Publications by authors named "June Hong Ahn"

39 Publications

Radial probe endobronchial ultrasound using guide sheath-guided transbronchial lung biopsy in peripheral pulmonary lesions without fluoroscopy.

Tuberc Respir Dis (Seoul) 2021 Jun 24. Epub 2021 Jun 24.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Respiratory Center, Yeungnam University Medical Center, Daegu, South Korea.

Background: : Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) has improved the diagnostic yield of bronchoscopic biopsy of peripheral pulmonary lesions (PPLs). The diagnostic yield and complications of RP-EBUS-TBLB for PPLs vary depending on the technique, such as using a guide sheath (GS) or fluoroscopy. We investigated the utility of RP-EBUS-TBLB using a GS without fluoroscopy for diagnosing PPLs.

Methods: We retrospectively reviewed data from 537 patients who underwent RP-EBUS-TBLB of PPLs from January 2019 to July 2020. TBLB was performed using RP-EBUS with a GS and without fluoroscopy. The diagnostic yield and complications were assessed. All lung lesions without a definitive diagnosis were excluded from analyses. Multivariable logistic regression analyses were used to identify factors affecting the diagnostic yields.

Results: The overall diagnostic accuracy, sensitivity, specificity, positive predictive, and negative predictive values were 93.0% (462/497), 89.7% (305/340), 100% (157/157), 100% (305/305), and 81.8% (157/192), respectively. In multivariable analyses, the size of the lesion (≥20 mm; odds ratio [OR], 2.20; 95% confidence interval [CI], 1.03-4.72; p = 0.043) and having the probe within the lesion (OR, 3.08; 95% CI, 1.47-6.44; p = 0.003) were associated with diagnostic success. Pneumothorax occurred in 2.2% (12/537) of cases and chest tube insertion was required in 0.6% (3/537) of patients.

Conclusions: When diagnosing PPLs, RP-EBUS-TBLB using a GS without fluoroscopy is a highly accurate diagnostic method that does not cause exposure to radiation with acceptable complication rates. Lesions ≥ 20 mm and having the probe within the lesion improve diagnostic success.
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http://dx.doi.org/10.4046/trd.2021.0002DOI Listing
June 2021

Utility of Radial Probe Endobronchial Ultrasound Guided Transbronchial Lung Biopsy in Bronchus Sign Negative Peripheral Pulmonary Lesions.

J Korean Med Sci 2021 Jun 21;36(24):e176. Epub 2021 Jun 21.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Respiratory Center, Yeungnam University Medical Center, Daegu, Korea.

Background: The presence of the bronchus sign on chest computed tomography is associated with an increased diagnostic yield of radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB). However, the utility of RP-EBUS-TBLB for bronchus sign negative peripheral pulmonary lesions (PPLs) remains unknown. We investigated the utility of RP-EBUS-TBLB in bronchus sign negative PPLs.

Methods: We retrospectively reviewed data from 109 patients who underwent RP-EBUS for bronchus sign negative PPLs from January 2019 to August 2020. TBLB was performed using RP-EBUS with a guide sheath and without fluoroscopy. The EBUS visualization and TBLB diagnostic yields were assessed. Multivariable logistic regression analyses were used to identify factors affecting the EBUS visualization and diagnostic yields.

Results: The EBUS visualization yield was 74.1% (68/109). Of the 109 lung lesions, 92 were definitively diagnosed. The overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 50.5% (55/109), 34.9% (29/83), 100% (26/26), 100% (29/29), and 32.5% (26/80), respectively. In multivariable analyses, the size of the lesion (≥ 20 mm; odds ratio [OR], 2.62; 95% confidence interval [CI], 1.16-5.93; = 0.021) and the distance from the pleura (> 10 mm; OR, 2.37; 95% CI, 1.02-5.52; = 0.045) were associated with EBUS visualization. Regarding diagnostic yield, having the probe within the lesion (OR, 28.50; 95% CI, 6.26-129.85; < 0.001) and a solid lesion (OR, 14.58; 95% CI, 2.64-80.38; = 0.002) were associated with diagnostic success. Pneumothorax and hemoptysis occurred in 3.7% (4/109) and 0.9% (1/109), respectively, of the patients.

Conclusion: RP-EBUS-TBLB using a GS can be considered a diagnostic method in bronchus sign negative solid PPLs. Having the probe within the lesion and a solid lesion were important for diagnostic success. Complication rates were acceptable.
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http://dx.doi.org/10.3346/jkms.2021.36.e176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216993PMC
June 2021

Dual attention multiple instance learning with unsupervised complementary loss for COVID-19 screening.

Med Image Anal 2021 08 24;72:102105. Epub 2021 May 24.

Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology (DGIST), Daegu, South Korea. Electronic address:

Chest computed tomography (CT) based analysis and diagnosis of the Coronavirus Disease 2019 (COVID-19) plays a key role in combating the outbreak of the pandemic that has rapidly spread worldwide. To date, the disease has infected more than 18 million people with over 690k deaths reported. Reverse transcription polymerase chain reaction (RT-PCR) is the current gold standard for clinical diagnosis but may produce false positives; thus, chest CT based diagnosis is considered more viable. However, accurate screening is challenging due to the difficulty in annotation of infected areas, curation of large datasets, and the slight discrepancies between COVID-19 and other viral pneumonia. In this study, we propose an attention-based end-to-end weakly supervised framework for the rapid diagnosis of COVID-19 and bacterial pneumonia based on multiple instance learning (MIL). We further incorporate unsupervised contrastive learning for improved accuracy with attention applied both in spatial and latent contexts, herein we propose Dual Attention Contrastive based MIL (DA-CMIL). DA-CMIL takes as input several patient CT slices (considered as bag of instances) and outputs a single label. Attention based pooling is applied to implicitly select key slices in the latent space, whereas spatial attention learns slice spatial context for interpretable diagnosis. A contrastive loss is applied at the instance level to encode similarity of features from the same patient against representative pooled patient features. Empirical results show that our algorithm achieves an overall accuracy of 98.6% and an AUC of 98.4%. Moreover, ablation studies show the benefit of contrastive learning with MIL.
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http://dx.doi.org/10.1016/j.media.2021.102105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141701PMC
August 2021

Incidence and Prognostic Factors of Respiratory Viral Infections in Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Int J Chron Obstruct Pulmon Dis 2021 7;16:1265-1273. Epub 2021 May 7.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea.

