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Ko Y, Tobino K, Hiramatsu Y, Sueyasu T, Nishizawa S, Yoshimatsu Y. Nodular pulmonary amyloidosis diagnosed by ultrasound-guided percutaneous needle biopsy. Respir Med Case Rep 2024; 50:102025. [PMID: 38745726 PMCID: PMC11091706 DOI: 10.1016/j.rmcr.2024.102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/05/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Pulmonary amyloidosis is characterized by extracellular deposition of fibrous protein called amyloid in the lungs and has three subtypes: nodular, diffuse, and tracheobronchial amyloidosis. Pulmonary nodular amyloidosis can mimic other lung diseases including infectious diseases, metastatic lung tumors, sarcoidosis, and pulmonary hyalinizing granuloma. A biopsy of the lesion is essential for a definitive diagnosis. Herein, we report the case of a 66-year-old man who presented for shortness of breath on exertion and was diagnosed with nodular pulmonary amyloidosis on ultrasound-guided percutaneous needle biopsy. A chest X-ray and computed tomography (CT) revealed bilateral slowly growing multiple calcified pulmonary nodules and cavities. Malignancy was suspected based on 18F-fluoro-deoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) images. An ultrasound-guided percutaneous needle biopsy was performed, and histopathologic examination of the lesion confirmed nodular pulmonary amyloidosis. This case highlights the importance of considering nodular pulmonary amyloidosis in the differential diagnosis of pulmonary nodules with increased uptake of 18F-FDG on PET/CT and the utility of ultrasound-guided needle biopsy in the definitive diagnosis.
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Affiliation(s)
- Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
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Abe S, Yasuda M, Tobino K, Harada S, Sasano H, Tanabe Y, Sandhu Y, Takeshige T, Matsuno K, Asao T, Sueyasu T, Nishizawa S, Yoshimine K, Ko Y, Yoshimatsu Y, Tsuruno K, Ide H, Takagi H, Ito J, Nagaoka T, Harada N, Takahashi K. Usefulness of Computed Tomography for Evaluating the Effects of Bronchial Thermoplasty in Japanese Patients with Severe Asthma. J Asthma Allergy 2024; 17:325-337. [PMID: 38601883 PMCID: PMC11005926 DOI: 10.2147/jaa.s452865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
Background Bronchial thermoplasty (BT) improves clinical outcomes and quality of life for patients with severe asthma and has shown sustained reductions in airway narrowing and air trapping in previous CT studies. However, there is a lack of a comprehensive analysis, including CT evaluation, of clinical outcomes in Japanese patients who have undergone BT for severe asthma. This study aimed to evaluate the impact of BT in Japanese asthma patients, with a focus on the CT metric "WA at Pi10" to assess airway disease. Methods Twelve patients with severe persistent asthma who underwent BT were assessed using ACQ6, AQLQ, pulmonary function tests, FeNO measurement, blood sampling, and chest CT before BT and one year after the third procedure for the upper lobes. Results The median age of the patient was 62.0 years, 7/12 (58.3%) were male, 4/12 (33.3%) used regular oral corticosteroids, and 8/12 (66.7%) received biologics. Median FEV1% was 73.6%, and median peripheral eosinophil count was 163.8/μL. After one year of BT, ACQ6 scores improved from 2.4 to 0.8 points (p = 0.007), and AQLQ scores improved from 4.3 to 5.8 points (p < 0.001). Significant improvements were also observed in asthma exacerbations, unscheduled visits due to exacerbations, FeNO, and √WA at Pi10 (p < 0.05). The baseline mucus score on the CT findings was negatively correlated with FEV1 (r = -0.688, p = 0.013) and with the maximum mid-expiratory flow rate (r = -0.631, p = 0.028), and positively correlated with the peripheral blood eosinophil count (r = -0.719, p = 0.008). Changes in √WA at Pi10 after one year were positively correlated with changes in the mucus score (r = 0.742, p = 0.007). Conclusion This study has limitations, including its single-arm observational design and the small sample size. However, BT led to a symptomatic improvement in patients with severe asthma. The validated "√WA at Pi10" metric on CT effectively evaluated the therapeutic response in Japanese asthma patients after BT.
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Affiliation(s)
- Sumiko Abe
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Mina Yasuda
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Sonoko Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
- Atopy (Allergy) Research Center, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Hitoshi Sasano
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Yuki Tanabe
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Yuuki Sandhu
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Haruhi Takagi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Jun Ito
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Tetsutaro Nagaoka
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
- Atopy (Allergy) Research Center, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
- Research Institute for Diseases of Old Age, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
- Research Institute for Diseases of Old Age, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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Hiramatsu Y, Tobino K, Saito Y, Sogabe S, Murakami Y. Immunoglobulin A Vasculitis After Initiation of Treatment for Tuberculous Pleurisy: A Case Report and Literature Review. Cureus 2024; 16:e58707. [PMID: 38779276 PMCID: PMC11109605 DOI: 10.7759/cureus.58707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/25/2024] Open
Abstract
Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein purpura (HSP), is a disease that causes inflammation and bleeding in small blood vessels in the skin, joints, intestines, and kidneys. Although various infections and chemicals are known to be triggers, the underlying cause of IgAV remains unknown. Here, we describe a case of an 86-year-old male patient with IgAV that developed after anti-tuberculosis treatment for tuberculous pleurisy. There have been several case reports implicating Mycobacterium tuberculosis and other acid-fast bacterium in the development of IgAV, but only a few case reports implicating anti-tuberculous drugs. This case highlights the importance of recognizing that IgAV can be caused by anti-tuberculous drugs.
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Affiliation(s)
| | | | - Yukari Saito
- Respiratory Medicine, Iizuka Hospital, Fukuoka, JPN
| | - Shota Sogabe
- Respiratory Medicine, Iizuka Hospital, Fukuoka, JPN
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Ota H, Munechika M, Tobino K, Uchida K, Muarakami Y. A Case Report of Hemophagocytic Lymphohistiocytosis and Meningitis Due to Atezolizumab Treatment for Lung Adenocarcinoma. Cureus 2024; 16:e58253. [PMID: 38745801 PMCID: PMC11091938 DOI: 10.7759/cureus.58253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) are used to treat a variety of tumors. Despite their broad beneficial effects, these inhibitors can cause immune-related adverse events (irAEs) and even death. Hemophagocytic lymphohistiocytosis (HLH) and meningitis, although infrequent, can be aggressive and life-threatening due to excessive immune activation. Herein, we report a case of an 80-year-old man who developed HLH after receiving atezolizumab monotherapy as a second-line treatment for lung adenocarcinoma. He was treated for HLH with oral prednisolone (PSL), but further ataxia and dysuria developed, and a lumbar puncture diagnosed meningitis. Both HLH and meningitis improved with continued oral PSL treatment. This is the first case of atezolizumab-induced HLH with meningitis and highlights the importance of early diagnosis and treatment for rare irAE.
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Affiliation(s)
- Hiroaki Ota
- Respiratory Medicine, Iizuka Hospital, Iizuka, JPN
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Jones P, Soutome T, Matsuki T, Shinoda M, Hataji O, Miura M, Kinoshita M, Mizoo A, Tobino K, Nishi T, Ishii T, Shibata Y. Health Status Progression Measured Using Weekly Telemonitoring of COPD Assessment Test Scores Over 1 Year and Its Association With COPD Exacerbations. Chronic Obstr Pulm Dis 2024; 11:144-154. [PMID: 38442134 DOI: 10.15326/jcopdf.2023.0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Background A previous longitudinal study of chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) score changes suggested patients fall into 3 patterns: stable, improving, and worsening. This study assessed the evolution of CAT scores over time and its relationship to exacerbations. Methods In total, 84 participants used a telemedicine platform to complete CAT weekly for 52 weeks. Completion rates, annualized change in CAT scores, and learning effects were measured, as well as CAT changes of >4 units during look-back periods of 4 and 8 weeks. In a subgroup of participants with at least a 25% completion rate (adherent group, n=68 [81%]), the relationship between change in CAT score and exacerbations at any time during the study was examined post hoc. Results Linear regression showed that 50%, 22%, and 28% of the adherent subgroup had CAT scores indicating worsening, stable, and improving health status, respectively. In the adherent subgroup, 70% (n=7/10) of participants who had an exacerbation during the study had worsening CAT scores, versus 47% (n=27/58) without an exacerbation. The hazard ratio association between CAT score increase and moderate exacerbation was 1.13 (95% confidence interval: 1.03-1.24). Most participants experienced at least one CAT score change of >4 units, and 7% showed an initial learning effect with a median of 2 weeks. Conclusion Measuring trends in CAT scores may allow future studies to group patients into 3 defined categories of change over time and quantify CAT change trajectories to assess treatment response and potentially predict medium-term outcomes within individual patients.
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Affiliation(s)
- Paul Jones
- GSK, Brentford, Middlesex, United Kingdom
| | - Toru Soutome
- Japan Medical and Development, GSK K.K, Tokyo, Japan
| | - Taizo Matsuki
- Japan Medical and Development, GSK K.K, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Motohiko Miura
- Department of Respiratory Medicine, Tohoku Rosai Hospital, Miyagi, Japan
| | | | - Akira Mizoo
- Department of Pulmonary Medicine, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | | | - Takeo Ishii
- Japan Medical and Development, GSK K.K, Tokyo, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
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Yasuda M, Tobino K, Harada N, Ooi R, Sueyasu T, Nishizawa S, Munechika M, Yoshimine K, Ko Y, Yoshimatsu Y, Tsuruno K, Ide H, Takahashi K. The prevalence of obstructive sleep apnea in Japanese asthma patients. Allergy Asthma Clin Immunol 2024; 20:10. [PMID: 38310323 PMCID: PMC10837859 DOI: 10.1186/s13223-024-00875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/16/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population because these conditions share some comorbidities. In Japan, the prevalence of OSA in the general population is reported to be approximately 20%; however, few reports have described the prevalence of OSA in asthma patients. Furthermore, the characteristics of Japanese patients with OSA and asthma are not clear. METHODS Adult asthma patients were recruited from the outpatient departments of our institution between August 31, 2017, and March 31, 2019. In all included patients, the presence and severity of OSA were evaluated by the Epworth Sleepiness Scale (ESS) and a home sleep test (HST) using portable polysomnography (PSG). The rate of coexisting OSA in asthma patients and the characteristics of those patients according to the severity of OSA were investigated. RESULTS Fifty-three patients were included. OSA was detected in 36 (67.9%) patients (mild, n = 15; moderate, n = 14; and severe, n = 7). Patients with OSA had significantly higher body mass index, Brinkman index, apnea-hypopnea index (AHI), and 3% oxygen desaturation index (ODI) values in comparison to those without OSA, while the percentage of the predicted value of forced vital capacity (%FVC) and lowest SpO2 levels were significantly lower. As the severity of OSA increased, age, brain natriuretic peptide level, AHI, and 3%ODI increased, and in contrast, FVC, %FVC, forced expiratory volume in one second (FEV1), percentage of the predicted value of FEV1 (%FEV1), Epworth Sleepiness Scale (ESS), 3%ODI, and lowest SpO2 levels decreased. In particular, the fact that the ESS value was inversely correlated with the severity of OSA in our patients was different from the general characteristics of OSA. Moreover, the AHI value was negatively correlated with FVC, %FVC, FEV1, and %FEV1. BMI was the only independent factor for the presence of OSA, and for asthma severity (FEV1, % of predicted), there was a weak correlation with smoking history. CONCLUSIONS This is the first report to investigate the prevalence of OSA in Japanese asthma patients, using an HST. This study suggests that an HST should be performed in addition to the sleep interview for asthma patients with refractory disease, a low pulmonary function, advanced age, and high BMI because the more severe the OSA, the lower the ESS value may be.
