Determination and pharmacokinetic study of riociguat by UPLC-MS/MS in human plasma

Pulmonary hypertension (PH) is frequent in the general population and is linked to an increased risk of death. Riociguat is a kind of endothelin receptor antagonist that is often used to treat PH. For pharmacokinetic studies and the determination of riociguat in PH patients, a new, quick, easy, and sensitive UPLC-MS/MS approach was designed and validated. Riociguat and irbesartan (IS) were detected using ESI in positive ion and multiple reaction monitoring mode, respectively, by monitoring the mass transitions m/z 423.0 → 391.0 and 429.1 → 206.9. A reverse-phase C18 column (5 μm, 4.6 × 150 mm) was used with an isocratic mobile phase of water containing 0.1 % formic acid-acetonitrile (25:75, v/v) at a flow rate of 1 ml/min for chromatographic separation. In the range of 5-400 ng/ml, the calibration curve was linear and had a good correlation coefficient (0.9972). This is the first UPLC-MS/MS technique that has been developed and validated for determining riociguat from human plasma. The developed analytical method was extensively validated for linearity, selectivity, specificity, accuracy, precision, sensitivity, stability, matrix effect and recovery, according to FDA criteria. The devised approach was successfully used for a pharmacokinetic research and riociguat determination in PH patients.

Are Trace Element Concentrations in Lung Cancer Tissue Associated with Metastasis?

OBJECTIVE

Lung cancer is among the leading causes of cancer-related deaths. Many exogenous and endogenous factors are associated with the development and progression of this cancer. Among these factors are trace elements, which have many biological functions despite their low concentrations in the body and may disrupt cellular functions and contribute to tumorigenesis when present in excessive or insufficient quantities. In this study, we performed elemental analysis of lung cancer tissues to evaluate the role of trace element concentrations in the formation of metastasis in lung cancer.

MATERIALS AND METHODS

Lung cancer tissue specimens were collected from 65 patients with different cancer stages and histological subtypes for elemental analysis. After the tissues were embedded in paraffin blocks and prepared, the concentrations of 19 elements were analyzed by using inductively coupled plasma-optical emission spectroscopy (ICP-OES). All of the patients included in the study underwent diagnosis, treatment, and follow-up in our center between 2015 and 2020.

RESULTS

Comparison of trace element concentrations in three different lung cancer subtypes according to cancer stage showed that lead (Pb) and aluminum (Al) concentrations increased significantly as cancer stage advanced (P < .0001 for both). Trace element concentrations did not differ significantly based on patient sex or age.

CONCLUSION

Lead and aluminum concentrations in the tissues of lung cancer patients may contribute to the formation of metastases, which have a major impact on the prognosis of lung cancer.

Behçet's Disease: Different Systemic Manifestations at Different Ages

Behçet's disease, an inflammatory condition, can involve various systems. The disease usually manifests with dermatologic and ocular signs but can also cause serious symptoms due to pulmonary or neurologic involvement. Although the onset may occur at any age, it typically emerges in the second to fourth decades of life. As in the case presented here, Behçet's disease can manifest with the central nervous system involvement early in life and pulmonary involvement in adulthood.

Comparison of Functional Capacity and Symptoms of COPD Patients with and without Pulmonary Hypertension

OBJECTIVE

Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD) associated with a decrease in the survival rate of patients with COPD. Our aim was to investigate whether PH impairs the functional capacity and symptoms in patients with COPD. In addition, we aimed to evaluate the correlation between the functional capacity and symptoms score in patients with COPD.

MATERIALS AND METHODS

This prospective cross-sectional study enrolled 64 patients with moderate to severe COPD, prospectively. All patients underwent the pulmonary function test, echocardiography, 6-minute walk test (6MWT), and cardiopulmonary exercise testing (CPET). We applied the modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) to all patients. The mean pulmonary arterial pressure (mPAP) >30 mmHg with echocardiography was considered as PH. The patients were grouped according to the presence of PH as COPD-PH (n=30) and COPD-nonPH (n=34).

