Background. The advent of macrolides has led to therapeutic advances in the treatment of Mycobacterium avium complex lung disease (MAC-LD). The aim of this study was to elucidate the treatment ...outcomes of macrolide-containing regimens. Methods. We performed a systematic review and meta-analysis of published studies reporting treatment outcomes of macrolide-containing regimens for MAC-LD using the Medline, Embase, and Cochrane Library databases through 31 July 2016. The rates of treatment success, default from treatment, and adverse events of macrolide-containing regimens were assessed. Treatment success was defined as either 12 months of sustained culture negativity while on therapy or achievement of culture conversion and completion of the planned treatment without relapse. Results. In total, 16 studies involving 1462 patients were included. The rate of treatment success was 60.0% (95% confidence interval CI, 55.1%–64.8%). The proportion of patients who defaulted from the treatment was 16.0% (95% CI, 12.3%–19.7%). When a thrice-weekly dosing schedule was available, the default rate was 12.0% (95% CI, 8.9%–15.0%). Adverse events necessitating treatment discontinuation or dosage modification of macrolides were observed in 6.4% of patients (95%, CI, 3.2%–9.5%), and decreased auditory acuity was the most common adverse event. Conclusions. Treatment outcomes of macrolide-containing regimens are relatively poor in terms of both the treatment success and default rates. The default rate could be reduced if a thrice-weekly dosing schedule is available. Clinicians should be aware of decreased auditory function as the most common adverse event associated with macrolide-containing regimens.
A series of Fe-30 wt%Mn-10.5 wt%Al-1.1 wt%C steels with Mo addition from 0 to 5 wt% were prepared to investigate the effect of Mo on the microstructure and tensile deformation behavior of austenitic ...lightweight steel. When the Mo content was below 4 wt%, the microstructure of solution-treated samples consisted of austenite and κ–carbide, while Mo-enriched M6C and M23C6 carbides were additionally precipitated in samples containing Mo more than 4 wt% during a solution treatment at 1050 °C. These carbides inhibited austenite grain growth during the solution treatment, resulting in significant grain refinement in the samples containing more that 4 wt% of Mo. Tensile test results showed that the yield strength gradually decreased with an increase in the Mo content up to 3 wt% due to the suppression of κ–carbide precipitation, whereas it significantly increased when the Mo content exceeded 4 wt% due to grain refinement and precipitation strengthening caused by Mo-enriched carbides. During the tensile deformation, the strain hardening rates of all alloys increased and then the deformation mode subsequently changed with an increase in the Mo content from shearband-induced plasticity (SIP) to microband-induced plasticity (MBIP). Finally, the change in the κ-carbide precipitation behavior upon the addition of Mo and its effect on the deformation behavior were carefully analyzed and discussed through nanoindentation experiments, first-principles calculations and atom probe tomography analyses.
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Background. Mycobacterium abscessus and Mycobacterium massiliense are grouped as the Mycobacterium abscessus complex. The aim of this study was to elucidate the differences between M. abscessus and ...M. massiliense lung diseases in terms of progression rate, treatment outcome, and the predictors thereof. Methods. Between 1 January 2006 and 30 June 2015, 56 patients and patients were diagnosed with M. abscessus and M. massiliense lung diseases, respectively. The time to progression requiring treatment and treatment outcomes were compared between the 2 groups of patients, and predictors of progression and sustained culture conversion with treatment were analyzed. In addition, mediation analysis was performed to evaluate the effect of susceptibility to clarithromycin on treatment outcomes. Results. During follow-up, 21 of 56 patients with M. abscessus lung diseases and 21 of 54 patients with M. massiliense lung diseases progressed, requiring treatment. No difference was detected in the time to progression between the 2 patient groups. Lower body mass index, bilateral lung involvement, and fibrocavitary-type disease were identified as predictors of disease progression. Among the patients who began treatment, infection with M. massiliense rather than M. abscessus and the use of azithromycin rather than clarithromycin were associated with sustained culture conversion. The difference in treatment outcomes was partly mediated by the organism's susceptibility to clarithromycin. Conclusions. Progression rates were similar but treatment outcomes differed significantly between patients with lung disease caused by M. abscessus and M. massiliense. This difference in treatment outcomes was partly explained by the susceptibility of these organisms to clarithromycin.
This study revealed that patients with IPF have a higher cancer incidence risk than matched controls without IPF. Physicians should be aware of this risk when treating patients with IPF.
ABSTRACT
...Background and objective
IPF shares common risk factors and has pathogenic similarities with cancer. However, limited population‐based data are available on cancer risk among patients with IPF. Herein, we investigated whether IPF is associated with an increased risk for cancer incidence from a nationwide database in South Korea.