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Affiliation(s)
- Mina Yasuda
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan.
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Ryunosuke Ooi
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Miyuki Munechika
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshio Iizuka, Fukuoka, 820-8505, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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Nagata K, Yokoyama T, Tsugitomi R, Nakashima H, Kuraishi H, Ohshimo S, Mori Y, Sakuraya M, Kagami R, Tanigawa M, Tobino K, Kamo T, Kadowaki T, Koga Y, Ogata Y, Nishimura N, Kondoh Y, Taniuchi S, Shintani A, Tomii K. Continuous positive airway pressure versus high-flow nasal cannula oxygen therapy for acute hypoxemic respiratory failure: A randomized controlled trial. Respirology 2024; 29:36-45. [PMID: 37648252 DOI: 10.1111/resp.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND AND OBJECTIVE The relative effectiveness of initial non-invasive respiratory strategies for acute respiratory failure using continuous positive airway pressure (CPAP) or high-flow nasal cannula (HFNC) is unclear. METHODS We conducted a multicenter, open-label, parallel-group randomized controlled trial to compare the efficacy of CPAP and HFNC on reducing the risk of meeting the prespecified criteria for intubation and improving clinical outcomes of acute hypoxemic respiratory failure. The primary endpoint was the time taken to meet the prespecified criteria for intubation within 28 days. RESULTS Eighty-five patients were randomly assigned to the CPAP or HFNC group. Eleven (28.9%) in the CPAP group and twenty (42.6%) in the HFNC group met the criteria for intubation within 28 days. Compared with HFNC, CPAP reduced the risk of meeting the intubation criteria (hazard ratio [HR], 0.327; 95% CI, 0.148-0.724; p = 0.006). There were no significant between-group differences in the intubation rates, in-hospital and 28-day mortality rates, ventilator-free days, duration of the need for respiratory support, or duration of hospitalization for respiratory illness. Pulmonary oxygenation was significantly better in the CPAP group, with significantly lower pH and higher partial pressure of carbon dioxide, but there were no differences in the respiratory rate between groups. CPAP and HFNC were associated with few possibly causal adverse events. CONCLUSION CPAP is more effective than HFNC at reducing the risk of meeting the intubation criteria in patients with acute hypoxemic respiratory failure.
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Affiliation(s)
- Kazuma Nagata
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Toshiki Yokoyama
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Ryosuke Tsugitomi
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo City, Tokyo, Japan
| | - Harunori Nakashima
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Hiroshi Kuraishi
- Department of Pulmonary Medicine, Nagano Red Cross Hospital, Nagano, Nagano, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Yoshihiro Mori
- Department of Respiratory Medicine, KKR Takamatsu Hospital, Takamatsu, Kagawa, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Hiroshima, Japan
| | - Ryogo Kagami
- Department of Pulmonary Medicine, National Hospital Organization Himeji Medical Center, Himeji, Hyogo, Japan
| | - Motoaki Tanigawa
- Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, Ise, Mie, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Tetsuro Kamo
- Department of Respiratory Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Toru Kadowaki
- Department of Pulmonary Medicine, National Hospital Organization Matsue Medical Center, Matsue, Shimane, Japan
| | - Yasutaka Koga
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Yoshitaka Ogata
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Yao, Osaka, Japan
| | - Naoki Nishimura
- Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, Chuo City, Tokyo, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Satsuki Taniuchi
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Osaka, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Sakamoto T, Matsubara T, Takahama T, Yokoyama T, Nakamura A, Tokito T, Okamoto T, Akamatsu H, Oki M, Sato Y, Tobino K, Ikeda S, Mori M, Mimura C, Maeno K, Miura S, Harada T, Nishimura K, Hiraoka M, Kenmotsu H, Fujimoto J, Shimokawa M, Yamamoto N, Nakagawa K. Biomarker Testing in Patients With Unresectable Advanced or Recurrent Non-Small Cell Lung Cancer. JAMA Netw Open 2023; 6:e2347700. [PMID: 38100106 PMCID: PMC10724778 DOI: 10.1001/jamanetworkopen.2023.47700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Biomarker testing for driver mutations is essential for selecting appropriate non-small cell lung cancer (NSCLC) treatment but is insufficient. Objective To investigate the status of biomarker testing and drug therapy for NSCLC in Japan for identifying problems in treatment. Design, Setting, and Participants The REVEAL cohort study included retrospective data collection and prospective follow-up from 29 institutions across Japan. Of 1500 patients diagnosed with advanced or recurrent NSCLC between January 1 and March 18, 2021, 1479 were eligible. Cases recognized at the wrong clinical stage (n = 12), diagnosed outside the study period (n = 6), not treated according to eligibility criteria before recurrence (n = 2), and with deficient consent acquisition procedure (n = 1) were excluded. Main Outcomes and Measures The primary end point was the biomarker testing status. Treatment-related factors were examined. Results Among the 1479 patients included in the analysis, the median age was 72 (range, 30-95) years; 1013 (68.5%) were men; 1161 (78.5%) had an Eastern Cooperative Oncology Group performance status 0 or 1; 1097 (74.2%) were current or past smokers; and 947 (64.0%) had adenocarcinoma. Biomarker status was confirmed in 1273 patients (86.1%). Multigene testing was performed in 705 cases (47.7%); single-gene testing, in 847 (57.3%); and both, in 279 (18.9%). Biomarker testing was performed for EGFR in 1245 cases (84.2%); ALK, in 1165 (78.8%); ROS1, in 1077 (72.8%); BRAF, in 803 (54.3%); and MET, in 805 (54.4%). Positivity rates among 898 adenocarcinoma cases included 305 (34.0%) for EGFR, 29 (3.2%) for ALK, 19 (2.1%) for ROS1, 11 (1.2%) for BRAF, and 14 (1.6%) for MET. Positivity rates among 375 nonadenocarcinoma cases were 14 (3.7%) for EGFR, 6 (1.6%) for ALK, 1 (0.3%) for ROS1, 3 (0.8%) for BRAF, and 8 (2.1%) for MET. Poor physical status, squamous cell carcinoma, and other comorbidities were associated with hampered multigene testing. Targeted therapy was received as first-line treatment by 263 of 278 cases (94.6%) positive for EGFR, 25 of 32 (78.1%) positive for ALK, 15 of 24 (62.5%) positive for ROS1, 9 of 12 (75.0%) positive for BRAF, and 12 of 19 (63.2%) positive for MET. Median overall survival of patients with positive findings for driver gene alteration and who received targeted therapy was 24.3 (95% CI, not reported) months; with positive findings for driver gene alteration and who did not receive targeted therapy, 15.2 (95% CI, 7.7 to not reported) months; and with negative findings for driver gene alteration, 11.0 (95% CI, 10.0-12.5) months. Multigene testing for nonadenocarcinomas and adenocarcinomas accounted for 705 (47.7%) of all NSCLC cases. Conclusions and Relevance These findings suggest that multigene testing has not been sufficiently implemented in Japan and should be considered prospectively, even in nonadenocarcinomas, to avoid missing rare driver gene alterations.
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Affiliation(s)
- Tomohiro Sakamoto
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Taichi Matsubara
- Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Takayuki Takahama
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Toshihide Yokoyama
- Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Atsushi Nakamura
- Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Tatsuro Okamoto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Hiroaki Akamatsu
- Department of Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Masahide Mori
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka City, Japan
| | - Chihiro Mimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoru Miura
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Toshiyuki Harada
- Center for Respiratory Diseases, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan
| | | | - Manabu Hiraoka
- Japan Medical Affairs, Japan Oncology Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | | | - Junya Fujimoto
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Nobuyuki Yamamoto
- Department of Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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9
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Tsubouchi K, Hamada N, Tokunaga S, Ichiki K, Takata S, Ishii H, Kitasato Y, Okamoto M, Kawakami S, Yatera K, Kawasaki M, Fujita M, Yoshida M, Maeyama T, Harada T, Wataya H, Torii R, Komori M, Mizuta Y, Tobino K, Harada E, Yabuuchi H, Nakanishi Y, Okamoto I. Survival and acute exacerbation for patients with idiopathic pulmonary fibrosis (IPF) or non-IPF idiopathic interstitial pneumonias: 5-year follow-up analysis of a prospective multi-institutional patient registry. BMJ Open Respir Res 2023; 10:e001864. [PMID: 37963676 PMCID: PMC10649622 DOI: 10.1136/bmjresp-2023-001864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Few prospective cohort studies with relatively large numbers of patients with non-idiopathic pulmonary fibrosis (non-IPF) of idiopathic interstitial pneumonia (IIP) have been described. We aimed to assess disease progression and cause of death for patients with non-IPF IIPs or IPF under real-life conditions. METHODS Data were analysed for a prospective multi-institutional cohort of 528 IIP patients enrolled in Japan between September 2013 and April 2016. Diagnosis of IPF versus non-IPF IIPs was based on central multidisciplinary discussion, and follow-up surveillance was performed for up to 5 years after patient registration. Survival and acute exacerbation (AE) were assessed. RESULTS IPF was the most common diagnosis (58.0%), followed by unclassifiable IIPs (35.8%) and others (6.2%). The 5-year survival rate for non-IPF IIP and IPF groups was 72.8% and 53.7%, respectively, with chronic respiratory failure being the primary cause of death in both groups. AE was the second most common cause of death for both non-IPF IIP (24.1%) and IPF (23.5%) patients. The cumulative incidence of AE did not differ significantly between the two groups (p=0.36), with a 1-year incidence rate of 7.4% and 9.0% in non-IPF IIP and IPF patients, respectively. We found that 30.2% and 39.4% of non-IPF IIP and IPF patients, respectively, who experienced AE died within 3 months after an AE event, whereas 55.8% and 66.7% of such patients, respectively, died within 5 years after registration. CONCLUSION Closer monitoring of disease progression and palliative care interventions after AE are important for non-IPF IIP patients as well as for IPF patients.