Purpose: Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) that require hospitalization and emergency department visits are associated with considerable morbidity and mortality. Respiratory viral infection is an important cause of severe AECOPD. We evaluated the incidence and prognostic factors of viral infection in severe AECOPD.

Patients And Methods: We performed a retrospective study of 262 cases of severe AECOPD in 192 patients who required hospitalization and emergency department visits at a tertiary teaching hospital in Daegu, Korea. A multiplex polymerase chain reaction panel using a nasopharyngeal swab sample was performed to detect viral infection.

Results: Viral infection was detected in 108 events (41.2%) from 96 patients. The most common virus was rhinovirus/enterovirus (27.5%), followed by influenza virus (22.5%), respiratory syncytial virus (13.3%), parainfluenza virus (12.5%), coronavirus (12.5%), metapneumovirus (7.5%), and adenovirus (4.2%). Virus-positive exacerbations, compared to virus-negative exacerbations, had a higher frequency of symptoms of rhinopharyngitis, higher neutrophil count and C-reactive protein (CRP) level, and lower eosinophil count. Multivariate analysis demonstrated that elevated CRP levels (odds ratio [OR], 2.76; 95% confidence interval [CI], 1.24-6.15), symptoms of rhinopharyngitis (OR, 1.98; 95% CI, 1.03-3.78), low eosinophil count (OR, 1.74; 95% CI, 1.03-2.92), and inhaled corticosteroid (ICS) use (OR, 1.70; 95% CI 1.04-2.80) were associated with viral infection in severe AECOPD.

Conclusion: The incidence of viral infection in severe AECOPD was 41.2%, and the most commonly detected virus was rhinovirus/enterovirus. Increased CRP level, symptoms of rhinopharyngitis, low eosinophil count, and use of ICS were associated with viral infection in severe AECOPD.
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http://dx.doi.org/10.2147/COPD.S306916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112874PMC
June 2021

Clinical impact of blood pressure variability in patients with COVID-19 and hypertension.

Blood Press Monit 2021 May 6. Epub 2021 May 6.

Division of Cardiology Division of Pulmonology and Allergy Division of Rheumatology and Infectious Disease, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Republic of Korea.

Objective: This study aimed to investigate the relationship between blood pressure variability (BPV) and clinical outcomes in patients with coronavirus disease 2019 (COVID-19) and hypertension.

Methods: A total of 136 patients hospitalized with COVID-19 were enrolled in this study. Patients were grouped according to the presence of hypertension and BPV. Mean arterial pressure (MAP) measured at 8 a.m. and 8 p.m. was analyzed, and BPV was calculated as the coefficient of variation of MAP (MAPCV). High BPV was defined as MAPCV values above the median. We compared the age, level of C-reactive protein (CRP), creatine kinase-MB (CK-MB), N-terminal pro-B type natriuretic peptide (NT-proBNP), creatinine and in-hospital mortality and investigated the relationship among the groups.

Results: COVID-19 patients with hypertension were older (70 ± 12 vs. 53 ± 17 years; P < 0.001), had higher levels of CRP (9.4 ± 9.2 vs. 5.3 ± 8.2 mg/dL; P = 0.009), MAPCV (11.4 ± 4.8 vs. 8.9 ± 3.2; P = 0.002), and higher in-hospital mortality (19.6% vs. 5.9%; P = 0.013) than those without hypertension. There was a proportional relationship between BPV and age, levels of CRP, CK-MB, NT-proBNP, creatinine and in-hospital mortality (all, P < 0.05). In Cox regression analysis, advanced age [≥80 years, hazard ratio (HR) 10.4, 95% confidence interval (CI) 2.264-47.772, P = 0.003] and higher MAPCV (HR 1.617, 95% CI, 1.281-2.040, P < 0.001) were significantly associated with in-hospital mortality.

Conclusion: High BPV in COVID-19 patients with hypertension is significantly associated with in-hospital mortality. Advanced age and systemic inflammation are proportional to high BPV. Additional attention is needed for COVID-19 patients with hypertension and high BPV.
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http://dx.doi.org/10.1097/MBP.0000000000000544DOI Listing
May 2021

Radial probe endobronchial ultrasound-guided transbronchial lung biopsy for the diagnosis of cavitary peripheral pulmonary lesions.

Thorac Cancer 2021 06 4;12(11):1735-1742. Epub 2021 May 4.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Respiratory Center, Yeungnam University Medical Center, Daegu, South Korea.

Background: Cavitary peripheral pulmonary lesions (PPLs) are often diagnosed via transthoracic needle biopsy. However, today, radial probe endobronchial ultrasound (RP-EBUS) is widely used to diagnose PPLs. The efficacy and safety of RP-EBUS-guided transbronchial lung biopsy (RP-EBUS-TBLB) used to diagnose cavitary PPLs remain poorly known. We investigated the utility of RP-EBUS-TBLB using a guide sheath (GS) without fluoroscopy to diagnose PPLs.

Methods: Of 743 RP-EBUS procedures conducted to diagnose PPLs performed at our institution from January 2019 to October 2020, we analyzed 77 cavitary PPLs. TBLB was performed using RP-EBUS with a GS without fluoroscopy. The diagnostic accuracy and complications were assessed. All lung lesions with a definitive diagnosis were included in analyses.