RESULTS

Hospitalization rate was higher in the COPD-PH group than in the COPD-nonPH group (p=0.006). The 6MWT results were lower in the COPD-PH group compared to the COPD-nonPH group (325±61 m vs. 354±46 m, respectively, p=0.025). In the COPD-PH group, the maximum oxygen consumption (VO2max) was lower, but the difference did not reach statistical significance (p=0.118). Although the maximum load and minute ventilation were lower in the COPD-PH group, the end-tidal pressure of CO2 (PETCO2) was higher (p=0.033, p=0.036, and p=0.009, respectively). However, the CAT score and mMRC were similar between the groups (p=0.405 and p=0.238, respectively).

CONCLUSION

An elevated PAP in patients with COPD limits the exercise capacity. Using CPET in the functional evaluation of patients with COPD may be beneficial in the early detection of PH.

Current Pharmacological Approach to ARDS: The Place of Bosentan

Acute respiratory distress syndrome is characterized by dyspnea at presentation, tachypnea on physical examination, findings of bilateral infiltration in chest radiography, refractory hypoxia, and high mortality. Although the main treatment approach is to address the underlying disease, there are also pharmacological and nonpharmacological options for supportive treatment. There is currently no pharmacological agent with proven efficacy in this syndrome, and many drugs are being studied for this purpose. One of these is the endothelin receptor antagonist bosentan.

Relevance of Pulmonary Alveolar Echinococcosis

BACKGROUND

Pulmonary alveolar echinococcosis (PAE) is a chronic disease caused by Echinococcus multilocularis with very low incidence in developed countries.

METHODS

This single-center, retrospective study included 34 patients who were diagnosed with PAE between January 2001 and February 2019 (15 males, 19 females, mean age: 52.4±15.8 years, age range: 28-78 years) in Ataturk University Medical School, Erzurum, Turkey.

RESULTS

The liver was the primary involved organ in all cases. Pulmonary involvement was detected in 13.0% (34/261) of all cases with hepatic alveolar echinococcosis (AE), and three patients (8.8%) had both pulmonary metastasis and brain metastasis. The route of spread to the lungs based on radiological data was hematogeneous in 25 patients (73.5%), transdiaphragmatic in three patients (8.8%) and both hematogeneous and transdiaphragmatic in six patients (17.7%). AE showed bilateral involvement in 19 patients (55.9%), whereas only the right lung was involved in 12 patients (35.3%) and the left lung in three patients (8.8%). Of the patients, five underwent surgery due to PAE and 29 patients received medical therapy with albendazole. A total of three patients died during the follow-up period (2, 5 and 10 years after the diagnosis of PAE), while 31 patients continued with follow-up and treatment for a mean duration of 5.4±3.8 years (1-14 years).

CONCLUSIONS

Patients with hepatic AE must, as a matter of course, be screened for possible lung involvement. Albendazole therapy may slow down disease progression in patients with widespread pulmonary involvement who are not eligible for surgery.

The Frequency of Monocyte Chemoattractant Protein-1 Gene Polymorphism in Obstructive Sleep Apnea Syndrome

PURPOSE

In obstructive sleep apnea syndrome (OSAS) many proinflammatory cytokines are released from activated endothelial cells due to repeated decreases in arterial oxygen saturation. Some of these proinflammatory cytokines are involved in the etiology of coronary artery disease (CAD). Although the association between OSAS and CAD is known, risk factors for CAD have not been determined in this patient group. Monocyte chemoattractant protein-1 (MCP-1) is a proinflammatory cytokine that plays a key role in the development of atherosclerosis. In this study, we compared the frequency of MCP1 rs1024610-rs1024611 single-nucleotide polymorphisms (SNPs) in OSAS patients with no comorbidity, OSAS patients with no comorbidity except CAD, and healthy individuals.

MATERIAL AND METHODS

The study included 301 subjects. Two hundred one patients with OSAS (OSAS only and OSAS + CAD groups) and 100 healthy control subjects underwent polysomnography. MCP1 rs1024610 and rs1024611 mutation frequencies were determined.

RESULTS

Body mass index, apnea-hypopnea index, triglyceride levels, and mean oxygen desaturation were significantly higher in the OSAS patients than in the healthy population (p < 0.05). In MCP1 rs1024611 SNP analysis, homozygous mutation was significantly more common in the OSAS + CAD group than in the OSAS and control groups (p < 0.001). MCP1 rs1024610 SNP analysis showed no significant differences among the study groups.