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Affiliation(s)
- Kazuya Tsubouchi
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Hamada
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shoji Tokunaga
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | | | - Shohei Takata
- Department of Respiratory Diseases, National Hospital Organization, Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yasuhiko Kitasato
- Department of Respiratory Medicine, Japan Community Health Care Organization Kurume General Hospital, Kurume, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Satoru Kawakami
- Division of Respiratory Medicine, Kyushu Rosai Hospital, Kitakyushu, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Masayuki Kawasaki
- Department of Respiratory Diseases, National Hospital Organisation Omuta National Hospital, Omuta, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Makoto Yoshida
- Department of Respiratory Diseases, National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
| | - Takashige Maeyama
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Taishi Harada
- Department of Respiratory Medicine, Japan Community Health Care Organisation Kyushu Hospital, Kitakyushu, Japan
| | - Hiroshi Wataya
- Department of Respiratory Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Ryo Torii
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Masashi Komori
- Department of Respiratory Medicine, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yuichi Mizuta
- Department of Respiratory Medicine, St Mary's Hospital, Kurume, Japan
| | - Kazunori Tobino
- Division of Respiratory Medicine, Aso Iizuka Hospital, Iizuka, Japan
| | - Eiji Harada
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Hidetake Yabuuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Isamu Okamoto
- Department of Respiratory Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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10
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Nishizawa S, Tobino K, Murakami Y, Uchida K, Kawabata T, Ota H, Hiramatsu Y, Sueyasu T, Tsuruno K. Mortality and prognostic factors for spontaneous pneumothorax in older adults. PLoS One 2023; 18:e0291233. [PMID: 37682952 PMCID: PMC10490947 DOI: 10.1371/journal.pone.0291233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Spontaneous pneumothorax occurs predominantly in young males and older adults, often as a secondary condition, and can be refractory and fatal. This study aimed to investigate the mortality and prognostic factors for pneumothorax in older patients. We retrospectively cohort studied patients with pneumothorax aged ≥65 years who visited our department from October 2012 to January 2019. Data on sex, age, medical history, smoking history, underlying lung disease, treatment, and prognosis were extracted from medical records. Cox proportional hazards regression analysis was used to investigate pneumothorax mortality and prognostic factors. In total, 239 patients were included. Among them, 36 (15%) died during hospitalization. Respiratory disease was the direct cause of death in 30 patients (83.3%), and 211 (88.3%) patients had underlying lung disease. The incidence of pneumonia in our hospital was 22.6% (54 cases). On admission, the mortality rate was 33% (18/54) in patients with concomitant pneumonia; univariate analysis showed significant differences in the Charlson Comorbidity Index (CCI), activities of daily living (ADL), and concomitant pneumonia. In the Cox proportional hazards analysis of ADL (p = 0.09), CCI (p = 0.05), and concomitant pneumonia on admission (p = 0.02), concomitant pneumonia on admission was found to be an independent predictor of in-hospital mortality. This study suggests that concomitant pneumonia at admission may be a mortality risk factor for pneumothorax.
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Affiliation(s)
- Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Yousuke Murakami
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Kazuki Uchida
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Takafumi Kawabata
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Hiroyuki Ota
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
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11
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Iwasaku M, Uchino J, Chibana K, Tanzawa S, Yamada T, Tobino K, Uchida Y, Kijima T, Nakatomi K, Izumi M, Tamiya N, Kimura H, Fujita M, Honda R, Takumi C, Yamada T, Kaneko Y, Kiyomi F, Takayama K. Prophylactic treatment of dacomitinib-induced skin toxicities in epidermal growth factor receptor-mutated non-small-cell lung cancer: A multicenter, Phase II trial. Cancer Med 2023; 12:15117-15127. [PMID: 37269194 PMCID: PMC10417098 DOI: 10.1002/cam4.6184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Dacomitinib significantly improves progression-free survival and overall survival (OS) compared with gefitinib in patients with non-small-cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR)-activating mutations. However, dacomitinib often causes skin toxicities, resulting in treatment discontinuation. We aimed to evaluate a prophylactic strategy for skin toxicity induced by dacomitinib. METHODS We performed a single-arm, prospective, open-label, multi-institutional phase II trial for comprehensive skin toxicity prophylaxis. Patients with NSCLC harboring EGFR-activating mutations were enrolled and received dacomitinib with comprehensive prophylaxis. The primary endpoint was the incidence of skin toxicity (Grade ≥2) in the initial 8 weeks. RESULTS In total, 41 Japanese patients participated between May 2019 and April 2021 from 14 institutions (median age 70 years; range: 32-83 years), 20 were male, and 36 had a performance status of 0-1. Nineteen patients had exon 19 deletions and L858R mutation. More than 90% of patients were perfectly compliant with prophylactic minocycline administration. Skin toxicities (Grade ≥2) occurred in 43.9% of patients (90% confidence interval [CI], 31.2%-56.7%). The most frequent skin toxicity was acneiform rash in 11 patients (26.8%), followed by paronychia in five patients (12.2%). Due to skin toxicities, eight patients (19.5%) received reduced doses of dacomitinib. The median progression-free survival was 6.8 months (95% CI, 4.0-8.6 months) and median OS was 21.6 months (95% CI, 17.0 months-not reached). CONCLUSION Although the prophylactic strategy was ineffective, the adherence to prophylactic medication was quite good. Patient education regarding prophylaxis is important and can lead to improved treatment continuity.
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Affiliation(s)
- Masahiro Iwasaku
- Department of Pulmonary Medicine, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Junji Uchino
- Department of Pulmonary Medicine, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Kenji Chibana
- Department of Respiratory MedicineNational Hospital Organization Okinawa National HospitalOkinawaJapan
| | - Shigeru Tanzawa
- Division of Medical Oncology, Department of Internal MedicineTeikyo University School of MedicineTokyoJapan
| | - Takahiro Yamada
- Department of Pulmonary MedicineMatsushita Memorial HospitalOsakaJapan
| | - Kazunori Tobino
- Department of Respiratory MedicineIizuka HospitalIizukaJapan
| | - Yasuki Uchida
- Division of Respiratory Medicine, Department of Internal MedicineShiga University of Medical ScienceJapan
| | - Takashi Kijima
- Department of Respiratory Medicine and HematologyHyogo Medical University, School of MedicineHyogoJapan
| | - Katsumi Nakatomi
- Department of Respiratory MedicineNational Hospital Organization Ureshino Medical CenterUreshinoJapan
| | - Miiru Izumi
- Department of Respiratory MedicineNational Hospital Organization, Omuta National HospitalFukuokaJapan
| | - Nobuyo Tamiya
- Department of Pulmonary MedicineRakuwakai Otowa HospitalKyotoJapan
| | - Hideharu Kimura
- Department of Respiratory MedicineKanazawa University HospitalIshikawaJapan
| | - Masaki Fujita
- Department of Respiratory MedicineFukuoka University HospitalFukuokaJapan
| | - Ryoichi Honda
- Department of Respiratory MedicineAsahi General HospitalAsahiJapan
| | - Chieko Takumi
- Department of Respiratory MedicineJapanese Red Cross Kyoto Daiichi HospitalKyotoJapan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yoshiko Kaneko
- Department of Pulmonary Medicine, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Fumiaki Kiyomi
- Statistics and Data Center, Clinical Research Support Center KyushuFukuokaJapan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
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12
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Ito Y, Anan K, Awano N, Kataoka Y, Johkoh T, Fujimoto K, Ichikado K, Tobino K, Tachikawa R, Ito H, Nakamura T, Kishaba T, Yamamoto Y, Inomata M, Izumo T. Skeletal muscle atrophy and short-term mortality in patients with acute exacerbation of idiopathic pulmonary fibrosis: an observational cohort study. Respir Investig 2023; 61:371-378. [PMID: 37079942 DOI: 10.1016/j.resinv.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/10/2023] [Accepted: 02/26/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Skeletal muscle atrophy, a common complication of idiopathic pulmonary fibrosis (IPF), and its presence upon diagnosis can indicate a poor prognosis. Patients with IPF frequently experience acute exacerbations (AE), which is associated with a high mortality rate. However, the association between skeletal muscle atrophy and short-term mortality remains unknown. METHODS We performed a retrospective, multicenter cohort study of patients admitted for AE-IPF in Japan. The cross-sectional areas of the erector spinae muscle (ESMCSA) and the pectoralis muscle (PMCSA) were analyzed via single-slice computed tomography (CT). The primary outcome was 90-day mortality. Survival probability was estimated using the Kaplan-Meier method, and the log-rank test was used between the low and high groups of ESMCSA and PMCSA. We used multivariable Cox proportional-hazards models to evaluate the association between ESMCSA and PMCSA and prognosis. RESULTS Of the 212 patients included, 94 (44%) died during the observation period. The low ESMCSA group (<25.6 cm2) had a significantly worse prognosis than that of the high ESMCSA group (≥25.6 cm2) (hazard ratio (HR) [95% confidence interval (CI)]: 1.52 [1.00-2.33], P = 0.049). Multivariable analyses showed that all-cause mortality was associated with low ESMCSA (model 1, adjusted HR [95% CI]: 1.59 [0.98-2.60]; model 2, 1.55 [0.95-2.56], and model 3, 1.67 [1.00-2.78], respectively). The adjusted HR of low PMCSA (<20.4 cm2) vs. high PMCSA (≥20.4 cm2) was 1.39 (95% CI: 0.88-2.20). CONCLUSIONS Low ESMCSA on CT images is associated with a high 90-day mortality rate in patients with AE-IPF.
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Affiliation(s)
- Yu Ito
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Keisuke Anan
- Department of Healthcare Epidemiology, Kyoto University, Graduate School of Medicine, Kyoto, Japan; Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan; Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan.
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, Kyoto University, Graduate School of Medicine, Kyoto, Japan; Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hiroyuki Ito
- Department of Pulmonology, Kameda Medical Center, Chiba, Japan
| | - Takahito Nakamura
- Department of General Internal Medicine, Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
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13
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Anan K, Kataoka Y, Ichikado K, Kawamura K, Johkoh T, Fujimoto K, Tobino K, Tachikawa R, Ito H, Nakamura T, Kishaba T, Inomata M, Kamitani T, Yamazaki H, Ogawa Y, Yamamoto Y. Correction: Early corticosteroid dose tapering in patients with acute exacerbation of idiopathic pulmonary fibrosis. Respir Res 2023; 24:107. [PMID: 37032327 PMCID: PMC10084659 DOI: 10.1186/s12931-023-02411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Affiliation(s)
- Keisuke Anan
- Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, Kyoto-City, 606-8501, Japan
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, Kyoto-City, 606-8501, Japan
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kodai Kawamura
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hiroyuki Ito
- Department of Pulmonology, Kameda Medical Center, Chiba, Japan
| | - Takahito Nakamura
- Department of General Internal Medicine, Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tsukasa Kamitani
- Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, Kyoto-City, 606-8501, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, Kyoto-City, 606-8501, Japan.