Methods
In this population‐based cohort study, patients with IPF were enrolled from 2009 to 2014, and matched controls were randomly selected at a control‐to‐case ratio of 3:1. In both groups, individuals diagnosed with any malignancy before the index date were excluded. The incidence rates of cancer were measured as the number of events per 1000 person‐years. Multivariable Cox regression models were used to assess the cancer incidence risk.
Results
This study included 25 241 patients with IPF and 75 723 matched controls. The overall cancer incidence in patients with IPF was 29.0 cases per 1000 person‐years, and it was significantly higher in the IPF group than in the non‐IPF group (HR, 2.09; 95% CI, 1.96–2.16). Lung cancer showed the highest HR (5.89; 95% CI, 5.40–6.42), followed by lymphoma, skin, uterine cervical, multiple myeloma, thyroid, leukaemia, pancreatic, liver and prostate cancer. Moreover, adjustment for the effects of smoking and other cancer‐associated covariates had little effect on the HR of overall and specific cancers.
Conclusion
The cancer incidence risk was higher in the IPF group than in the non‐IPF group. Therefore, healthcare providers should be aware of this risk when treating patients with IPF.
The severity of the coronavirus disease (COVID-19) is associated with various comorbidities. However, no studies have yet demonstrated the potential risk of respiratory failure and mortality in ...COVID-19 patients with pre-existing asthma. We selected 7272 adult COVID-19 patients from the Korean Health Insurance Review and Assessment COVID-19 database for this nationwide retrospective cohort study. Among these, 686 patients with asthma were assessed by their severities and evaluated by the clinical outcome of COVID-19 compared to patients without asthma. Of 7272 adult COVID-19 patients, 686 with asthma and 6586 without asthma were compared. Asthma was not a significant risk factor for respiratory failure or mortality among all COVID-19 patients (odds ratio OR = 0.99, P = 0.997 and OR = 1.06, P = 0.759) after adjusting for age, sex, and the Charlson comorbidity score. However, a history of acute exacerbation (OR = 2.63, P = 0.043) was significant risk factors for death among COVID-19 patients with asthma. Asthma is not a risk factor for poor prognosis of COVID-19. However, asthma patients who had any experience of acute exacerbation in the previous year before COVID-19 showed higher COVID-19-related mortality, especially in case of old age and male sex.
Underlying chronic respiratory disease may be associated with the severity of coronavirus disease 2019 (COVID-19). This study investigated the impact of chronic obstructive pulmonary disease (COPD) ...on the risk for respiratory failure and mortality in COVID-19 patients. A nationwide retrospective cohort study was conducted in 4610 patients (≥ 40 years old) infected with COVID-19 between January 20 and May 27, 2020, using data from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The clinical course and various clinical features were compared between COPD and non-COPD patients, and the risks of respiratory failure and all-cause mortality in COPD patients were analyzed using a multivariate logistic regression model. Among 4610 COVID-19 patients, 4469 (96.9%) and 141 (3.1%) were categorized into the non-COPD and COPD groups, respectively. The COPD group had greater proportions of older (≥ 60 years old) (78.0% vs. 45.2%, P < 0.001) and male (52.5% vs. 36.6%, P < 0.001) patients than the non-COPD group. Relatively greater proportions of patients with COPD received intensive critical care (7.1% vs. 3.7%, P = 0.041) and mechanical ventilation (5.7% vs. 2.4%, P = 0.015). Multivariate analyses showed that COPD was not a risk factor for respiratory failure but was a significant independent risk factor for all-cause mortality (OR = 1.80, 95% CI 1.11-2.93) after adjustment for age, sex, and Charlson Comorbidity Index score. Among COVID-19 patients, relatively greater proportions of patients with COPD received mechanical ventilation and intensive critical care. COPD is an independent risk factor for all-cause mortality in COVID-19 patients in Korea.
Smoking has been considered an important risk factor for idiopathic pulmonary fibrosis (IPF) incidence. However, there are no population-based large-scale studies demonstrating the effects of smoking ...on the development of IPF. We aimed to evaluate the effect of smoking on IPF development using a nationwide population-based cohort.
Using the Korean National Health Information Database, we enrolled individuals who had participated in the health check-up service between 2009 and 2012. Participants having a prior diagnosis of IPF were excluded. The history of smoking status and quantity was collected by a questionnaire. We identified all cases of incident IPF through 2016 on the basis of ICD-10 codes for IPF and medical claims. Cox proportional hazards models were used to calculate the adjusted HR (aHR) of the development of IPF.