CONCLUSION

OSAS patients with homozygous MCP1 rs1024611 SNP are at higher risk for CAD. The MCP1 rs1024610 SNP was not associated with incidence of CAD. Patients with OSAS and MCP1 rs1024611 homozygous mutation are more susceptible to CAD and early detection and treatment may significantly reduce mortality and morbidity.

Female workers' silicosis diagnosis delayed due to gender bias

After excluding alternative explanations, a silicosis diagnosis is based on the combination of appropriate silica exposure history and compatible clinical, radiological and occasionally pathological findings. Not taking appropriate occupational history by a physician may cause a misdiagnosis or underdiagnosis of silicosis. Herein, we present a female worker in a small-scale sandblasting factory who worked as a controller. Her silicosis diagnosis was established 10 years after her first symptoms, and she underwent invasive procedures due to a lack of inquiry about her occupational history. Gender bias may be one of the reasons that her occupational history was not taken.

Sulfasalazine-Induced Interstitial Fibrosis

Sulfasalazine has been used in the treatment of inflammatory bowel disease for over 60 years. Although the drug is frequently associated with gastrointestinal adverse effects, pulmonary adverse effects are very rare. Herein, we report a case of interstitial fibrosis resulting from 4-month sulfasalazine therapy for ulcerative colitis in a patient under long-term follow-up in our clinic due to chronic obstructive pulmonary disease.

Acute respiratory distress syndrome after the use of gadolinium contrast agent

Acute respiratory distress syndrome (ARDS) is a life-threatening medical emergency. The etiology of ARDS can involve various causes. ARDS associated with the use of iodinated contrast media is rarely reported, and the literature includes only one case of ARDS due to gadobutrol. A 46-year-old female patient presented to our emergency department with shortness of breath, wheezing, swelling of the lips, and difficulty swallowing about 30 minutes after undergoing magnetic resonance imaging with 6.5 ml (0.1 ml/kg) gadobutrol (Gadovist) contrast for a submandibular mass. She was treated for anaphylaxis, then immediately evaluated using chest x-ray and arterial blood gas analysis. Based on the findings, she was diagnosed with ARDS and started on continuous positive airway pressure (CPAP) ventilatory support and methylprednisolone at a dose of 1 mg/kg/day. On day 3 of follow-up, all symptoms had completely regressed.

Comparison of long-term outcomes of 50 and 100 mg rt-PA in the management of acute pulmonary thromboembolism

BACKGROUND

Pulmonary thromboembolism (PTE) is a life-threatening disease. In this study, we aimed to evaluate long-term outcomes of the use of 50 mg recombinant tissue-type plasminogen activator (rt-PA) in the management of PTE in terms of relapse, pulmonary hypertension (PH), mortality and hemorrhage and to compare with the use of 100 mg rt-PA.

METHODS

The study was designed as a retrospective cohort. Patients who were diagnosed as acute PTE and received either 50 or 100 mg rt-PA in a tertiary care hospital between 2010 and 2015 were included in the study. Rates of relapse, PH, mortality (in-hospital and long-term) and hemorrhage (major and minor) were calculated for each treatment group.

RESULTS

A total 117 patients, 73 females and 44 males, were evaluated. Eighty-three patients were administered 100 mg rt-PA, and 34 were administered 50 mg rt-PA. The mean age was lower in the 100 mg group compared to the 50 mg group (61 ± 15 vs 69 ± 14 years). There was a significant decrease in PH in each group at 3 months follow-up (P < .001). Although statistically nonsignificant, the relapse rate was lower in the 50 mg rt-PA group, but the 5-year mortality rate was higher in 50 mg rt-PA group (35.2% vs 27.7%, P = .50). Mortality was associated with older age and presence of malignancy.

CONCLUSIONS

Our results suggest that both doses of rt-PA have similar efficacy. The high mortality rate in the 50 mg group may have resulted from patient selection.

Acute respiratory distress syndrome; A rare complication caused by usage of ruxolitinib

Ruxolitinib-associated acute respiratory distress has rarely been reported, mostly due to discontinuation of treatment. Herein we report a 58-year-old male patient with primary myelofibrosis who presented with malaise and dyspnea 15 days after initiation of the treatment. The patient was diagnosed as mild acute respiratory distress syndrome (ARDS). After excluding other potential causes such as infection and cardiac pathologies, it was considered secondary to ruxolitinib use. The medication was discontinued and 1 mg/kg methylprednisolone was given to prevent cytokine rebound syndrome and continuous positive airway pressure therapy was prescribed for ARDS. Symptomatic improvement and complete radiological resolution was observed. This case suggests that ARDS may develop secondary to ruxolitinib use and ARDS should be keep in mind in the cases with respiratory symptoms who were on treatment.