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14
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Shinoda M, Hataji O, Miura M, Kinoshita M, Mizoo A, Tobino K, Soutome T, Nishi T, Ishii T, Miller BE, Tal-Singer R, Tomlinson R, Matsuki T, Jones PW, Shibata Y. A Telemedicine Approach for Monitoring COPD: A Prospective Feasibility and Acceptability Cohort Study. Int J Chron Obstruct Pulmon Dis 2022; 17:2931-2944. [PMID: 36419950 PMCID: PMC9677662 DOI: 10.2147/copd.s375049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/31/2022] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Telemedicine may help the detection of symptom worsening in patients with chronic obstructive pulmonary disease (COPD), potentially resulting in improved outcomes. This study aimed to determine the feasibility and acceptability of telemedicine among patients with COPD and physicians and facility staff in Japan. METHODS This was a 52-week multicenter, prospective, single-arm, feasibility and acceptability cohort study of Japanese patients ≥40 years of age with COPD or asthma-COPD overlap. Participants underwent training to use YaDoc, a telemedicine smartphone App, which included seven daily symptom questions and weekly COPD Assessment Test (CAT) questions. The primary endpoint was participant compliance for required question completion. The secondary endpoint was participant and physician/facility staff acceptability of YaDoc based on questionnaires completed at Week 52. The impact of the Japanese COVID-19 pandemic state of emergency on results was also assessed. RESULTS Of the 84 participants enrolled (mean age: 68.7 years, 88% male), 72 participants completed the study. Completion was high in the first six months but fell after that. Median (interquartile range [IQR]) compliance for daily questionnaire entry was 66.6% (31.0-91.8) and 81.0% (45.3-94.3) for weekly CAT entry. Positive participant responses to the exit questionnaire were highest regarding YaDoc ease of use (83.8%), positive impact on managing health (58.8%), and overall satisfaction (53.8%). Of the 26 physicians and facility staff enrolled, 24 completed the study. Of these, the majority (66.7%) responded positively regarding app facilitation of communication between physicians and participants to manage disease. Compliance was similar before and after the first COVID-19 state of emergency in Japan. CONCLUSION Daily telemedicine monitoring is potentially feasible and acceptable to both patients and physicians in the management of COPD. These results may inform potential use of telemedicine in clinical practice and design of future studies. CLINICAL TRIAL REGISTRATION JapicCTI-194916.
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Affiliation(s)
- Masahiro Shinoda
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, Shinagawa, Tokyo, Japan
| | - Osamu Hataji
- Respiratory Center, Matsusaka Municipal Hospital, Matsusaka, Mie, Japan
| | - Motohiko Miura
- Department of Respiratory Medicine, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Masaharu Kinoshita
- Department of Respiratory Medicine, Nagata Hospital, Yanagawa, Fukuoka, Japan
| | - Akira Mizoo
- Department of Pulmonary Medicine Japan, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Shinjuku, Tokyo, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan
| | - Toru Soutome
- Japan Medical & Development, GSK K.K, Minato-Ku, Tokyo, Japan
| | - Takanobu Nishi
- Japan Medical & Development, GSK K.K, Minato-Ku, Tokyo, Japan
| | - Takeo Ishii
- Japan Medical & Development, GSK K.K, Minato-Ku, Tokyo, Japan
| | | | | | | | - Taizo Matsuki
- Japan Medical & Development, GSK K.K, Minato-Ku, Tokyo, Japan
| | | | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
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15
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Yoshimatsu Y, Tobino K, Ortega O, Oda H, Ota H, Kawabata T, Hiramatsu Y, Murakami Y, Clavé P. Development and implementation of an aspiration pneumonia cause investigation algorithm. Clin Respir J 2022; 17:20-28. [PMID: 36373578 PMCID: PMC9829530 DOI: 10.1111/crj.13557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 10/28/2022] [Indexed: 11/16/2022]
Abstract
The diagnostic criteria of aspiration pneumonia have not been established, and it remains an underdiagnosed entity. Diagnosis and cause investigation is essential in improving the management of aspiration pneumonia. The Japanese Respiratory Society Guidelines for the Management of Pneumonia in Adults (JRS Guidelines) show a list of risk factors for aspiration pneumonia. We developed an algorithm to aid physicians in evaluating these possible underlying factors and guide their management with a focus on aspiration pneumonia. The algorithm was developed based on the JRS Guidelines. The algorithm suggested dysphagia screening, pneumococcal and influenza vaccination, and other preventative measures for pneumonia. The algorithm was implemented in the acute setting of a general hospital among older patients admitted with pneumonia. Their outcomes were compared with a historical control group constituting similar patients from the previous year. Forty patients with pneumonia were assessed with the algorithm group, and 44 patients were included in the control group. In the algorithm group, significantly more cases (95.0% vs. 15.9%, p < 0.01) underwent early screening for a swallowing disorder. Two patients in the algorithm group were diagnosed with a new condition causing aspiration pneumonia, as opposed to none in the control group. Drugs with a potential risk for aspiration were identified and discontinued in 27.5% of the patients in the algorithm group and 4.5% in the control group. In conclusion, an aspiration pneumonia cause investigation algorithm translating the JRS guideline approach into practice enhanced the rate of swallow screening and preventative measures for aspiration.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory MedicineIizuka HospitalFukuokaJapan,Department of PhysiologyHyogo College of MedicineNishinomiyaJapan
| | - Kazunori Tobino
- Department of Respiratory MedicineIizuka HospitalFukuokaJapan,Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Omar Ortega
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd)Instituto de Salud Carlos IIIBarcelonaSpain,Gastrointestinal Motility Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del MaresmeUniversitat Autònoma de BarcelonaMataróSpain
| | - Hiroyuki Oda
- Department of General MedicineIizuka HospitalFukuokaJapan
| | - Hiroaki Ota
- Department of Respiratory MedicineIizuka HospitalFukuokaJapan
| | | | - Yuri Hiramatsu
- Department of Respiratory MedicineIizuka HospitalFukuokaJapan
| | - Yosuke Murakami
- Department of Respiratory MedicineIizuka HospitalFukuokaJapan
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd)Instituto de Salud Carlos IIIBarcelonaSpain,Gastrointestinal Motility Laboratory, Department of Surgery, Hospital de Mataró, Consorci Sanitari del MaresmeUniversitat Autònoma de BarcelonaMataróSpain
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16
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Yoshimine K, Tobino K, Tsuruno K. P70-2 A study of carboplatin-related hypersensitivity reactions in our hospital. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.05.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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17
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Sueyasu T, Tobino K, Murakami Y, Uchida K, Hiramatsu Y, Kawabata T, Ota H, Sakabe M, Yamamoto R, Ooi R, Maeda A, Yoshimine K, Nishizawa S, Koh Y, Yoshimatsu Y, Ide H, Tsuruno K, Hanaka M. Corrigendum to "The Japanese Respiratory Society guidelines may reduce unnecessary chest computed tomography in patients with pneumonia requiring hospitalization: A retrospective study" [Respir. Investig. 60 (2022) 264-270]. Respir Investig 2022; 60:734. [PMID: 35778271 DOI: 10.1016/j.resinv.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan.
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan; Department of Respiratory Medicine, Juntendo University, School of Medicine, Tokyo, Japan
| | - Yosuke Murakami
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kazuki Uchida
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | | | - Hiroaki Ota
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Mitsukuni Sakabe
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Ryuta Yamamoto
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Ryunosuke Ooi
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Akiko Maeda
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yuki Koh
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Minako Hanaka
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
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18
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Hiramatsu T, Tobino K. Necrotizing pneumonia caused by methicillin‐resistant
Staphylococcus aureus. Clin Case Rep 2022; 10:e05619. [PMID: 35356187 PMCID: PMC8938601 DOI: 10.1002/ccr3.5619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
We report a fatal case of methicillin‐resistant Staphylococcus aureus (MRSA)‐induced necrotizing pneumonia that was refractory to adequate vancomycin treatment (trough value, 13.1 µg/ml), drainage of hydropneumothorax, and veno‐arterial extracorporeal membrane oxygenation. Despite appropriate treatment, MRSA infection can cause rapidly progressive disease with a high‐case fatality rate.
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Affiliation(s)
| | - Kazunori Tobino
- Department of Respiratory Medicine Iizuka Hospital Iizuka Japan
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19
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Anan K, Kataoka Y, Ichikado K, Kawamura K, Johkoh T, Fujimoto K, Tobino K, Tachikawa R, Ito H, Nakamura T, Kishaba T, Inomata M, Yamamoto Y. The Accuracy of Japanese Administrative Data in Identifying Acute Exacerbation of Idiopathic Pulmonary Fibrosis. Ann Clin Epidemiol 2022; 4:53-62. [PMID: 38504851 PMCID: PMC10760466 DOI: 10.37737/ace.22008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/22/2021] [Indexed: 03/21/2024]
Abstract
BACKGROUND This study aimed to develop criteria for identifying patients with acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) from Japanese administrative data and validate the pre-existing criteria. METHODS This retrospective, multi-center validation study was conducted at eight institutes in Japan to verify the diagnostic accuracy of the disease name for AE-IPF. We used the Japanese Diagnosis Procedure Combination data to identify patients with a disease name that could meet the diagnostic criteria for AE-IPF, who were admitted to the eight institutes from January 2016 to February 2019. As a reference standard, two respiratory physicians performed a chart review to determine whether the patients had a disease that met the diagnostic criteria for AE-IPF. Furthermore, two radiologists interpreted the chest computed tomography findings of cases considered AE-IPF and confirmed the diagnosis. We calculated the positive predictive value (PPV) for each disease name and its combination. RESULTS We included 830 patients; among them, 216 were diagnosed with AE-IPF through the chart review. We combined the groups of disease names and yielded two criteria: the criteria with a high PPV (0.72 [95% confidence interval 0.62 to 0.81]) and that with a slightly less PPV (0.61 [0.53 to 0.68]) but more true positives. Pre-existing criteria showed a PPV of 0.40 (0.31 to 0.49). CONCLUSION The criteria derived in this study for identifying AE-IPF from Japanese administrative data show a fair PPV. Although these criteria should be carefully interpreted according to the target population, our findings could be utilized in future database studies on AE-IPF.