Results: The overall diagnostic accuracy was 85.7% (66/77). Of malignant lesions (n = 34), 29 (85.3%) were diagnosed successfully. Of benign lesions (n = 43), 37 (86.0%) were diagnosed successfully. In multivariate analyses, a thicker cavity wall (≥10 mm, odds ratio [OR] 14.22, 95% confidence interval [CI] 2.58-78.35, p = 0.002) and EBUS imaging with the probe within the lesion (OR 12.02, 95% CI 1.91-75.53, p = 0.008) independently affected diagnostic success. The likelihood of success increased with increasing thickness of the cavity wall (p < 0.001, test for trend). The specimens obtained for molecular confirmation of malignancy were satisfactory. There were four cases of infection (5.2%) and three cases of pneumothorax (3.9%).

Conclusions: RP-EBUS-TBLB of cavitary PPLs affords high diagnostic accuracy with acceptable complication rates.
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http://dx.doi.org/10.1111/1759-7714.13980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169283PMC
June 2021

PEGylated nanoparticle albumin-bound steroidal ginsenoside derivatives ameliorate SARS-CoV-2-mediated hyper-inflammatory responses.

Biomaterials 2021 06 14;273:120827. Epub 2021 Apr 14.

Aging Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, 34141, Republic of Korea. Electronic address:

The rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on a global scale urges prompt and effective countermeasures. Recently, a study has reported that coronavirus disease-19 (COVID-19), the disease caused by SARS-CoV-2 infection, is associated with a decrease in albumin level, an increase in NETosis, blood coagulation, and cytokine level. Here, we present drug-loaded albumin nanoparticles as a therapeutic agent to resolve the clinical outcomes observed in severe SARS-CoV-2 patients. PEGylated nanoparticle albumin-bound (PNAB) was used to promote prolonged bioactivity of steroidal ginsenoside saponins, PNAB-Rg6 and PNAB-Rgx365. Our data indicate that the application of PNAB-steroidal ginsenoside can effectively reduce histone H4 and NETosis-related factors in the plasma, and alleviate SREBP2-mediated systemic inflammation in the PBMCs of SARS-CoV-2 ICU patients. The engineered blood vessel model confirmed that these drugs are effective in suppressing blood clot formation and vascular inflammation. Moreover, the animal model experiment showed that these drugs are effective in promoting the survival rate by alleviating tissue damage and cytokine storm. Altogether, our findings suggest that these PNAB-steroidal ginsenoside drugs have potential applications in the treatment of symptoms associated with severe SARS-CoV-2 patients, such as coagulation and cytokine storm.
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http://dx.doi.org/10.1016/j.biomaterials.2021.120827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046382PMC
June 2021

Comparative Study of Inhaler Device Handling Technique and Risk Factors for Critical Inhaler Errors in Korean COPD Patients.

Int J Chron Obstruct Pulmon Dis 2021;16:1051-1059. Epub 2021 Apr 19.

Department of Internal Medicine, Division of Pulmonology and Allergy, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Republic of Korea.

Objective: Critical inhaler handling errors are associated with an increased risk of adverse outcomes in patients with chronic obstructive pulmonary disease (COPD). However, real-world data on inhaler device handling techniques and the risk factors for critical inhaler errors in the Asian population have been examined in only a few studies. We evaluated the rates and risk factors for critical inhaler errors in the COPD population in Korea.

Methods: COPD patients were prospectively enrolled from January 2018 to November 2019. An advanced practice nurse evaluated their inhaler technique. The 308 inhalers used by the 261 participants in this study included dry powder inhalers (DPIs; Turbuhaler, Breezhaler, Ellipta, Diskus, Genuair), a soft mist inhaler (SMI; Respimat), and pressurized metered dose inhalers (pMDIs).

Results: The percentage critical errors for Turbuhaler, Breezhaler, Ellipta, Diskus, Genuair, Respimat, and pMDI usage were 60.0%, 41.0%, 27.8%, 12.5%, 44.4%, 45.5%, and 55.0%, respectively. In the multivariate analyses, female sex, short COPD duration, dissatisfaction with the inhaler (assessed by FSI-10), and moderate acute exacerbations (AEs) in the prior year were independent risk factors for any critical error in the DPI group. In the SMI group, a low education level and frequent AEs in the prior year were independent risk factors for any critical error, whereas a high COPD assessment test (CAT) score was the only risk factor in the pMDI group.

Conclusion: Critical inhaler errors are common among patients with COPD, regardless of their preferred inhaler device. The rates and risk factors for critical inhaler errors differed among patients using different devices. Optimal device selection considering the risk factors of inhaler misusage will improve disease control in COPD patients.
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http://dx.doi.org/10.2147/COPD.S303761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064673PMC
July 2021

Lung-selective 25-hydroxycholesterol nanotherapeutics as a suppressor of COVID-19-associated cytokine storm.

Nano Today 2021 Jun 8;38:101149. Epub 2021 Apr 8.

Aging Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon 34141, Republic of Korea.

In response to the coronavirus disease-19 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), global efforts are focused on the development of new therapeutic interventions. For the treatment of COVID-19, selective lung-localizing strategies hold tremendous potential, as SARS-CoV-2 invades the lung via ACE2 receptors and causes severe pneumonia. Similarly, recent reports have shown the association of COVID-19 with decreased 25-hydroxycholesterol (25-HC) and increased cytokine levels. This mechanism, which involves the activation of inflammatory NF-κB- and SREBP2-mediated inflammasome signaling pathways, is believed to play a crucial role in COVID-19 pathogenesis, inducing acute respiratory distress syndrome (ARDS) and sepsis. To resolve those clinical conditions observed in severe SARS-CoV-2 patients, we report 25-HC and didodecyldimethylammonium bromide (DDAB) nanovesicles ([email protected]) as a COVID-19 drug candidate for the restoration of intracellular cholesterol level and suppression of cytokine storm. Our data demonstrate that [email protected] can selectively accumulate the lung tissues and effectively downregulate NF-κB and SREBP2 signaling pathways in COVID-19 patient-derived PBMCs, reducing inflammatory cytokine levels. Altogether, our findings suggest that [email protected] is a promising candidate for the treatment of symptoms associated with severe COVID-19 patients, such as decreased cholesterol level and cytokine storm.
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http://dx.doi.org/10.1016/j.nantod.2021.101149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026257PMC
June 2021

Delayed sarcoidosis onset mimicking mediastinal lymphoma recurrence after complete remission of diffuse large B cell lymphoma: A case report.