A total of 25 113 individuals (0.11%) with incident IPF were identified out of 23 242 836 participants registered in the database. The risk of IPF was significantly higher in current and former smokers than in never smokers, with an aHR of 1.66 (95% CI 1.61 to 1.72) and 1.42 (95% CI 1.37 to 1.48), respectively. Current smokers had a higher risk of IPF than former smokers (aHR 1.17, 95% CI 1.13 to 1.21). The risk of IPF development increased as the smoking intensity and duration increased.
Smoking significantly increased the risk of IPF development. Current smokers had a higher risk of IPF than former smokers. A dose-response relationship was observed between smoking and the development of IPF.
Abstract
Introduction
Metabolic syndrome is known to increase the risk of several cancers. However, the association between lung cancer and metabolic syndrome remains unclear. Thus, we investigated ...the impact of metabolic syndrome on the incidence of lung cancer.
Methods
This study enrolled participants in a health screening program provided by the Korean National Health Insurance Service between January 2009 and December 2012. The incidence of lung cancer was observed until December 2016. We analyzed the risk of lung cancer according to the presence of metabolic syndrome, metabolic syndrome components, and number of metabolic syndrome components.
Results
During the study, 45 635 new cases of lung cancer were recorded among 9 586 753 participants. The presence of metabolic syndrome and all its components was positively associated with the risk of lung cancer in men after multivariate adjustment (hazard ratio HR of metabolic syndrome 1.15; 95% confidence interval CI, 1.12-1.18). The risk of lung cancer increased with the number of components present. The effect of metabolic syndrome on the increasing risk of lung cancer is may be higher in underweight male ever-smokers than in other participants.
Conclusion
Metabolic syndrome was associated with an increased risk of lung cancer in men. Moreover, the higher the number of metabolic syndrome components, the higher the risk of lung cancer.
Background: The proportion of never?smokers with non?small cell lung cancer(NSCLC) is increasing, but that in Korea has not been well addressed in a large population. We aimed to evaluate the ...proportion and clinical features of never?smokers with NSCLC in a large single institution.Methods: We analyzed clinical data of 1860 consecutive patients who were newly diagnosed with NSCLC between June 2011 and December 2014.Results: Of the 1860 NSCLC patients, 707(38.0%) were never?smokers. The proportions of women(83.7% vs. 5.6%) and adenocarcinoma(89.8% vs. 44.9%) were higher among never?smokers than among ever?smokers. Significantly more never?smokers were diagnosed at a younger median age(65 vs. 68 years, P < 0.001) and earlier stage(stage I–II, 44.5% vs. 38.9%, P < 0.001) a= 0.015) compared with ever?smokers. Epidermal growth factor receptor mutations(57.8% vs. 24.4%, Pnd anaplastic lymphoma kinase rearrangements(7.8% vs. 2.8%, P < 0.001) were more common in never?smokers, whereas Kirsten rat sarcoma viral oncogene homolog mutations(5.8% vs. 9.6%, P ntly encountered in never?smokers than in ever?smokers. Never?smokers showed longer su= 0.021) were less frequervival after adjust?ing for the favorable effects of younger age, female sex, adenocarcinoma histology, better performance status, early stage disease, being asymptomatic at diagnosis, received antitumor treatment, and the presence of driver mutations(hazard ratio, 0.624; 95% confidence interval, 0.460–0.848; P = 0.003).Conclusions: More than one?third of the Korean patients with NSCLC were never?smokers. NSCLC in never?smokers had different clinical characteristics and major driver mutations and resulted in longer overall survival compared with NSCLC in ever?smokers.
Given the pleiotropic effects of statins beyond their lipid-lowering effects, there have been attempts to evaluate the role of statin therapy in IPF, but they have shown inconclusive results. Data ...from the National Health Insurance Service (NHIS) database of South Korea were used to investigate the effects of statin therapy on IPF. The IPF cohort consisted of a total of 10,568 patients who were newly diagnosed with IPF between 2010 and 2017. These patients were then matched in a 1:3 ratio to 31,704 subjects from a control cohort without IPF, with matching based on age and sex. A case-control study was performed to evaluate the association between statin use and the risk for IPF, and the multivariable analysis revealed that statin use was associated with a lower risk for IPF (adjusted OR 0.847, 95% CI 0.800-0.898). Using the IPF cohort, we also evaluated whether statin use at the time of diagnosis was associated with future clinical outcomes. The statin use at the time of IPF diagnosis was associated with improved overall survival (adjusted HR 0.779, 95% CI 0.709-0.856). Further prospective studies are needed to clarify the role of statin therapy in IPF.
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