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Affiliation(s)
- Keisuke Anan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yuki Kataoka
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kodai Kawamura
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hiroyuki Ito
- Department of Pulmonology, Kameda Medical Center, Chiba, Japan
| | - Takahito Nakamura
- Department of Internal Medicine, Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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20
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Yoshimatsu Y, Tobino K, Nishizawa S, Yoshimine K, Oku Y. Interferential Current Stimulation for Swallowing Disorders in Chronic Obstructive Pulmonary Disease: A Preliminary Study. Prog Rehabil Med 2022; 7:20220007. [PMID: 35274062 PMCID: PMC8850183 DOI: 10.2490/prm.20220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives: Swallowing function is affected in patients with chronic obstructive pulmonary disease (COPD), putting them at risk of exacerbation of COPD. We previously reported the effectiveness of the repetitive saliva swallowing test (RSST) in screening for patients at risk of COPD exacerbation. However, evidence on how to improve swallowing function in this population is extremely limited. Interferential current transcutaneous electrical sensory stimulation (IFC-TESS) stimulates the larynx and pharynx, thereby improving their sensory function. IFC-TESS is an emerging tool to enhance airway protection and increase swallowing frequency; however, its safety and efficacy in patients with COPD is unknown. Therefore, we performed a preliminary prospective study focusing on stable COPD patients. Methods: Patients with stable COPD who were hospitalized for yearly evaluation were recruited. Patients were included if their RSST was 5 or less. Nurses carried out IFC-TESS twice daily for 10 days. Swallow screening results were compared before and after the 10-day intervention. Results: Ten patients were included in the study. The IFC-TESS intervention was performed safely. Patients and nurses reported no discomfort or concerns regarding the intervention. The EAT-10 and RSST scores improved significantly after the intervention, and tongue pressure also tended to improve. Conclusions: IFC-TESS may be a promising intervention to improve swallowing in patients with COPD who are easily fatigued and struggle to perform swallowing exercises.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Japan
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21
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Yamamoto R, Tobino K, Uchida K, Ooi R, Yoshimine K. A case of ruptured ovarian metastasis of small cell lung cancer. Respir Med Case Rep 2022; 39:101717. [PMID: 35965489 PMCID: PMC9364014 DOI: 10.1016/j.rmcr.2022.101717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
A 53-year-old woman with small-cell lung cancer (SCLC) presented at our hospital complaining of abdominal distention. Blood tests revealed rapidly progressive normocytic anemia and elevated lactate dehydrogenase levels. Pelvic magnetic resonance imaging revealed a left ovarian tumor and ascites. As her symptoms rapidly worsened, she underwent emergency surgery, which revealed a ruptured metastatic ovarian tumor of SCLC. Emergency surgery averted a life-threatening situation in this patient, and subsequent chemotherapy facilitated long-term survival. As seen from literature review, in female SCLC patients, ovarian metastasis and rupture is a rare but possible complication that should be considered because of its life-threatening nature.
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22
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Sakabe M, Tobino K, Uchida K, Murakami Y, Hiramatsu Y, Ota H, Kawabata T. Isolated congenital interruption of the right interlobar pulmonary artery with unilateral interstitial lung abnormality. Respir Med Case Rep 2022; 39:101734. [PMID: 36111180 PMCID: PMC9467893 DOI: 10.1016/j.rmcr.2022.101734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
We report a case of an isolated congenital interruption of the right interlobar pulmonary artery with unilateral interstitial lung abnormality. 3D-CT with enhancement showed absent right interlobar pulmonary artery without any other abnormalities of the pulmonary artery and an enlarged inferior phrenic artery. High-resolution CT demonstrated ground-glass opacities, reticular changes, and small cysts in the right middle and lower lobes, which were compatible with interstitial lung abnormality. The patient was diagnosed with an isolated congenital interruption of the right interlobar pulmonary artery since chronic pulmonary thromboembolism, structural heart disease, systemic congenital disease, and systemic vasculitis were ruled out.
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Affiliation(s)
- Mitsukuni Sakabe
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
- Corresponding author.
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Bunkyo-Ku, Hongo, 113-8421, Japan
| | - Kazuki Uchida
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Yosuke Murakami
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Hiroaki Ota
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Takafumi Kawabata
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
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23
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Anan K, Kataoka Y, Ichikado K, Kawamura K, Johkoh T, Fujimoto K, Tobino K, Tachikawa R, Ito H, Nakamura T, Kishaba T, Inomata M, Kamitani T, Yamazaki H, Ogawa Y, Yamamoto Y. Early corticosteroid dose tapering in patients with acute exacerbation of idiopathic pulmonary fibrosis. Respir Res 2022; 23:291. [PMID: 36289512 PMCID: PMC9609246 DOI: 10.1186/s12931-022-02195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although corticosteroid therapy with dose tapering is the most commonly used treatment for acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF), there is no consensus on the tapering regimen. This study aimed to investigate the association between early corticosteroid dose tapering and in-hospital mortality in patients with AE-IPF. Methods In this retrospective cohort study, we analyzed the data of a cohort from eight Japanese tertiary care hospitals and routinely collected administrative data from a cohort from 185 Japanese hospitals. Patients with AE-IPF were classified into the early and non-early tapering groups depending on whether the maintenance dose of corticosteroids was reduced within two weeks of admission. Propensity score analysis with inverse probability weighting (IPW) was performed to estimate the effect of early corticosteroid dose tapering. Results The multi-center cohort included 153 eligible patients, of whom 47 (31%) died, whereas the administrative cohort included 229 patients, of whom 51 (22%) died. Patients with early tapering tended to have a better prognosis than those without it (unadjusted hazard ratio [95% confidence interval] 0.41 [0.22–0.76] and 0.65 [0.36–1.18] in the multi-center and administrative cohorts, respectively). After IPW, the early tapering group had a better prognosis than the non-early tapering group (IPW-adjusted hazard ratio [95% confidence interval] 0.37 [0.14–0.99] and 0.27 [0.094–0.83] in the multi-center and administrative cohorts, respectively). Conclusion Early corticosteroid dose tapering was associated with a favorable prognosis in patients with AE-IPF. Further studies are warranted to confirm the effects of early corticosteroid dose tapering in patients with AE-IPF. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02195-3.
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Affiliation(s)
- Keisuke Anan
- grid.258799.80000 0004 0372 2033Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, 606-8501 Kyoto-City, Japan ,grid.416612.60000 0004 1774 5826Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan ,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yuki Kataoka
- grid.258799.80000 0004 0372 2033Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, 606-8501 Kyoto-City, Japan ,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan ,Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan ,grid.258799.80000 0004 0372 2033Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Ichikado
- grid.416612.60000 0004 1774 5826Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kodai Kawamura
- grid.416612.60000 0004 1774 5826Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Takeshi Johkoh
- grid.414976.90000 0004 0546 3696Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | - Kiminori Fujimoto
- grid.410781.b0000 0001 0706 0776Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Kazunori Tobino
- grid.413984.3Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Ryo Tachikawa
- grid.410843.a0000 0004 0466 8016Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hiroyuki Ito
- grid.414927.d0000 0004 0378 2140Department of Pulmonology, Kameda Medical Center, Chiba, Japan
| | - Takahito Nakamura
- Department of General Internal Medicine, Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Tomoo Kishaba
- grid.416827.e0000 0000 9413 4421Department of Respiratory Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Minoru Inomata
- grid.414929.30000 0004 1763 7921Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tsukasa Kamitani
- grid.411217.00000 0004 0531 2775Section of Education for Clinical Research, Kyoto University Hospital, Kyoto, Japan
| | - Hajime Yamazaki
- grid.258799.80000 0004 0372 2033Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Ogawa
- grid.258799.80000 0004 0372 2033Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, 606-8501 Kyoto-City, Japan
| | - Yosuke Yamamoto
- grid.258799.80000 0004 0372 2033Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho Sakyo-ku, 606-8501 Kyoto-City, Japan
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24
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Sueyasu T, Tobino K, Murakami Y, Uchida K, Hiramatsu Y, Kawabata T, Ota H, Sakabe M, Yamamoto R, Ooi R, Maeda A, Yoshimine K, Nishizawa S, Koh Y, Yoshimatsu Y, Ide H, Tsuruno K, Hanaka M. The Japanese Respiratory Society guidelines may reduce unnecessary chest computed tomography in patients with pneumonia requiring hospitalization: A retrospective study. Respir Investig 2021; 60:264-270. [PMID: 34953763 DOI: 10.1016/j.resinv.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND With the abundance of CT scanners in Japan, doctors can easily order CT scans to diagnose pneumonia. The Japanese Respiratory Society (JRS) guidelines uniquely recommend conditions for which additional CT scans should be considered at the time of diagnosis of pneumonia, a feature not found in other guidelines. In this study, we aimed to evaluate the usefulness of the recommendations in a bid to reduce the number of unnecessary CT examinations. METHODS We retrospectively reviewed the electronic medical records of consecutive patients with pneumonia hospitalized between April 2016 and March 2017 to extract patients' backgrounds and clinical courses. Conformity with the JRS guideline recommendations was also examined. In the patients who did not meet the recommendations, we investigated the proportion of them for whom an additional CT scan influenced the clinical decisions. Finally, we evaluated whether there was a difference in hospital stay depending on the additional chest CT at the time of admission. RESULTS We included 363 hospitalized patients with pneumonia. Chest CT scan was performed in 306 patients (84.3%), of whom 186 (60.8%) did not meet the JRS guideline recommendations. Chest CT revealed findings requiring a change in treatment strategy in only 14 (7.5%) of the 186 patients. Among the 240 patients (66.1%) who did not meet the recommendations, no statistically significant difference was observed in the hospital stay or mortality between patients with and without CT scans. CONCLUSIONS Adherence to the JRS guideline recommendations may reduce the excessive use of CT scans in the diagnosis of pneumonia.
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Affiliation(s)
- Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan.
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan; Department of Respiratory Medicine, Juntendo University, School of Medicine, Tokyo, Japan
| | - Yosuke Murakami
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kazuki Uchida
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | | | - Hiroaki Ota
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Mitsukuni Sakabe
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Ryuta Yamamoto
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Ryunosuke Ooi
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Akiko Maeda
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yuki Koh
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Minako Hanaka
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
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25
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Yoshimatsu Y, Tobino K, Ooi R, Sueyasu T, Nishizawa S, Yoshimine K, Ko Y, Ide H, Tsuruno K. A Need for a Diagnostic Management Protocol in Barium Aspiration. Intern Med 2021; 60:3285-3287. [PMID: 33896861 PMCID: PMC8580774 DOI: 10.2169/internalmedicine.6052-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We experienced a patient who presented with lung abscess one month after aspirating barium during a gastric cancer screening examination. The patient had no subjective symptoms suggesting a swallowing disorder. Rigorous history taking under suspicion of aspiration and a further assessment of the cause of aspiration revealed hypopharyngeal cancer. Lung abscess and hypopharyngeal cancer, both treatable but potentially fatal conditions, were not diagnosed until one month after the aspiration. This highlights the need for guidance for patients and physicians to follow in the event of barium aspiration, as it is the most common complication of a barium examination. A health checkup for one condition (gastric cancer) may also be an opportunity to diagnose another underlying condition.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Physiology, Hyogo College of Medicine, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Ryunosuke Ooi
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | | | | | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Japan
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26
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Sueyasu T, Tobino K, Yamamoto R, Nishizawa S, Ko Y. Varicella-zoster pneumonia with endobronchial lesions. Respirol Case Rep 2021; 9:e0846. [PMID: 34522387 PMCID: PMC8426793 DOI: 10.1002/rcr2.846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
Varicella-zoster pneumonia with endobronchial lesions is rare. When immunosuppressed patients get skin lesions with systemic symptoms, the possibility of varicella-zoster virus infection of the respiratory tract should be kept in mind. In our case, the pulmonary lesions persisted for 15 months.