Thorac Cancer 2021 04 21;12(8):1231-1233. Epub 2021 Feb 21.

Department of Pathology, Yeungnam University College of Medicine, Daegu, South Korea.

Sarcoidosis-lymphoma syndrome describes a pathological state wherein both sarcoidosis and lymphoma are present. Sarcoidosis and lymphoma may occur concurrently, or sarcoidosis may precede lymphoma. There are few reports which have previously described the temporal progression from lymphoma to sarcoidosis. Here, we present a patient with stage II diffuse large B-cell lymphoma in the right breast. The patient achieved complete remission after chemotherapy. Five years after remission, the patient visited our clinic with newly developed enlarged mediastinal lymph nodes; lymphoma recurrence was suspected. However, mediastinal lymph node biopsy showed numerous noncaseating granulomas with no evidence of malignancy in the mediastinal lymph nodes. Consequently, a diagnosis of sarcoidosis was made. This case report highlights the need for pathological confirmation following biopsy when recurrence of lymphoma is suspected.
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http://dx.doi.org/10.1111/1759-7714.13885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046158PMC
April 2021

Delayed onset of mediastinitis with tracheomediastinal fistula following endobronchial ultrasound-guided transbronchial needle aspiration; A case report.

Thorac Cancer 2021 04 19;12(7):1134-1136. Epub 2021 Feb 19.

Department of Thoracic and Cardiovascular Surgery, College of Medicine, Yeungnam University and Yeungnam University Medical Center, Daegu, South Korea.

Infectious complications after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are rare but serious. Here, we report a very rare case of delayed onset of mediastinitis with tracheomediastinal fistula after EBUS-TBNA. Surgical debridement was performed, antibiotics were administered, and the postoperative course of the patient was good. Careful monitoring is needed to prevent the possible development of infectious complications after EBUS-TBNA.
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http://dx.doi.org/10.1111/1759-7714.13888DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017241PMC
April 2021

Quantitative Assessment of Chest CT Patterns in COVID-19 and Bacterial Pneumonia Patients: a Deep Learning Perspective.

J Korean Med Sci 2021 Feb 1;36(5):e46. Epub 2021 Feb 1.

Division of Pulmonology and Allergy, Department of Internal Medicine, Regional Center for Respiratory Diseases, Yeungnam University Medical Center, College of Medicine, Yeungnam University, Daegu, Korea.

Background: It is difficult to distinguish subtle differences shown in computed tomography (CT) images of coronavirus disease 2019 (COVID-19) and bacterial pneumonia patients, which often leads to an inaccurate diagnosis. It is desirable to design and evaluate interpretable feature extraction techniques to describe the patient's condition.

Methods: This is a retrospective cohort study of 170 confirmed patients with COVID-19 or bacterial pneumonia acquired at Yeungnam University Hospital in Daegu, Korea. The Lung and lesion regions were segmented to crop the lesion into 2D patches to train a classifier model that could differentiate between COVID-19 and bacterial pneumonia. The K-means algorithm was used to cluster deep features extracted by the trained model into 20 groups. Each lesion patch cluster was described by a characteristic imaging term for comparison. For each CT image containing multiple lesions, a histogram of lesion types was constructed using the cluster information. Finally, a Support Vector Machine classifier was trained with the histogram and radiomics features to distinguish diseases and severity.

Results: The 20 clusters constructed from 170 patients were reviewed based on common radiographic appearance types. Two clusters showed typical findings of COVID-19, with two other clusters showing typical findings related to bacterial pneumonia. Notably, there is one cluster that showed bilateral diffuse ground-glass opacities (GGOs) in the central and peripheral lungs and was considered to be a key factor for severity classification. The proposed method achieved an accuracy of 91.2% for classifying COVID-19 and bacterial pneumonia patients with 95% reported for severity classification. The CT quantitative parameters represented by the values of cluster 8 were correlated with existing laboratory data and clinical parameters.

Conclusion: Deep chest CT analysis with constructed lesion clusters revealed well-known COVID-19 CT manifestations comparable to manual CT analysis. The constructed histogram features improved accuracy for both diseases and severity classification, and showed correlations with laboratory data and clinical parameters. The constructed histogram features can provide guidance for improved analysis and treatment of COVID-19.
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http://dx.doi.org/10.3346/jkms.2021.36.e46DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850864PMC
February 2021

A rare case of primary solitary endobronchial plasmacytoma.

Thorac Cancer 2021 03 27;12(6):958-961. Epub 2021 Jan 27.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea.

Extramedullary plasmacytoma (EMP) is a rare plasma cell tumor involving the organs but without bone marrow involvement or the characteristics of multiple myeloma. Primary solitary endobronchial plasmacytoma is extremely rare. Here we present the case of an 86-year-old male ex-smoker who visited our outpatient clinic for an endobronchial mass in the left upper lobe of the lung. Fiberoptic bronchoscopy revealed a protruding mass in the left upper lobar bronchus; based on the bronchoscopic biopsy findings, a primary solitary endobronchial plasmacytoma was diagnosed. After radiation therapy the patient was well and 6 months after treatment showed no evidence of disease recurrence. Extramedullary plasmacytoma should be considered in the differential diagnosis of an endobronchial mass.
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http://dx.doi.org/10.1111/1759-7714.13853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7952851PMC
March 2021

GSK-LSD1, an LSD1 inhibitor, quashes SARS-CoV-2-triggered cytokine release syndrome in-vitro.

