission tomography did not reveal any primary focus of malignancy. Finally, a surgical mediastinoscopic biopsy of several mediastinal lymph nodes was performed, revealing non-necrotizing granulomas, consistent with sarcoidosis. After a month of treatment of prednisolone, the left pleural effusion had resolved, and after 2 months the serum CA-125 level was normalized.
Tuberculosis and Respiratory Diseases 12/2012; 73(6):320-4.
-
Minkyu Jung,
Byoung Chul Cho,
Chul Ho Lee,
Hyung Soon Park,
Young Ae Kang,
Se Kyu Kim, Joon Chang,
Dae Jun Kim,
Sun Young Rha,
Joo Hang Kim,
Ji Hyun Lee
[show abstract]
[hide abstract]
ABSTRACT: Purpose: Mutations in the epidermal growth factor receptor (EGFR) have been confirmed as predictors of the efficacy of treatment with EGFR-tyrosine kinase inhibitors (TKIs). We investigated whether polymorphisms of the EGFR gene were associated with clinical outcomes in non-small cell lung cancer (NSCLC) patients treated with EGFR-TKI. Materials and Methods: A polymorphic dinucleotide repeat in intron 1 [CA simple sequence repeat in intron 1(CA-SSR1)] in intron 1 and single nucleotide polymorphisms (SNP-216) in the promoter region of the EGFR gene were evaluated in 71 NSCLC patients by restriction fragment length polymorphism and DNA sequencing. The relationship between genetic polymorphisms and clinical outcomes of treatment with EGFR-TKIs was evaluated. Results: SNP-216G/T polymorphisms were associated with the efficacy of EGFR-TKI. The response rate for the SNP-216G/T tended to be higher than that for G/G (62.5% vs. 27.4%, p=0.057). The SNP-216G/T genotype was also associated with longer progression-free survival compared with the GG genotype (16.7 months vs. 5.1 months, p=0.005). However, the length of CA-SSR1 was not associated with the efficacy of EGFR-TKI. Conclusion: SNP-216G/T polymorphism was a potential predictor of clinical outcomes in NSCLC patients treated with EGFR-TKI.
Yonsei medical journal 11/2012; 53(6):1128-35. · 0.77 Impact Factor
-
Sungmo Jung,
In Seon Lee,
Sae Byol Kim,
Chan Soo Moon,
Ji Ye Jung,
Young Ae Kang,
Moo Suk Park,
Young Sam Kim,
Se Kyu Kim, Joon Chang,
Eun Young Kim
[show abstract]
[hide abstract]
ABSTRACT: The level of urine cotinine is an indicator of tobacco smoke exposure. The purpose of this study is to investigate urine cotinine for the purpose of assessing the smoking status of Korean smokers and non-smokers exposed to tobacco smoke.
The subjects were identified from the 2007-2009 and the 2010 data sets of the Korea National Health and Nutrition Examination Survey (KNHANES). They were assigned as non-smokers, current smokers and ex-smokers. Non-smokers were also divided into three subset groups according to the duration of smoke exposure. Each group was stratified by gender prior to analysis.
The median value of urine cotinine in the male current smokers was 1,221.93 ng/mL which was the highest among all groups. The difference between levels of urine cotinine for male and the female groups was statistically significant (p<0.01). In the female group, passive smoke exposure groups reported higher urine cotinine levels than non-exposure groups (p=0.01). The cutoff point for the discrimination of current smokers from non-smokers was 95.6 ng/mL in males and 96.8 ng/mL in females. The sensitivity and specificity were 95.2% and 97.1%, respectively, in males, 96.1% and 96.5% in females. However, the determination of urine cotinine level was not useful in distinguishing between passive smoke exposure groups and non-exposure groups.
Urine cotinine concentration is a useful biomarker for discriminating non-smokers from current smokers. However, careful interpretation is necessary for assessing passive smoke exposure by urine cotinine concentration.