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Affiliation(s)
- Takuto Sueyasu
- Department of Respiratory MedicineIizuka HospitalIizukaJapan
| | - Kazunori Tobino
- Department of Respiratory MedicineIizuka HospitalIizukaJapan
| | - Ryuta Yamamoto
- Department of Respiratory MedicineIizuka HospitalIizukaJapan
| | - Saori Nishizawa
- Department of Respiratory MedicineIizuka HospitalIizukaJapan
| | - Yuki Ko
- Department of Respiratory MedicineIizuka HospitalIizukaJapan
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27
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Abstract
Laryngeal and endobronchial cryptococcosis are rare conditions, and to our knowledge, there have been only 23 cases of laryngeal cryptococcosis, and 18 cases of endobronchial cryptococcosis previously reported in the English literature. We herein report an extremely rare case of cryptococcosis with simultaneous laryngeal and endobronchial involvement. This case highlights the importance of paying close attention to possible occurrence of cryptococcosis of the airway tract in patients with asthma treated with high-dose inhaled corticosteroids.
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Affiliation(s)
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | | | - Ryunosuke Ooi
- Department of Respiratory Medicine, Iizuka Hospital, Japan
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28
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Sakamoto N, Hamada N, Okamoto M, Tobino K, Ichiyasu H, Ishii H, Ichikado K, Morimoto S, Hosogaya N, Mukae H. Efficacy and safety of nintedanib in Japanese patients with early-stage idiopathic pulmonary fibrosis: a study protocol for an observational study. BMJ Open 2021; 11:e047249. [PMID: 34187824 PMCID: PMC8245432 DOI: 10.1136/bmjopen-2020-047249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a fibrotic disease of unknown aetiology with a poor prognosis. Several clinical trials of nintedanib in patients with IPF have reported its inhibitory effect on reduced lung function, incidence of acute exacerbation of IPF and worsened health-related quality of life. Although nintedanib has a manageable safety and tolerability profile over long-term use, it was discontinued in over 20% of patients because of adverse events such as diarrhoea and liver dysfunction. This might explain why nintedanib use in patients with IPF is not widespread, especially among patients with early-stage IPF. In the present study, we aimed to clarify the efficacy, safety and tolerability of nintedanib in patients with stage I/II IPF, based on the Japanese IPF disease severity staging classification system. METHODS AND ANALYSIS This is an ongoing, prospective, multicentre observational cohort study of patients with stage I/II IPF who will start receiving nintedanib. Totally, 215 patients at 35 sites in Kyushu and Okinawa, Japan will be enrolled and followed up for 3 years. Nintedanib therapy would be initiated at the discretion of the investigator. The primary endpoint, change in forced vital capacity (FVC) at 156 weeks, will be shown as the mean change in FVC from baseline to week 156 with 95% CIs estimated using the Wald method. The safety endpoint-occurrence of adverse events-will be assessed in each system organ class/preferred term. ETHICS AND DISSEMINATION The study protocol and informed consent documents were approved by the Institutional Review Board at Nagasaki University Hospital (approval number 19102146) and each participating site. Written informed consent was obtained from all participants. Patient recruitment has begun. The results will be disseminated through scientific peer-reviewed publications and national and international conferences. TRIAL REGISTRATION NUMBER UMIN000038192.
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Affiliation(s)
- Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoki Hamada
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
- Department of Respirology and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Hidenori Ichiyasu
- Department of Respiratory Medicine, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Shimpei Morimoto
- Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoki Hosogaya
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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29
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Yoshimatsu Y, Tobino K, Kawabata T, Noguchi N, Sato R, Motomura D, Sueyasu T, Yoshimine K, Nishizawa S, Natori Y. Hemorrhaging from an Intramedullary Cavernous Malformation Diagnosed Due to Recurrent Pneumonia and Diffuse Aspiration Bronchiolitis. Intern Med 2021; 60:1451-1456. [PMID: 33281156 PMCID: PMC8170235 DOI: 10.2169/internalmedicine.5752-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
While aspiration pneumonia constitutes the majority of pneumonia cases in the elderly, it remains highly underdiagnosed. We experienced a case of recurrent pneumonia and chronic cough that was later diagnosed as aspiration pneumonia and diffuse aspiration bronchiolitis (DAB) due to recurrent hemorrhaging from an intramedullary cavernous malformation. The patient was finally diagnosed when life-threatening respiratory depression caused emergency attention. This is the first report of hemorrhaging from an intramedullary cavernous malformation diagnosed due to aspiration pneumonia and DAB. These findings highlight the importance of considering aspiration in cases with recurrent pneumonia or chronic cough. The underlying cause may be a life-threatening condition.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Physiology, Hyogo College of Medicine, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | | | | | - Ryo Sato
- Department of Gastroenterology, Iizuka Hospital, Japan
| | | | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
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30
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Yoshimatsu Y, Ebi N, Ooi R, Sueyasu T, Nishizawa S, Munechika M, Yoshimine K, Ko Y, Ide H, Tsuruno K, Tobino K. Osimertinib for Lung Squamous Cell Carcinoma: A Case Report and Literature Review. Intern Med 2021; 60:1067-1071. [PMID: 33132329 PMCID: PMC8079920 DOI: 10.2169/internalmedicine.5463-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The efficacy of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in lung squamous cell carcinoma is said to be low. Thus far, only four cases of osimertinib in lung squamous cell carcinoma have been published. We experienced a case of EGFR mutant lung squamous cell carcinoma in which fifth-line treatment with osimertinib was effective after T790M EGFR mutation turned positive. Osimertinib was resumed after sixth-line chemotherapy was ineffective, showing efficacy again. Osimertinib may be a promising treatment option for EGFR mutant lung squamous cell carcinoma. This is the first report to show its effect in a case of rechallenge after intervening chemotherapy. It may therefore be important to evaluate EGFR in never-smoker lung squamous cell carcinoma patients.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Physiology, Hyogo College of Medicine, Japan
| | - Noriyuki Ebi
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Ryunosuke Ooi
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | | | | | | | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
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31
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Murakami Y, Tobino K. Lymphangioleiomyomatosis associated with prolactinoma: A case report and literature review. Respir Med Case Rep 2021; 33:101406. [PMID: 33898216 PMCID: PMC8053810 DOI: 10.1016/j.rmcr.2021.101406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 10/25/2022] Open
Abstract
The thirty-five-year-old woman had been experiencing dyspnea on exertion since her second child's birth five years before presenting to hospital A, where she was diagnosed with lymphangioleiomyomatosis (LAM) based on video-assisted thoracoscopic surgery lung biopsy and referred to our hospital. She was treated with sirolimus for one year. Although her subjective symptom of dyspnea improved, she found that her amenorrhea had persisted for six years. A blood test revealed high prolactin (PRL) levels of 98 ng/mL and head magnetic resonance imaging revealed a pituitary adenoma, which was complicated by a prolactinoma. We continued with follow-up observation without any pharmacotherapy for the prolactinoma. However, she was administered oral cabergoline (0.25 mg per week) when her PRL levels were elevated to 250 ng/mL 38 months after therapeutic intervention with sirolimus. For the next 14 months, her respiratory function and PRL concentration both demonstrated improvement and her condition did not worsen any further. It has been reported that prolactin may exacerbate LAM. Our case suggests that a clinical reduction in PRL levels may also improve LAM.
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Affiliation(s)
- Yosuke Murakami
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan.,Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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32
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Inomata M, Kuse N, Awano N, Tone M, Yoshimura H, Jo T, Minami J, Takada K, Muto Y, Fujimoto K, Harada A, Bae Y, Kumasaka T, Yamakawa H, Sato S, Tobino K, Matsushima H, Takemura T, Izumo T. Utility of radial endobronchial ultrasonography combined with transbronchial lung cryobiopsy in patients with diffuse parenchymal lung diseases: a multicentre prospective study. BMJ Open Respir Res 2021; 8:8/1/e000826. [PMID: 33441374 PMCID: PMC7812092 DOI: 10.1136/bmjresp-2020-000826] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022] Open
Abstract
Background Radial endobronchial ultrasonography (R-EBUS) has been used in conjunction with transbronchial lung cryobiopsy (TBLC) to diagnose diffuse parenchymal lung disease (DPLD) and to decrease the risk of bleeding complications. The diagnostic utility of different R-EBUS signs, however, remains unknown. Objectives This study aimed to determine whether different R-EBUS signs could be used to more accurately diagnose DPLD and whether bronchial bleeding could be prevented with use of R-EBUS during TBLC. Method Eighty-seven patients with DPLD were included in this multicentre prospective study, with 49 patients undergoing R-EBUS. R-EBUS signals were characterised as displaying either dense or blizzard signs. Pathological confidence of specimens obtained from TBLC was compared between patients with dense versus blizzard signs, and severity of bronchial bleeding was determined based on whether R-EBUS was performed or not. Results All patients with dense signs on R-EBUS showed consolidation on high-resolution CT (HRCT) imaging. Pathological confidence of lung specimens was significantly higher in patients with dense signs versus those with blizzard signs (p<0.01) and versus those who did not undergo R-EBUS (p<0.05). Patients who underwent TBLC with R-EBUS were more likely to experience no or mild bronchial bleeding than patients who did not undergo R-EBUS (p<0.01), with shorter procedure times (p<0.01). Conclusions The dense R-EBUS sign corresponded with consolidation on HRCT. High-quality lung specimens may be obtainable when the dense sign is observed on R-EBUS, and R-EBUS combined with TBLC may reduce risk of bronchial bleeding and shorten procedure times.