Predictive Value of Mean Platelet Volume for Pulmonary Embolism Recurrence

PURPOSE

Recurrence is a major clinical problem in patients with pulmonary embolism and can affect mortality. The decision to discontinue treatment is important for recurrence and is based on patients' clinical features as well as certain blood parameters. Our aim in this study was to evaluate whether mean platelet volume (MPV) and platelet distribution width (PDW) have utility as new predictive parameters for recurrence and mortality in pulmonary embolism.

MATERIALS AND METHODS

A total of 440 patients with pulmonary embolism underwent computed tomography, Doppler ultrasonography, and echocardiography before and at the conclusion of treatment. Thrombocyte count, MPV, PDW, and D-dimer parameters were also evaluated at the same time points.

RESULTS

MPV and PDW were significantly higher in deceased patients (8.8 ± 1.2 fl and 17.4 ± 0.8) compared to surviving patients (7.7 ± 0.9 fl and 17 ± 0.9) (p < 0.0001). Initial MPV and PDW were also significantly higher in patients with recurrence (8.4 ± 0.7 vs 7.6 ± 0.8 fl, p < 0.0001 and 17.3 ± 0.8 vs 16.9 ± 0.9, p = 0.002, respectively) than in patients without recurrence. At the end of treatment, MPV was still higher in patients with recurrence compared to patients without recurrence (8.7 ± 0.5 and 7.5 ± 0.7 fl, respectively, p < 0.0001). MPV values over 8.05 fl at the end of treatment predicted recurrence with 91% sensitivity and 77% specificity.

CONCLUSION

MPV seems to be an indicator of recurrence in pulmonary embolism and may have utility in the prediction of recurrence. Elevated MPV can also be used to predict mortality in pulmonary embolism.

Added value of DCE-MRI in the management of cystic-cavitary lung lesions

BACKGROUND AND OBJECTIVE

We evaluated the added value of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) to CT in the evaluation of cystic-cavitary lung lesions. We aimed to compare morphological parameters, including wall thickness and inner wall irregularity, and to determine whether DCE-MRI with morphological and dynamic parameters was useful in indeterminate lesions. We also aimed to investigate the added value of DCE-MRI in terms of whether to biopsy, and if so the site of biopsy.

METHODS

This prospective study included 39 consecutive patients with cystic and/or cavitary lung lesions detected by CT who then underwent additional DCE-MRI. After initial evaluation, the lesions were classified as benign, indeterminate or malignant and the findings of CT and DCE-MRI compared with each other by considering the final diagnosis that was determined by histopathological findings and clinical evaluation and follow up.

RESULTS

The mean values for wall thickness obtained by DCE-MRI were lower and the range of wall thickness for indeterminate lesions was narrower than those obtained by CT (5.50-11.50 mm and 5.75-13.50 mm for DCE-MRI and CT), and inner wall irregularity on DCE-MRI was more sensitive in malignant lesions. Also, DCE-MRI obviated biopsy in three benign patients and changed the biopsy site in two patients.

CONCLUSION

Our study suggests that DCE-MRI is helpful in indeterminate cystic-cavitary lung lesions, with morphological and dynamic features. It narrowed the range of wall thickness used for indeterminate lesions, was more sensitive than CT in determining malignant inner wall irregularity, and was also useful in determining the need for and appropriate site of biopsy. See article, page 576.

Silicosis Appears Inevitable Among Former Denim Sandblasters: A 4-Year Follow-up Study

BACKGROUND

The course of denim sandblasting silicosis is unknown. We aimed to reevaluate former sandblasters studied in 2007 for incident silicosis, radiographic progression, pulmonary function loss, and mortality and to examine any associations between these outcomes and previously demonstrated risk factors for silicosis.

METHODS

We defined silicosis on chest radiograph as category 1/0 small opacity profusion using the International Labor Organization classification. We defined radiographic progression as a profusion increase of two or more subcategories, development of a new large opacity, or an increase in large opacity category. We defined pulmonary function loss as a ≥ 12% decrease in FVC.