Signal Transduct Target Ther 2020 11 17;5(1):267. Epub 2020 Nov 17.

Aging Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, 34141, Republic of Korea.

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http://dx.doi.org/10.1038/s41392-020-00391-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670835PMC
November 2020

The effects of repeated inhaler device handling education in COPD patients: a prospective cohort study.

Sci Rep 2020 11 12;10(1):19676. Epub 2020 Nov 12.

Division of Pulmonology and Allergy, Department of Internal Medicine, Yeungnam University Medical Center, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Namgu, 42415, Daegu, Republic of Korea.

Inhaler education for chronic obstructive pulmonary disease (COPD) patients improves inhaler technique and adherence. However, the effects of such education on the quality of life and inhaler satisfaction remain unclear. Here, we evaluated inhaler handling and adherence, and changes in quality of life and inhaler satisfaction, after repeated education for COPD patients. We prospectively enrolled COPD patients who had used inhalers for over 1 month and evaluated the effects of repeated education. Three visits were made over 6 months; an advanced practice nurse evaluated inhaler technique and adherence, and instructed the patients in inhaler technique during face-to-face sessions. Inhaler technique and adherence were assessed at every visits, and the modified Medical Research Council (mMRC) test, COPD Assessment Test (CAT), EuroQol-5D (EQ-5D), Patient Health Questionnaire (PHQ-9), and Feeling of Satisfaction with Inhaler questionnaire (FSI-10) were administered before (visit 1) and after two educational sessions (visit 3). A total of 261 COPD patients (308 inhalers) were included. Education significantly reduced the proportion of critical errors after two educational sessions (visit 3), from 43.2 to 8.8% (p < 0.001). The proportion of highly compliant patients increased after two visits, from 81.6% to 87.7% (p = 0.005). The FSI-10 score improved significantly after education, from 44.36 ± 4.69 to 47.64 ± 4.08 (p < 0.001); the scores on the other instruments (mMRC, CAT, EQ-5D, and PHQ-9) did not improve. Repeated face-to-face inhaler education by an advanced practice nurse significantly improved inhaler satisfaction, technique, and adherence. However, inhaler education did not significantly improve quality of life.
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http://dx.doi.org/10.1038/s41598-020-76961-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665176PMC
November 2020

Bioinspired DNase-I-Coated Melanin-Like Nanospheres for Modulation of Infection-Associated NETosis Dysregulation.

Adv Sci (Weinh) 2020 Oct 20:2001940. Epub 2020 Oct 20.

Department of Biomedical Engineering SKKU Institute for Convergence Sungkyunkwan University (SKKU) Suwon Republic of Korea.

The current outbreak of the beta-coronavirus (beta-Cov) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in December 2019. No specific antiviral treatments or vaccines are currently available. A recent study has reported that coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2 infection, is associated with neutrophil-specific plasma membrane rupture, and release excessive neutrophil extracellular traps (NETs) and extracellular DNAs (eDNAs). This mechanism involves the activation of NETosis, a neutrophil-specific programmed cell death, which is believed to play a crucial role in COVID-19 pathogenesis. Further progression of the disease can cause uncontrolled inflammation, leading to the initiation of cytokine storms, acute respiratory distress syndrome (ARDS), and sepsis. Herein, it is reported that DNase-I-coated melanin-like nanospheres (DNase-I pMNSs) mitigate sepsis-associated NETosis dysregulation, thereby preventing further progression of the disease. Recombinant DNase-I and poly(ethylene glycol) (PEG) are used as coatings to promote the lengthy circulation and dissolution of NET structure. The data indicate that the application of bioinspired DNase-I pMNSs reduce neutrophil counts and NETosis-related factors in the plasma of SARS-CoV-2 sepsis patients, alleviates systemic inflammation, and attenuates mortality in a septic mouse model. Altogether, the findings suggest that these nanoparticles have potential applications in the treatment of SARS-CoV-2-related illnesses and other beta-CoV-related diseases.
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http://dx.doi.org/10.1002/advs.202001940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7645930PMC
October 2020

Long-acting nanoparticulate DNase-1 for effective suppression of SARS-CoV-2-mediated neutrophil activities and cytokine storm.

Biomaterials 2021 01 23;267:120389. Epub 2020 Oct 23.

Department of Biomedical Engineering, SKKU Institute for Convergence, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea; Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University, Suwon, 16419, Republic of Korea; Department of Intelligent Precision Healthcare Convergence, SKKU Institute for Convergence, Sungkyunkwan University (SKKU), Suwon 16419, Republic of Korea; Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon 16419, Republic of Korea. Electronic address:

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus not previously identified in humans. Globally, the number of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) have risen dramatically. Currently, there are no FDA-approved antiviral drugs and there is an urgency to develop treatment strategies that can effectively suppress SARS-CoV-2-mediated cytokine storms, acute respiratory distress syndrome (ARDS), and sepsis. As symptoms progress in patients with SARS-CoV-2 sepsis, elevated amounts of cell-free DNA (cfDNA) are produced, which in turn induce multiple organ failure in these patients. Furthermore, plasma levels of DNase-1 are markedly reduced in SARS-CoV-2 sepsis patients. In this study, we generated recombinant DNase-1-coated polydopamine-poly(ethylene glycol) nanoparticulates (named long-acting DNase-1), and hypothesized that exogenous administration of long-acting DNase-1 may suppress SARS-CoV-2-mediated neutrophil activities and the cytokine storm. Our findings suggest that exogenously administered long-acting nanoparticulate DNase-1 can effectively reduce cfDNA levels and neutrophil activities and may be used as a potential therapeutic intervention for life-threatening SARS-CoV-2-mediated illnesses.
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http://dx.doi.org/10.1016/j.biomaterials.2020.120389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583619PMC
January 2021

Metastatic large cell carcinoma of the lung: A rare cause of acute small bowel obstruction.