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Affiliation(s)
- Minoru Inomata
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naoyuki Kuse
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nobuyasu Awano
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Mari Tone
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hanako Yoshimura
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Tatsunori Jo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Jonsu Minami
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kohei Takada
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yutaka Muto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazushi Fujimoto
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Akinori Harada
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuan Bae
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hideaki Yamakawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Shintaro Sato
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Hidekazu Matsushima
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan.,Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
| | - Takehiro Izumo
- Department of Respiratory Medicine, Japanese Red Cross Medical Center, Tokyo, Japan
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33
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Nishizawa S, Tobino K, Murakami Y, Hiramatsu Y, Kawabata T, Sakabe M, Sueyasu T. MORTALITY AND PROGNOSTIC FACTORS FOR SPONTANEOUS PNEUMOTHORAX IN THE ELDERLY. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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34
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Kawabata T, Tobino K, Sueyasu T, Nishizawa S. THE UTILITY AND SAFETY OF ULTRASOUND-GUIDED TRANSTHORACIC BIOPSY. Chest 2020. [DOI: 10.1016/j.chest.2020.09.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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35
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Sakabe M, Tobino K, Murakami Y, Kawabata T, Hiramatsu Y, Sueyasu T, Nishizawa S. A CASE OF NONTUBERCULOUS MYCOBACTERIA ASSOCIATED WITH BRONCHIAL ATRESIA. Chest 2020. [DOI: 10.1016/j.chest.2020.08.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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36
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Hiramatsu Y, Tobino K. A CASE OF HENOCH-SCHONLEIN PURPURA ASSOCIATED WITH TUBERCULOUS PLEURISY. Chest 2020. [DOI: 10.1016/j.chest.2020.08.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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37
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Ooi R, Tobino K, Sakabe M, Kawabata T, Hiramatsu Y, Sueyasu T, Yoshimine K. A case of large-cell lung carcinoma successfully treated with pembrolizumab but complicated with cholangitis. Respir Med Case Rep 2020; 31:101197. [PMID: 32944497 PMCID: PMC7481563 DOI: 10.1016/j.rmcr.2020.101197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022] Open
Abstract
Large-cell carcinoma (LCC) of the lung is defined as an undifferentiated non-small cell lung cancer (NSCLC) and accounts for approximately 7.5% of lung cancers. Immune checkpoint inhibitors (ICIs) may be effective for LCC, but there has been no firm evidence due to its low frequency. We herein report an 80-year-old woman with LCC of the lung who was successfully treated with pembrolizumab but developed sclerosing cholangitis as an immune-related adverse event. This case highlights the efficacy of ICIs for LCC as well as the importance of the immediate and detailed management of ICI-related sclerosing cholangitis.
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Affiliation(s)
- Ryunosuke Ooi
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan.,Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Mitsukuni Sakabe
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Takafumi Kawabata
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
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38
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Affiliation(s)
- Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
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39
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Yoshimatsu Y, Tobino K, Nagami S, Yagi N, Oku Y. Breathing-Swallowing Discoordination and Inefficiency of an Airway Protective Mechanism Puts Patients at Risk of COPD Exacerbation. Int J Chron Obstruct Pulmon Dis 2020; 15:1689-1696. [PMID: 32764914 PMCID: PMC7381778 DOI: 10.2147/copd.s257622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Dysphagia is a newly acknowledged multifactorial risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). Effective screening methods are awaited. We performed a prospective study to evaluate the impact of musculature and breathing-swallowing discoordination on the exacerbation of COPD with a novel swallowing monitor using a piezoelectric sensor. Patients and Methods This was the second part of a prospective study of patients with COPD from the Iizuka COPD cohort. Seventy patients with stable COPD underwent dysphagia screening, skeletal muscle mass index (SMI) and tongue pressure measurements, and swallowed 3 mL and 30 mL of water while wearing a swallowing monitor. Patients were followed for one year. Results During the follow-up period, 28 patients experienced exacerbations (E group), and 42 had none (non-E group). There was no significant difference in tongue pressure measurements between the two groups. The SMI in the E group was significantly lower than that in the non-E group. Among the swallowing monitor measurements, the 3 mL I-SW% (the percentage of swallows in which inspiration preceded the swallow [out of ten 3 mL swallows]) was significantly lower in the E group than in the non-E group. Conclusion Breathing-swallowing coordination is an independent factor related to the exacerbation of COPD. Not only the presence of discoordination but also the inability to produce an airway protection mechanism may contribute to more frequent aspiration and exacerbations.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan.,Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Iizuka, Fukuoka, Japan.,Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Naomi Yagi
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Department of Neurology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Medical Engineering, Himeji Dokkyo University, Himeji, Hyogo, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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40
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Yoshimatsu Y, Tobino K, Ko Y, Yasuda M, Ide H, Oku Y. Careful history taking detects initially unknown underlying causes of aspiration pneumonia. Geriatr Gerontol Int 2020; 20:785-790. [DOI: 10.1111/ggi.13978] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
- Department of PhysiologyHyogo College of Medicine Nishinomiya Japan
| | - Kazunori Tobino
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
- Department of Respiratory MedicineJuntendo University Graduate School of Medicine Tokyo Japan
| | - Yuki Ko
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
| | - Mina Yasuda
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
| | - Hiromi Ide
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
| | - Yoshitaka Oku
- Department of PhysiologyHyogo College of Medicine Nishinomiya Japan
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41
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Inomata M, Kuse N, Awano N, Tone M, Yoshimura H, Jo T, Minami J, Takada K, Yuan B, Kumasaka T, Yamakawa H, Sato S, Tobino K, Matsushima H, Takemura T, Izumo T. Prospective multicentre study on the safety and utility of transbronchial lung cryobiopsy with endobronchial balloon. ERJ Open Res 2020; 6:00008-2020. [PMID: 32607371 PMCID: PMC7306501 DOI: 10.1183/23120541.00008-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022] Open
Abstract
Transbronchial lung cryobiopsy (TBLC) has been increasingly utilised to diagnose diffuse parenchymal lung diseases (DPLDs) and lung cancers; however, TBLC protocols have not yet been standardised and the rate of complications associated with this procedure vary widely. Therefore, this prospective multicentre observational study investigated the safety and utility of the TBLC technique in patients with diffuse and localised respiratory diseases. This study was conducted at multiple medical centres in Japan between July 2018 and April 2019. The study's primary end-point was the rate of severe or serious adverse events associated with TBLC. Adverse events included bronchial bleeding, pneumothorax, pneumonia, respiratory failure, and an acute exacerbation of interstitial pneumonia. Adverse events were graded according to severity. During the TBLC procedure, an endobronchial balloon catheter for bronchial blockade was used in all patients. Pathological confidence and quality of specimens were categorised into three groups. A total of 112 patients were included. Neither severe nor serious adverse events were identified; therefore, the primary end-point was met. Nineteen patients (17%) experienced no bronchial bleeding. Mild or moderate bronchial bleeding was identified in 67% and 16% of patients, respectively. Mild pneumothoraces were identified in four patients (3.6%). The safety profile in patients aged ≥75 years was not significantly different from younger patients. Definite or probable pathological diagnoses were made in 84.9% of patients. This TBLC protocol with routine use of an endobronchial balloon had an acceptable safety profile and diagnostic yield in patients, including elderly ones, with diffuse and localised respiratory diseases.
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Affiliation(s)
- Minoru Inomata
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Naoyuki Kuse
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Nobuyasu Awano
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Mari Tone
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Hanako Yoshimura
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Tatsunori Jo
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Jonsu Minami
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Kohei Takada
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Bae Yuan
- Dept of Pathology, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Toshio Kumasaka
- Dept of Pathology, Japanese Red Cross Medical Center, Shibuya, Japan
| | - Hideaki Yamakawa
- Dept of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Shintaro Sato
- Dept of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Kazunori Tobino
- Dept of Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | | | - Tamiko Takemura
- Dept of Pathology, Japanese Red Cross Medical Center, Shibuya, Japan.,Dept of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takehiro Izumo
- Dept of Respiratory Medicine, Japanese Red Cross Medical Center, Shibuya, Japan
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42
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Tsuruno K, Tobino K, Sakabe M, Okahisa M, Nishizawa S, Yoshimine K, Ko Y, Ide H. Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer. Respir Med Case Rep 2020; 30:101094. [PMID: 32518745 PMCID: PMC7270597 DOI: 10.1016/j.rmcr.2020.101094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
We herein report a case with intractable pleural effusion attributed to superior vena cava (SVC) and upper extremity deep vein thrombosis in a patient with lung cancer. A 62-year-old woman presented to our hospital with shortness of breath and bilateral upper extremity edema. One year ago, she was diagnosed with stage IVB lung adenocarcinoma with bilateral malignant pleural effusions. A genetic analysis of the cells from pleural effusion revealed an epidermal growth factor receptor (EGFR) point mutation at exon 21 (L858R); since then, she was treated with gefitinib. Although her lung cancer and metastatic lesions had markedly reduced and the tumor cells in the pleural effusion had disappeared, pleural effusion remained. Contrast-enhanced whole-body computed tomography (CT) revealed intravenous thrombosis extending from the SVC to the left brachiocephalic and subclavian veins, and her pleural effusion was attributed to this thrombosis. Anticoagulant therapy with intravenous heparin and oral warfarin was started, nevertheless, the thrombus remained and pleural effusion did not decrease. After the placement of a pleuroperitoneal shunt, her pleural effusion resolved and her symptoms improved. This case highlights the importance of awareness of SVC or upper extremity deep vein thrombosis as a differential diagnosis of intractable pleural effusion in lung cancer patients.
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Affiliation(s)
- Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan.,Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Mitsukuni Sakabe
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Masanobu Okahisa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
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Goto Y, Tobino K, Munechika M, Yoshimatsu Y, Ide H, Tsuruno K. A familial case of Birt-Hogg-Dubé syndrome complicated with various cancers. Respirol Case Rep 2020; 8:e00549. [PMID: 32190329 PMCID: PMC7064864 DOI: 10.1002/rcr2.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/12/2020] [Accepted: 02/25/2020] [Indexed: 11/26/2022] Open
Abstract
An 89-year-old woman with small papules on her face presented to our hospital complaining of progressive dyspnoea. Chest computed tomography (CT) showed bilateral multiple lung cysts, a nodular opacity in the right lower lobe, and bilateral pleural effusion. She was diagnosed with adenocarcinoma. Her son, a 65-year-old man, also had bilateral basally located lung cysts and a past medical history of spontaneous pneumothorax. He had multiple papules on the face and neck, which were pathologically diagnosed as fibrofolliculomas. We considered these cases to be Birt-Hogg-Dubé syndrome (BHDS). Folliculin (FLCN) gene mutations that may be tumour suppressive are suspected to be causative of this syndrome. FLCN dysfunction might lead to the development of various types of tumours other than renal tumours.
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Affiliation(s)
- Yuki Goto
- Respiratory MedicineIizuka HospitalIizukaJapan
| | | | | | | | - Hiromi Ide
- Respiratory MedicineIizuka HospitalIizukaJapan
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Goto Y, Tobino K, Yoshimine K, Sueyasu T, Okahisa M, Sakabe M, Tsuruno K. An autopsy case of ruptured liver metastases from small cell lung cancer: A case report and literature review. Respir Med Case Rep 2020; 30:101039. [PMID: 32257791 PMCID: PMC7097517 DOI: 10.1016/j.rmcr.2020.101039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/15/2020] [Indexed: 01/04/2023] Open
Abstract
A 50-year-old male presented to our hospital complaining of dry cough and slight fever. A chest CT scan showed a mass in the right upper lung lobe, pleural effusion on both sides, and multiple liver tumors. He was diagnosed with small cell lung cancer (SCLC), and then antitumor chemotherapy was started. Thereafter, his condition deteriorated rapidly, and died 2 days later. An autopsy revealed that the cause of death was ruptured liver metastases. SCLC is a highly invasive disease and often metastasizes to the liver, but the rupture of liver metastases is rare. Clinical features and imaging findings were of a great help in diagnosing ruptured hepatic metastasis. Physicians need to pay attention to this condition, especially after chemotherapy has initiated.