Tuberculosis and respiratory diseases. 10/2012; 73(4):210-8.
-
Jin Hur,
Hye-Jeong Lee,
Ji Eun Nam,
Young Jin Kim,
Yoo Jin Hong,
Hee Yeong Kim,
Se Kyu Kim, Joon Chang,
Joo-Hang Kim,
Kyung Young Chung,
Hye Sun Lee,
Byoung Wook Choi
[show abstract]
[hide abstract]
ABSTRACT: Cytological fluid from a needle aspiration biopsy (NAB) is obtained directly from tumor tissue, therefore many biomarker candidates will be present in high concentrations. The aim of this study was to prospectively assess and validate the tumor markers CYFRA 21-1, CEA, and SCC in cytological fluid obtained from NAB samples to determine if they improved the performance of NAB for diagnosing non-small cell lung cancer (NSCLC).
A total of 194 patients (M:F = 128:66, mean age 63.7 years) with suspected malignant pulmonary lesions were prospectively enrolled and underwent percutaneous NAB. Levels of CYFRA 21-1, CEA, and SCC were measured by immunoassay in serum and cytological fluid obtained during aspiration biopsy. Cut-off values to determined malignancy were 3.3 ng/mL in serum and 15.7 ng/mL in cytological fluid for CYFRA 21-1, 5 ng/mL and 0.6 ng/mL for CEA, and 2 ng/mL and 0.86 ng/mL for SCC.
Of 194 patients, 139 patients (71.6%) had NSCLC and 55 (28.4%) had benign lesions. Sensitivity increased significantly for NAB combined with cytological tumor markers compared with NAB alone (CYFRA 21-1: 95% versus 83.5%, p < 0.001, CEA: 92.1% versus 83.5%, p = 0.002, SCC: 91.4% versus 83.5%, p = 0.003). Accuracy improved significantly for NAB combined with cytological CYFRA 21-1 compared with NAB alone (95.9% versus 88.1%, p < 0.001). The area under curve (AUC) of NAB with cytological CYFRA 21-1 was significantly larger than for NAB alone (0.966 versus 0.917, p = 0.009).
Of the tested tumor markers, cytological fluid measurements of CYFRA 21-1 improved the diagnostic performance of NAB for NSCLC.
BMC Cancer 09/2012; 12:392. · 3.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: This study evaluated inducible protein 10 (IP-10) as a diagnostic biomarker for specific tuberculosis (TB) infection and evaluated the ability of IP-10 to distinguish between active TB and latent TB infection (LTBI). METHODS: Forty-six patients with active pulmonary TB, 22 participants with LTBI, and 32 non-TB controls were enrolled separately. We measured IP-10 in serum and in supernatants from whole blood stimulated with TB-specific antigens. RESULTS: TB antigen-dependent IP-10 secretion was significantly increased in the active TB patients and LTBI subjects compared with controls, but did not differ significantly between the active TB patients and LTBI subjects. Serum IP-10 levels were higher in active TB than in LTBI (174.9 vs. 102.7pg/ml, p=0.002). The respective rates of positive responders of TB antigen-dependent IP-10 were 97.8%, 90.9%, and 12.5% in active TB, LTBI, and non-TB controls, respectively. For serum IP-10, 87.5%, 45.5%, and 9.5% of responders were positive in the respective groups. CONCLUSIONS: The IP-10 response to TB antigen may constitute a specific biomarker for TB infection, but does not by itself distinguish between active TB and LTBI. Serum IP-10 may enhance the diagnostic performance when used in combination with another marker.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 09/2012; · 2.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The development of clinically relevant biomarkers is important for diagnosing latent tuberculosis infection (LTBI) and active tuberculosis (TB) and predicting their prognoses. This study examined whether the responses of multiple cytokines can be used as a biomarker to distinguish the TB infection status and mycobacterial load. We analyzed the responses of multiple cytokines (IFN-γ, IL-2, IL-10, IL-13, IL-17, and TNF-α) in the supernatant from the QuantiFERON- TB Gold In-Tube assay following stimulation of whole-blood from the TB group (n = 32), LTBI group (n = 19), and healthy controls (n = 30) with TB antigens (ESAT-6, CFP-10, and TB7.7). The median responses of IFN-γ, IL-2, IL-10, and IL-13 were higher in the LTBI and active TB groups than in the non-TB control group (IFN-γ, p < 0.001; IL-2, p < 0.001; IL-10, p = 0.012; IL-13, p < 0.001). The median IL-2/IFN-γ ratio of the LTBI group was higher than that of the active TB group (p = 0.014) and differed significantly among LTBI, smear-negative TB, and smear-positive TB patients (p = 0.027). This difference was especially evident between the LTBI and smear-positive TB patients (p = 0.047). In conclusion, IFN-γ, IL-2, IL-10, and IL-13 can serve as biomarkers for distinguishing TB infection. In addition, the IL-2/IFN-γ ratio appears to be a biomarker for diagnosing LTBI and may be useful as a prognostic factor and for evaluating treatment responses.