Thorac Cancer 2020 11 11;11(11):3379-3382. Epub 2020 Sep 11.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea.

Here, we report a case of acute intestinal obstruction as the initial presentation of primary lung cancer in a male patient. Abdominal computed tomography (CT) showed multiple polypoid masses and regional lymphadenopathy with small bowel obstruction. The patient underwent emergency surgery for multiple luminal malignancy with mesenteric masses. According to the various clinicopathological features, the tumor was confirmed to be metastatic large cell carcinoma originating from the lung. Large masses in the left lower lobe of the lung were identified on the chest CT after emergency surgery, and non-small cell lung cancer (NSCLC), not otherwise specified (NOS), was finally diagnosed on biopsy through bronchoscopy.
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http://dx.doi.org/10.1111/1759-7714.13656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606013PMC
November 2020

An update on the role of bronchoscopy in the diagnosis of pulmonary disease.

Authors:
June Hong Ahn

Yeungnam Univ J Med 2020 Oct 28;37(4):253-261. Epub 2020 Aug 28.

Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.

Bronchoscopy has evolved over the past few decades and has been used by respiratory physicians to diagnose various airway and lung diseases. With the popularization of medical check-ups and growing interest in health, early diagnosis of lung diseases is essential. With the development of endobronchial ultrasound, ultrathin bronchoscopy, and electromagnetic navigational bronchoscopy, bronchoscopy has been able to widen its scope in diagnosing pulmonary diseases. In this review, we have described the brief history, role, and complications of bronchoscopy used in diagnosing pulmonary lesions, from simple flexible bronchoscopy to bronchoscopy combined with several up-to-date technologies.
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http://dx.doi.org/10.12701/yujm.2020.00584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606953PMC
October 2020

COVID-19-activated SREBP2 disturbs cholesterol biosynthesis and leads to cytokine storm.

Signal Transduct Target Ther 2020 09 3;5(1):186. Epub 2020 Sep 3.

Aging Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, 34141, Republic of Korea.

Sterol regulatory element binding protein-2 (SREBP-2) is activated by cytokines or pathogen, such as virus or bacteria, but its association with diminished cholesterol levels in COVID-19 patients is unknown. Here, we evaluated SREBP-2 activation in peripheral blood mononuclear cells of COVID-19 patients and verified the function of SREBP-2 in COVID-19. Intriguingly, we report the first observation of SREBP-2 C-terminal fragment in COVID-19 patients' blood and propose SREBP-2 C-terminal fragment as an indicator for determining severity. We confirmed that SREBP-2-induced cholesterol biosynthesis was suppressed by Sestrin-1 and PCSK9 expression, while the SREBP-2-induced inflammatory responses was upregulated in COVID-19 ICU patients. Using an infectious disease mouse model, inhibitors of SREBP-2 and NF-κB suppressed cytokine storms caused by viral infection and prevented pulmonary damages. These results collectively suggest that SREBP-2 can serve as an indicator for severity diagnosis and therapeutic target for preventing cytokine storm and lung damage in severe COVID-19 patients.
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http://dx.doi.org/10.1038/s41392-020-00292-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471497PMC
September 2020

Response: The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study ( 2020;44:405-13).

Diabetes Metab J 2020 08;44(4):625-626

Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.

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http://dx.doi.org/10.4093/dmj.2020.0167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453983PMC
August 2020

The Clinical Characteristics and Outcomes of Patients with Moderate-to-Severe Coronavirus Disease 2019 Infection and Diabetes in Daegu, South Korea.

Diabetes Metab J 2020 08 12;44(4):602-613. Epub 2020 Aug 12.

Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic that had affected more than eight million people worldwide by June 2020. Given the importance of the presence of diabetes mellitus (DM) for host immunity, we retrospectively evaluated the clinical characteristics and outcomes of moderate-to-severe COVID-19 in patients with diabetes.

Methods: We conducted a multi-center observational study of 1,082 adult inpatients (aged ≥18 years) who were admitted to one of five university hospitals in Daegu because of the severity of their COVID-19-related disease. The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM. In addition, 1:1 propensity score (PS)-matching was conducted with the DM group.

Results: Compared with the non-DM group (=847), patients with DM (=235) were older, exhibited higher mortality, and required more intensive care. Even after PS-matching, patients with DM exhibited more severe disease, and DM remained a prognostic factor for higher mortality (hazard ratio, 2.40; 95% confidence interval, 1.38 to 4.15). Subgroup analysis revealed that the presence of DM was associated with higher mortality, especially in older people (≥70 years old). Prior use of a dipeptidyl peptidase-4 inhibitor or a renin-angiotensin system inhibitor did not affect mortality or the clinical severity of the disease.

Conclusion: DM is a significant risk factor for COVID-19 severity and mortality. Our findings imply that COVID-19 patients with DM, especially if elderly, require special attention and prompt intensive care.
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http://dx.doi.org/10.4093/dmj.2020.0146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453989PMC
August 2020

Early Hydroxychloroquine Administration for Rapid Severe Acute Respiratory Syndrome Coronavirus 2 Eradication.

Infect Chemother 2020 Sep 16;52(3):396-402. Epub 2020 Jul 16.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea.