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Affiliation(s)
- Yuki Goto
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
- Corresponding author.
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo; Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Masanobu Okahisa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Mitsukuni Sakabe
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
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Ko Y, Asakawa K, Tobino K, Oguma T, Hirai T, Takada T, Takahashi K, Seyama K. Quantitative analysis of computed tomography of the lungs in patients with lymphangioleiomyomatosis treated with sirolimus. Heliyon 2020; 6:e03345. [PMID: 32072050 PMCID: PMC7011043 DOI: 10.1016/j.heliyon.2020.e03345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/03/2019] [Accepted: 01/30/2020] [Indexed: 01/30/2023] Open
Abstract
Objectives We aimed to study sirolimus-related lung parenchymal changes by quantitative analysis of computed tomography (CT) of the lungs in patients with lymphangioleiomyomatosis (LAM). Methods We studied 20 participants from the Multicenter Lymphangioleiomyomatosis Sirolimus Trial for Safety study, who had undergone both thin-section CT scans and pulmonary function tests at baseline, 12, and 24 months. Quantitative CT parameters such as CT-derived total lung capacity, percentage of low attenuation area (LAA%), lung density histogram, fractal property of low attenuation area, and airway dimensions were analyzed, and correlations were conducted between the longitudinal change in each quantitative CT measurement and changes in pulmonary function were examined. Among 20 participants, pre-trial (n = 8) and post-trial (n = 16) CT data were also analyzed to deduce pathophysiologic implications of the serial changes in CT parameters during trial periods. Results FEV1 significantly increased from baseline to 24 months (slope 3.71 ± 1.50 ml/month) whereas FVC didn't during sirolimus therapy. Strikingly, LAA%, and skewness and kurtosis of density histogram significantly increased from baseline to 24 months, while mean and mode CT values significantly decreased from baseline to 24 months. Statistically significant positive correlations were found between ΔFEV1 and Δskewness (r = 0.465, p = 0.045). Taking the changes in lung density during pre-trial period into consideration, sirolimus decreases the area of -800 to -750 Housefield unit (HU) density and inhibits the decrease of -950 to -800 HU area during treatment, then producing the increased LAA% during the trial and post-trial periods. Given few sirolimus-related changes in airway dimensions, possible changes in lung mechanics may have contributed to increased FEV1. Conclusion Our study suggests that the lung density histogram parameters, kurtosis, and skewness, may be useful as indicators of the efficacy of sirolimus.
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Affiliation(s)
- Yuki Ko
- Division of Respiratory Medicine, Iizuka Hospital, Yoshio-Machi 3-83, Iizuka-Shi, Fukuoka 820-8505, Japan.,Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Katsuaki Asakawa
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital, Asahi-Dori 1-754, Chyuo-Ku, Niigata, 951-8520, Japan
| | - Kazunori Tobino
- Division of Respiratory Medicine, Iizuka Hospital, Yoshio-Machi 3-83, Iizuka-Shi, Fukuoka 820-8505, Japan.,Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Tsuyoshi Oguma
- Division of Respiratory Medicine, Kyoto University Faculty of Medicine and Graduate School of Medicine, Kawara-Machi 54, Seigoin, Sakyo-Ku, Kyoto 606-8507, Japan
| | - Toyohiro Hirai
- Division of Respiratory Medicine, Kyoto University Faculty of Medicine and Graduate School of Medicine, Kawara-Machi 54, Seigoin, Sakyo-Ku, Kyoto 606-8507, Japan
| | - Toshinori Takada
- Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Urasa 4132, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Kazuhisa Takahashi
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan
| | - Kuniaki Seyama
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Hongo 3-1-3, Bunkyo-Ku, Tokyo 113-8421, Japan
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Yoshimatsu Y, Tobino K, Sueyasu T, Nishizawa S, Ko Y, Yasuda M, Ide H, Tsuruno K, Miyajima H. Repetitive Saliva Swallowing Test Predicts COPD Exacerbation. Int J Chron Obstruct Pulmon Dis 2019; 14:2777-2785. [PMID: 31824143 PMCID: PMC6900275 DOI: 10.2147/copd.s226268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022] Open
Abstract
Introduction Predicting phenotypes at risk of chronic obstructive pulmonary disease (COPD) exacerbation is extremely important. Dysphagia is becoming recognized as one of these phenotypes. A convenient method of screening for dysphagia and COPD exacerbation risk is desired. The repetitive saliva swallowing test (RSST) is one of the least invasive dysphagia screening methods. We previously reported the possible relation between the RSST result and COPD exacerbation in a retrospective study. Based on this, we performed a prospective study to evaluate the efficacy of RSST as a predictor of COPD exacerbation and to determine its optimal cut-off value for COPD. Methods Seventy patients with COPD were recruited. Patients underwent the following dysphagia screening tests: the 10-item Eating Assessment Tool, Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease, RSST, water swallowing test, and simple swallow provocation test. After one year, they were classified into two groups according to the presence of COPD exacerbation during the follow-up period. Results Twenty-seven patients had one or more exacerbations in the past year. During the follow-up period, 28 patients had one or more exacerbations (E group), and 42 had none (non-E group). There were no significant differences between the groups except for the presence of past exacerbations and the results of the RSST, when the cut-off value was set at 2, 3, 4, or 5 swallows. The number of swallows in the RSST was significantly lower in the E group than in the Non-E group. A cut-off value of 5 was the most effective. The time to first exacerbation was significantly longer in those with an RSST value of >5. The RSST was more reliable for differentiating the E group and non-E group than the presence of exacerbation in the past year (hazard ratios: 13.78 and 2.70, respectively). Conclusion An RSST cut-off value of 5 may be a strong predictor of COPD exacerbation.
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Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan.,Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8431, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Mina Yasuda
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
| | - Hiroyuki Miyajima
- Department of Respiratory Medicine, Iizuka Hospital, Fukuoka 820-8505, Japan
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Abstract
Primary pleural melanoma is an extremely rare neoplasm, and to the best of our knowledge, there have been only 8 case reports of this condition in the English literature. We herein report a rare case in which the cytological and immunocytochemical analyses of pleural fluid and ultrasonography (US)-guided biopsy of a pleural lesion were useful for the diagnosis primary pleural melanoma. This case highlights the importance of careful physical examinations, cytomorphologic and immunocytochemical analyses of pleural fluid, as well as the utility of US-guided biopsy of the pleural lesions in the diagnosis of primary pleural melanoma.
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Affiliation(s)
- Kojin Murakami
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Yoshikazu Yamaji
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Japan
| | - Ryunosuke Ooi
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | | | - Yuki Enzan
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | | | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Hiromi Ide
- Department of Respiratory Medicine, Iizuka Hospital, Japan
| | - Noriyuki Ebi
- Department of Respiratory Medicine, Iizuka Hospital, Japan
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48
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Yoshimatsu Y, Tobino K, Sueyasu T, Nishizawa S, Goto Y, Murakami K, Munechika M, Yoshimine K, Miyajima H. Repetitive saliva swallowing test and water swallowing test may identify a COPD phenotype at high risk of exacerbation. Clin Respir J 2019; 13:321-327. [DOI: 10.1111/crj.13014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/16/2019] [Accepted: 02/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory Medicine Iizuka Hospital Fukuoka Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine Iizuka Hospital Fukuoka Japan
- Department of Respiratory Medicine Juntendo University Graduate School of Medicine Tokyo Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine Iizuka Hospital Fukuoka Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine Iizuka Hospital Fukuoka Japan
| | - Yuki Goto
- Department of Respiratory Medicine Iizuka Hospital Fukuoka Japan
| | - Kojin Murakami
- Department of Respiratory Medicine Iizuka Hospital Fukuoka Japan
| | - Miyuki Munechika
- Department of Respiratory Medicine Iizuka Hospital Fukuoka Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine Iizuka Hospital Fukuoka Japan
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Yamate R, Matono T, Yaguchi T, Fujii Y, Goto Y, Tobino K, Imura H, Nagano S. Disseminated nocardiosis with Nocardia brasiliensis bacteremia in a patient with rheumatoid arthritis using tocilizumab. J Infect Chemother 2019; 25:552-555. [PMID: 30852105 DOI: 10.1016/j.jiac.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/08/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023]
Abstract
Here, we present a case of disseminated nocardiosis, involving pneumonia, percutaneous abscess, and bacteremia, in a 67-year-old Japanese woman. She had also been treated for rheumatoid arthritis with prednisolone, methotrexate, and tocilizumab (interleukin-6 receptor inhibitor). Based on the 16S rRNA sequence analysis and a blast search, we identified the isolate as Nocardia brasiliensis. We discontinued methotrexate and tocilizumab on admission, and administered intravenous antimicrobial combination therapy for 6 weeks, followed by oral trimethoprim-sulfamethoxazole for 12 months, in total. Nocardia bacteremia is rare, often difficult to diagnose, and substantially fatal. However, due to our prompt diagnosis within one day of the onset of symptoms, and administration of appropriate treatment based on antimicrobial susceptibilities, this patient succeeded in surviving the infection. Not only microbiologists but also clinicians should be aware of the characteristic bacterial form of Gram/Kinyoun staining for early recognition of nocardiosis.
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Affiliation(s)
| | | | - Takashi Yaguchi
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Yuki Goto
- Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | | | - Hiroshi Imura
- Department of General Internal Medicine, Iizuka, Japan
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Yoshimatsu Y, Tobino K, Maeda K, Kubota K, Haruta Y, Adachi H, Abe T, Masunaga T, Sueyasu T, Osaki T. Management of Airway Obstruction due to Diffuse Idiopathic Skeletal Hyperostosis in the Cervical Spine: A Case Report and Literature Review. Intern Med 2019; 58:271-276. [PMID: 30146564 PMCID: PMC6378156 DOI: 10.2169/internalmedicine.1071-18] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively common progressive noninflammatory entheses disease. Patients are often asymptomatic or are undiagnosed due to minor chronic symptoms. We herein report a rare case in which the primary symptom was sudden-onset upper airway obstruction due to exuberant osteophytosis in the cervical spine. Treatment was successful with careful airway management and surgical osteophyectomy. Most DISH cases in the literature with airway obstruction have been managed with tracheotomy. However, the safety and necessity of this approach remain questionable. We herein discuss the possibility of conservative management as a choice of airway control. Airway obstruction due to DISH may be underrecognized. This highlights the importance of including DISH in the differential diagnosis of airway obstruction. In addition, a detailed evaluation and personalized care for each individual case is essential.
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Affiliation(s)
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, Japan
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Ken Maeda
- Department of Orthopedic Surgery, Spinal Injuries Center, Japan
| | - Kensuke Kubota
- Department of Orthopedic Surgery, Spinal Injuries Center, Japan
| | - Yohei Haruta
- Department of Orthopedic Surgery, Iizuka Hospital, Japan
| | | | - Toshiyuki Abe
- Department of Gastroenterology, Iizuka Hospital, Japan
| | | | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, Japan
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