Scandinavian Journal of Immunology 09/2012; · 2.23 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The prognostic and predictive value of pretreatment serum levels of carcinoembryonic antigen (CEA) and cytokeratin-19 fragments (CYFRA 21-1) were assessed in advanced non-small cell lung cancer (NSCLC) patients treated with gefitinib or erlotinib.
Pretreatment CEA and CYFRA 21-1 were measured in 123 advanced NSCLC patients receiving gefitinib or erlotinib. High CEA levels (h-CEA) were significantly associated with females, patients with adenocarcinoma, and non-smokers.
Low CYFRA 21-1 levels (l-CYFRA) were significantly associated with a good performance status (ECOG PS 0-1). The overall response rate (RR) was 27.6%, and higher RR was associated with adenocarcinoma, h-CEA, and epidermal growth factor receptor (EGFR) mutation. Patients with h-CEA had significantly longer progression-free survival (PFS) (p=0.021). Patients with l-CYFRA had significantly longer PFS and overall survival (p=0.006 and p<0.001, respectively). Of note, h-CEA and l-CYFRA had good prognosis in patients with unknown EGFR mutation status or patients with squamous cell carcinoma (p=0.021 and p=0.015, respectively). A good ECOG PS (HR=0.45, p=0.017), h-CEA (HR=0.41, p=0.007), l-CYFRA 21-1 (HR=0.52, p=0.025), and an EGFR mutation (HR=0.22, p<0.001) were independently predictive of a longer PFS.
h-CEA and l-CYFRA 21-1 may be prognostic and predictive serum markers for higher response and longer survival in patients with advanced NSCLC receiving gefitinib or erlotinib, especially in patients with unknown EGFR mutation status or patients with squamous cell carcinoma.
Yonsei medical journal 09/2012; 53(5):931-9. · 0.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Acinetobacter baumannii (A. baumannii) has emerged as a major cause of nosocomial pneumonia and sepsis in seriously ill patients. Multidrug-resistant A. baumannii (MDRAB) is increasing in frequency, and the management of it's infections is consequently difficult. Therefore, tigecycline is considered to be the drug of choice for MDRAB treatment. The aim of our study was to evaluate the microbiological eradication and clinical effectiveness of tigecycline against MDRAB in seriously ill patients, including patients with ventilator-associated pneumonia (VAP).
We conducted a retrospective study including patients with A. baumannii infections who were treated with tigecycline between April 1, 2009 and March 31, 2010. We treated 27 patients with tigecycline for MDRAB infections.
The mean age of patients was 66.2 years, and 20 (74.1%) patients were male. The median length of stay at hospital was 74.6 days. MDRAB was eradicated from the site of infection in 23 cases (85.2%), however, only 17 cases (63.0%) showed positive clinical responses. Overall, an in-hospital mortality rate of 51.9% was observed, and 4 cases of death were attributable to sepsis. The combination therapy showed better clinical and microbial success rates than the monotherapy without significant difference.