There are no proven therapeutics for Coronavirus disease 2019 (COVID-19) pneumonia outbreak. We observed and analyzed the clinical efficacy of the most used hydroxychloroquine (HCQ) for 30 days. In this study, administration of HCQ <5 days from diagnosis (odds ratio: 0.111, 95% confidence interval: 0.034 - 0.367, = 0.001) was the only protective factor for prolonging of viral shedding in COVID-19 patients. Early administration of HCQ significantly ameliorates inflammatory cytokine secretion by eradicating COVID-19, at discharge. Our findings suggest that patients confirmed of COVID-19 infection should be administrated HCQ as soon as possible.
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http://dx.doi.org/10.3947/ic.2020.52.3.396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533217PMC
September 2020

The Author's Response: Prognostic Accuracy of the SIRS, qSOFA, and NEWS for Early Detection of Clinical Deterioration in SARS-CoV-2 Infected Patients.

J Korean Med Sci 2020 08 3;35(30):e275. Epub 2020 Aug 3.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea.

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http://dx.doi.org/10.3346/jkms.2020.35.e275DOI Listing
August 2020

Successful osimertinib retreatment after extremely early onset severe pneumonitis in first-line treatment of lung adenocarcinoma.

Authors:
June Hong Ahn

Thorac Cancer 2020 09 15;11(9):2713-2716. Epub 2020 Jul 15.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea.

Drug-induced pneumonitis is rare, and can result in death. Here, we present a report of a patient with adenocarcinoma harboring EGFR exon 19 deletion mutation treated with osimertinib as first-line treatment. After six days of treatment, extremely early onset severe pneumonitis was diagnosed. Discontinuation of osimertinib as well as administration of corticosteroid, and retreatment with osimertinib were successful. This case report highlights that extremely early onset severe pneumonitis can occur after osimertinib administration, and retreatment of osimertinib may be a useful treatment option after resolution of pneumonitis.
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http://dx.doi.org/10.1111/1759-7714.13565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471046PMC
September 2020

The Risk of Diabetes on Clinical Outcomes in Patients with Coronavirus Disease 2019: A Retrospective Cohort Study.

Diabetes Metab J 2020 06 21;44(3):405-413. Epub 2020 May 21.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea.

Background: To determine the role of diabetes mellitus (DM) in the coronavirus disease 2019 (COVID-19), we explored the clinical characteristics of patients with DM and compared risk factors such as age, glycemic control, and medications to those without DM.

Methods: This was a retrospective cohort study of 117 confirmed patients with COVID-19 which conducted at a tertiary hospital in Daegu, South Korea. The primary outcome was defined as the severe and critical outcome (SCO), of which the composite outcomes of acute respiratory distress syndrome, septic shock, intensive care unit care, and 28-day mortality. We analyzed what clinical features and glycemic control-related factors affect the prognosis of COVID-19 in the DM group.

Results: After exclusion, 110 participants were finally included. DM patients (=29) was older, and showed higher blood pressure compared to non-DM patients. DM group showed higher levels of inflammation-related biomarkers and severity score, and highly progressed to SCO. After adjustment with other risk factors, DM increased the risk of SCO (odds ratio [OR], 10.771; <0.001). Among the DM patients, SCO was more prevalent in elderly patients of ≥70 years old and age was an independent risk factor for SCO in patients with DM (OR, 1.175; =0.014), while glycemic control was not. The use of medication did not affect the SCO, but the renin-angiotensin system inhibitors showed protective effects against acute cardiac injury (OR, 0.048; =0.045).

Conclusion: The COVID-19 patients with DM had higher severity and resulted in SCO. Intensive and aggressive monitoring of COVID-19 clinical outcomes in DM group, especially in elderly patients is warranted.
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http://dx.doi.org/10.4093/dmj.2020.0105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332325PMC
June 2020

Prognostic Accuracy of the SIRS, qSOFA, and NEWS for Early Detection of Clinical Deterioration in SARS-CoV-2 Infected Patients.

J Korean Med Sci 2020 Jun 29;35(25):e234. Epub 2020 Jun 29.

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea.

Background: The case fatality rate of coronavirus disease 2019 (COVID-19) is estimated to be between 4.3% and 11.0%. Currently there is no effective antiviral treatment for COVID-19. Thus, early recognition of patients at high risk is important.

Methods: We performed a retrospective observational study of 110 patients with severe acute respiratory syndrome coronavirus 2 infection. We compared the effectiveness of three scoring systems: the Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) systems, for predicting the prognosis of COVID-19. The area under the receiver operating characteristic curve (AUROC) was used for these assessments, and Kaplan-Meier survival curves were used to identify the cumulative risk for 28-day mortality according to the NEWS stratification.

Results: For predicting 28-day mortality, NEWS was superior to qSOFA (AUROC, 0.867 vs. 0.779, P < 0.001), while there was no significant difference between NEWS and SIRS (AUROC, 0.867 vs. 0.639, = 0.100). For predicting critical outcomes, NEWS was superior to both SIRS (AUROC, 0.918 vs. 0.744, = 0.032) and qSOFA (AUROC, 0.918 vs. 0.760, = 0.012). Survival time was significantly shorter for patients with NEWS ≥ 7 than for patients with NEWS < 7.

Conclusion: Calculation of the NEWS at the time of hospital admission can predict critical outcomes in patients with COVID-19. Early intervention for high-risk patients can thereby improve clinical outcomes in COVID-19 patients.
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http://dx.doi.org/10.3346/jkms.2020.35.e234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324266PMC
June 2020

Prognostic Factors for Severe Coronavirus Disease 2019 in Daegu, Korea.

J Korean Med Sci 2020 Jun 15;35(23):e209. Epub 2020 Jun 15.

Division of Pulmonology and Allergy, Department of Internal Medicine, Regional Center for Respiratory Diseases, Yeungnam University Medical Center, College of Medicine, Yeungnam University, Daegu, Korea.

Background: Since its first detection in December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 infection has spread rapidly around the world. Although there have been several studies investigating prognostic factors for severe COVID-19, there have been no such studies in Korea.