We observed the relatively low clinical success rate although the microbial eradication rate was high, probably due to superinfections in VAP and bacteremia. We suggest that clinicians should limit tigecycline monotherapy for MDRAB infection in critically ill patients, until large controlled clinical trials should be conducted.
Yonsei medical journal 09/2012; 53(5):974-84. · 0.77 Impact Factor
-
Song Yee Kim,
Ji Ye Jung,
Young Ae Kang,
Joo Eun Lim,
Eun Young Kim,
Sang Kook Lee,
Seon Cheol Park,
Kyung Soo Chung,
Byung Hoon Park,
Young Sam Kim,
Se Kyu Kim, Joon Chang,
Moo Suk Park
[show abstract]
[hide abstract]
ABSTRACT: To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia and for 30-day mortality in patients with CRAB bacteremia in the intensive care unit (ICU), we conducted a retrospective study in the ICU at Severance Hospital in Korea from January 2008 to December 2009. Patients who acquired CRAB bacteremia in the ICU were enrolled as the case group and patients whose specimens of blood culture, sputum/endotracheal aspirate and urine revealed no AB were enrolled as controls. The case group comprised 106 patients and 205 patients were included as controls. Risk factors independently associated with CRAB bacteremia included prior chemotherapy or radiotherapy treatment (Odds ratio [OR], 3.6; P = 0.003), recent central venous catheter insertion (OR, 5.7; P < 0.001) or abdominal drainage insertion (OR, 21.9; P = 0.004), the number of antibiotics treated with (OR, 1.3; P = 0.016), and respiratory failure in the ICU (OR, 2.5; P = 0.035). The 30-day mortality was 79.8%. Renal failure during ICU stay was independently associated with 30-day mortality (OR, 3.7; P = 0.047). It is important to minimize invasive procedures, and to restrict excessive use of antibiotics, especially in immunocompromised patients, in order to prevent the development of CRAB bacteremia. Greater concern for CRAB bacteremia patients is needed when renal failure develops during ICU stay.
Journal of Korean medical science 08/2012; 27(8):939-47. · 0.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Abstract Objectives: Pulmonary nontuberculous mycobacteria (NTM) are increasing worldwide, but data from regions with an intermediate tuberculosis (TB) burden are insufficient, and the reason for the changing epidemiology of NTM lung disease is unclear. We investigated the trends of NTM lung disease at a tertiary hospital in Korea and evaluated the contribution of liquid culture systems. Methods: We conducted a retrospective observational study of mycobacterial cultures of respiratory specimens from 26,793 patients at Severance Hospital in South Korea from January 2006 to December 2010. Results: The recovery percent of Mycobacterium tuberculosis isolates was 5.9% in 2006 and 7.1% in 2010, and the recovery percent of NTM isolates was 2.0% in 2006 and 6.3% in 2010. The annual percent of NTM isolation has increased steadily every year (p for trend < 0.001), and the proportion of patients from whom NTM was isolated increased from 21.4% in 2006 to 55.0% in 2010 (p for trend < 0.001). The incidence (per 100,000 inpatients and outpatients) of patients with NTM lung disease was 1.82 in 2006 and increased to 4.38 in 2010 (p < 0.001). Although the proportion of positive cultures in liquid medium only was higher for NTM than for M. tuberculosis (p < 0.001), the NTM recovery rate has increased in solid medium culture systems. Conclusions: The incidence of patients with NTM isolated from respiratory specimens and NTM lung disease increased from 2006 to 2010 in South Korea, a region with an intermediate TB burden.
Scandinavian Journal of Infectious Diseases 06/2012; 44(10):733-8. · 1.72 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Health care-associated pneumonia (HCAP) includes a broad range of patients having frequent or chronic contact with health care systems. However, the relationship between current defining criteria for HCAP and the risk of potentially drug-resistant (PDR) pathogens is controversial.
We retrospectively evaluated patients admitted to Severance Hospital in South Korea with culture-positive pneumonia from January 2008 to December 2009. We analyzed the associations between risk factors for HCAP and infection with PDR pathogens, and developed a new scoring system to predict infection with PDR pathogens.
Among 339 patients, PDR pathogens were observed in 122 (36.0%). PDR pathogens were more common in HCAP than community-acquired pneumonia (CAP) (48.5% versus 23.8%, P<0.001). In a logistic regression, prior hospitalization within 90 days of pneumonia (OR=2.51, P=0.003), recent treatment with antimicrobials (OR=2.35, P=0.039), and nasogastric tube feeding (OR=15.28, P<0.001) were independently associated with PDR pathogens. For the prediction of PDR pathogens, the sensitivity and specificity of current HCAP criteria were 66.4% and 60.4%, respectively, and 68.0% and 67.3%, respectively, for the new scoring system. Moreover, the new scoring system showed better diagnostic accuracy than current HCAP criteria (area under curve=0.711 versus 0.634, P<0.001).
The current HCAP criteria are poor predictors of PDR pathogens and all patients with HCAP should not be empirically treated for these pathogens. To avoid excessive antibiotic use, individual risk stratification approaches should be considered.
Respiratory medicine 05/2012; 106(9):1311-9. · 2.33 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to examine the usefulness of the TST and the interferon-γ release assays (IGRA) for diagnosing smear-negative pulmonary TB in immunocompromised patients in an intermediate TB burden.
We conducted a prospective study enrolling 119 immunocompromised participants with suspected smear-negative pulmonary TB in Seoul, South Korea. Clinical assessment, TST, QuantiFERON-TB Gold In Tube (QFT-GIT), and T-SPOT.TB were performed in immunosuppressed condition.
All participants were categorized according to the type of immunosuppression: 29 patients with diabetes mellitus, 53 with malignancy, 23 with taking immunosuppressive drugs, and 14 with end stage renal disease. IGRA sensitivity and specificity (95% CI) were: QFT-GIT [59.0% (44.9-72.0)] and [61.3% (54.4-67.6)] and T-SPOT.TB [72.0% (54.2-86.2)] and [42.3% (33.8-49.1)], respectively. For TST, sensitivity was 41.2% (28.3-50.8) and specificity was 91.8% (85.8-96.30). The sensitivities of the three diagnostic methods tended to be lower in the immunosuppressive drug group than in other groups (QFT-GIT 11.1%, T-SPOT.TB 40.0% and TST 25.0% in patients with taking immunosuppressive drugs). Among 111 patients who underwent a chest CT examination, there were no significant differences in the CT findings between the immunocompromised TB and non-TB patients.
The IGRAs and TST had no value as a single test either to rule-in or rule-out active TB in immunocompromised patients in an intermediate burden.
The Journal of infection 11/2011; 64(2):188-96. · 4.13 Impact Factor
-
Yoo Jin Hong,
Jin Hur,
Hye-Jeong Lee,
Ji Eun Nam,
Young Jin Kim,
Hua Sun Kim,
Hee Yeong Kim,
Se Kyu Kim, Joon Chang,
Joo-Hang Kim,
Kyung Young Chung,
Byoung Wook Choi,
Kyu Ok Choe
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to prospectively assess whether analysis of the tumor markers cytokeratin 19 fragments (CYFRA 21-1), carcinoembryonic antigen (CEA), and squamous cell carcinoma (SCC) antigen in cytological fluid can improve the performance of computed tomography (CT)-guided needle aspiration biopsy (NAB) in the diagnosis of non-small cell lung cancer (NSCLC).