Methods: We performed a retrospective observational study of 110 patients with confirmed COVID-19 hospitalized at a tertiary hospital in Daegu, Korea. Demographic, clinical, laboratory, and outcome data were collected and analyzed. Severe disease was defined as a composite outcome of acute respiratory distress syndrome, intensive care unit care, or death.

Results: Diabetes mellitus (odds ratio [OR], 19.15; 95% confidence interval [CI], 1.90-193.42; = 0.012), body temperature ≥ 37.8°C (OR, 10.91; 95% CI, 1.35-88.36; = 0.025), peripheral oxygen saturation < 92% (OR, 33.31; 95% CI, 2.45-452.22; = 0.008), and creatine kinase-MB (CK-MB) > 6.3 (OR, 56.84; 95% CI, 2.64-1,223.78, = 0.010) at admission were associated with higher risk of severe COVID-19. The likelihood of development of severe COVID-19 increased with an increasing number of prognostic factors.

Conclusion: In conclusion, we found that diabetes mellitus, body temperature ≥ 37.8°C, peripheral oxygen saturation < 92%, and CK-MB > 6.3 are independent predictors of severe disease in hospitalized COVID-19 patients. Appropriate assessment of prognostic factors and close monitoring to provide the necessary interventions at the appropriate time in high-risk patients may reduce the case fatality rate of COVID-19.
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http://dx.doi.org/10.3346/jkms.2020.35.e209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7295599PMC
June 2020

Sarcopenia Is an Independent Risk Factor for NAFLD in COPD: A Nationwide Survey (KNHANES 2008-2011).

Int J Chron Obstruct Pulmon Dis 2020 7;15:1005-1014. Epub 2020 May 7.

Division of Pulmonary and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea.

Background: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with chronic obstructive pulmonary disease (COPD) and is independently associated with cardiometabolic comorbidities and systemic inflammation. Although several factors are associated with NAFLD, the influence of sarcopenia on NAFLD has not been fully determined in patients with COPD. We explored whether sarcopenia is associated with NAFLD in a COPD population.

Methods: Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 were analyzed. The subjects were defined as having NAFLD when they had a hepatic steatosis index (HSI) score >36, which is a previously validated NAFLD prediction score. Sarcopenia_BMI (=total appendicular skeletal muscle mass [kg]/body mass index [kg/m]), sarcopenia_BW (=total appendicular skeletal muscle mass [kg]/body weight [kg] × 100), and sarcopenia_height (= total appendicular skeletal muscle mass (kg)/height (m)) measured using dual-energy X-ray absorptiometry was used to diagnose sarcopenia.

Results: NAFLD was identified in 124 (14.6%) of 850 COPD subjects using the HSI. Multivariable logistic analyses adjusted for age, sex, hypertension, diabetes mellitus (DM), forced vital capacity (FVC), and metabolic syndrome demonstrated that sarcopenia (sarcopenia_BMI, odds ratio [OR] = 1.95; 95% confidence interval [CI], 1.11-3.46, p = 0.022; sarcopenia_BW, OR = 2.25; 95% CI, 1.30-3.92, p = 0.004) was associated with NAFLD in patients with COPD. The proportion of sarcopenia_BMI was higher in patients with a high fibrotic burden from NAFLD (Q3, Q4) than in subjects with a low fibrotic burden from NALFD (Q1, Q2) (54.8% vs 24.2%, p = 0.024). The proportion of sarcopenia_BW was also higher in patients with a high fibrotic burden from NAFLD than in patients with a low fibrotic burden from NAFLD (51.6% vs 30.6%, p = 0.029).

Conclusion: Sarcopenia was associated with an increased risk for NAFLD in patients with COPD, independent of age, sex, lung function, and metabolic factors. Sarcopenic COPD was also associated with a high fibrotic burden in NAFLD patients. Pulmonologists should be aware of possible liver comorbidities in the sarcopenic COPD phenotype.
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http://dx.doi.org/10.2147/COPD.S249534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213902PMC
June 2021

Clinical Features and Outcomes of 98 Patients Hospitalized with SARS-CoV-2 Infection in Daegu, South Korea: A Brief Descriptive Study.

Yonsei Med J 2020 May;61(5):431-437

Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea.

Although some information on the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a few selected cases has been reported, data on the clinical characteristics and outcomes of patients hospitalized therewith in South Korea are lacking. We conducted a retrospective single-center study of 98 consecutive hospitalized patients with confirmed SARS-CoV-2 infection at Yeungnam University Medical Center in Daegu, South Korea. Sixty patients were women (61.2%), and the mean age was 55.4±17.1 years. Thirteen patients (13.3%) were treated in the intensive care unit (ICU). The mean interval from symptom onset to hospitalization was 7.7±4.5 days. Patients who received ICU care were significantly older and were more likely to have diabetes mellitus. The National Early Warning Score on the day of admission was significantly higher in patients requiring ICU care. Acute respiratory distress syndrome (13/13 patients; 100%), septic shock (9/13; 69.2%), acute cardiac injury (9/13; 69.2%), and acute kidney injury (8/13; 61.5%) were more common in patients who received ICU care. All patients received antibiotic therapy, and most (97/98 patients; 99.0%) received antiviral therapy (lopinavir/ritonavir). Hydroxychloroquine was used in 79 patients (80.6%), and glucocorticoid therapy was used in 18 patients (18.4%). In complete blood counts, lymphopenia was the most common finding (40/98 patients; 40.8%). Levels of all proinflammatory cytokines were significantly higher in ICU patients. As of March 29, 2020, the mortality rate was 5.1%. Here, we report the clinical characteristics and laboratory findings of SARS-CoV-2 patients in South Korea up to March 29, 2020.
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http://dx.doi.org/10.3349/ymj.2020.61.5.431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214108PMC
May 2020
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