A total of 100 patients (men:women = 41:59, mean age: 63 years) with suspected malignant pulmonary lesions were prospectively enrolled for CT-guided NAB procedures. Levels of CYFRA 21-1, CEA, and SCC in the cytological fluid were measured by immunoradiometric assays. The cutoff value for tumor markers was selected on the basis of best accuracy through receiver operating characteristic curves. The sensitivity and areas under the curve (AUC) of NAB alone were compared with those of NAB combined with cytological tumor markers (CYFRA 21-1, CEA, and SCC).
Among 100 patients, 71 (71%) had NSCLC and 29 (29%) had benign lesions. The sensitivity, specificity, and accuracy for diagnosing NSCLC were 85.7%, 100%, and 89%, respectively, for NAB alone. The sensitivity increased significantly for NAB combined with a tumor marker compared with NAB alone (100% for CYFRA 21-1, 92.9% for CEA, and 94.2% for SCC; p = 0.001, p = 0.025, and p = 0.014, respectively). The AUC of NAB with CYFRA 21-1 was significantly larger than the AUC of NAB alone (p = 0.001).
Evaluation of tumor markers CYFRA 21-1, CEA, and SCC in the cytological fluid can improve the diagnostic performance of CT-guided NAB for NSCLC. Of these markers, CYFRA 21-1 is the most useful cytological tumor marker.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 08/2011; 6(8):1330-5. · 4.55 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Limited information is available on the risk factors for false-negative results with the new generation of QuantiFERON-TB Gold In-Tube (QFT-GIT) tests in non-HIV-infected patients with tuberculosis (TB). We sought to identify risk factors for false-negative QFT-GIT results in culture-confirmed TB patients. We reviewed the microbiological, laboratory, radiographic, and clinical data of 362 patients with positive M. tuberculosis cultures who received QFT-GIT tests at a Korean tertiary hospital between September 2006 and March 2010. Of these, 311 (85.9%) had true-positive and 51 (14.1%) had false-negative results. The false-negative group was more likely to have immunosuppressant diseases and lower platelet, protein, and albumin levels than the true-positive group. An immunosuppressive condition was an independent risk factor for false-negative QFT-GIT results in non-HIV-infected patients with active TB (odds ratio, 2.98; 95% confidence interval, 1.38-6.47; P = .006). Careful interpretation of negative QFT-GIT results is thus necessary in immunocompromised patients suspected of having active TB.
Diagnostic microbiology and infectious disease 07/2011; 70(3):324-9. · 2.45 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We investigated the prognostic utility of changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) in combination with Sequential Organ Failure Assessment (SOFA) score in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) concomitant with septic shock. Forty-nine mechanically ventilated patients with ALI/ARDS concomitant with septic shock were studied. N-terminal pro-brain natriuretic peptide levels were measured on the first 3 days (days 0, 1, and 2) in the intensive care unit. The median NT-proBNP levels in survivors and nonsurvivors were 3,999 vs. 2,819 pg/mL on day 0 (P = 0.719); 4,495 vs. 5,397 pg/mL on day 1 (P = 0.543); and 2,325 vs. 14,173 pg/mL on day 2 (P = 0.028). N-terminal pro-brain natriuretic peptide levels increased significantly from baseline values in nonsurvivors only. We observed a monotonic increase in 28-day mortality associated with increasing quartiles of percent change in NT-proBNP on day 2 (P < 0.0001). Kaplan-Meier survival analysis revealed that mortality was significantly higher in patients with a change in NT-proBNP of 30% or more (log-rank P < 0.0001). On day 2, areas under the receiver operating characteristic curves for predicting 28-day mortality were 0.74 for SOFA alone and 0.85 (P = 0.028) for SOFA combined with percent change in NT-proBNP. In conclusion, in patients with ALI/ARDS concomitant with septic shock, a rising trend (high percent change) in NT-proBNP levels had better prognostic utility than absolute levels. The combination of percent change in NT-proBNP with SOFA may provide superior prognostic accuracy to SOFA alone.
Shock (Augusta, Ga.) 04/2011; 36(2):109-14. · 2.87 Impact Factor