RESULTS

Among the 145 former sandblasters studied in 2007, 83 were reassessed in 2011. In the 4-year follow-up period, nine (6.2%) had died at a mean age of 24 years. Of the 74 living sandblasters available for reexamination, the prevalence of silicosis increased from 55.4% to 95.9%. Radiographic progression, observed in 82%, was associated with younger age, never smoking, foreman work, and sleeping at the workplace. Pulmonary function loss, seen in 66%, was positively associated with never smoking and higher initial FVC % predicted. Death was associated with never smoking, foreman work, number of different denim-sandblasting places of work, sleeping at the workplace, and lower pulmonary function, of which only the number of different places worked remained in multivariate analyses.

CONCLUSIONS

This 4-year follow-up suggests that almost all former denim sandblasters may develop silicosis, despite short exposures and latency.

Correlation of diffusion MRI with the Ki-67 index in non-small cell lung cancer

BACKGROUND

The primary objective of the study was to evaluate the association between the minimum apparent diffusion coefficient (ADCmin) and Ki-67, an index for cellular proliferation, in non-small cell lung cancers. Also, we aimed to assess whether ADCmin values differ between tumour subtypes and tissue sampling method.

METHODS

The patients who had diffusion weighted magnetic resonance imaging (DW-MRI) were enrolled retrospectively. The correlation between ADCmin and the Ki-67 index was evaluated.

RESULTS

Ninety three patients, with a mean age 65 ± 11 years, with histopathologically proven adenocarcinoma and squamous cell carcinoma of the lungs and had technically successful DW-MRI were included in the study. The numbers of tumour subtypes were 47 for adenocarcinoma and 46 for squamous cell carcinoma. There was a good negative correlation between ADCmin values and the Ki-67 proliferation index (r = -0.837, p < 0.001). The mean ADCmin value was higher and the mean Ki-67 index was lower in adenocarcinomas compared to squamous cell carcinoma (p < 0.0001). There was no statistical difference between tissue sampling methods.

CONCLUSIONS

Because ADCmin shows a good but negative correlation with Ki-67 index, it provides an opportunity to evaluate tumours and their aggressiveness and may be helpful in the differentiation of subtypes non-invasively.

Preventive Role of Hilar Parasympathetic Ganglia on Pulmonary Artery Vasospasm in Subarachnoid Hemorrhage: An Experimental Study

AIM

Pulmonary arteries are mainly innervated by sympathetic vasoconstrictor and parasympathetic vasodilatory fibers. We examined whether there is a relationship between the neuron densities of hilar parasympathetic ganglia and pulmonary vasospasm in subarachnoid hemorrhage (SAH).

MATERIAL AND METHODS

Twenty-four rabbits were divided into two groups: control (n=8) and SAH (n=16). The animals were observed for 20 days following experimental SAH. The number of hilar parasympathetic ganglia and their neuron densities were determined. Proportion of pulmonary artery ring surface to lumen surface values was accepted as vasospasm index (VSI). Neuron densities of the hilar ganglia and VSI values were compared statistically.

RESULTS

Animals in the SAH group experienced either mild (n=6) or severe (n=10) pulmonary artery vasospasm. In the control group, the mean VSI of pulmonary arteries was 0.777±0.048 and the hilar ganglion neuron density was estimated as 12.100±2.010/mm < sup > 3 < /sup > . In SAH animals with mild vasospasm, VSI=1.148±0.090 and neuron density was estimated as 10.110±1.430/mm < sup > 3 < /sup > ; in animals with severe vasospasm, VSI=1.500±0.120 and neuron density was estimated as 7.340±990/mm < sup > 3 < /sup > .

CONCLUSION

There was an inverse correlation between quantity and neuron density of hilar ganglia and vasospasm index value. The low numbers and low density of hilar parasympathetic ganglia may be responsible for the more severe artery vasospasm in SAH.

A comparison of two different culture methods for use in the diagnosis of pulmonary tuberculosis

OBJECTIVE

Tuberculosis (TB) continues to be a significant health problem worldwide. Pulmonary TB is a contagious disease. To control the spread of TB, the disease must be diagnosed early and treated effectively.

MATERIALS AND METHODS

In this study, we determined the rates and periods of TB bacterial reproduction using the Lowenstein-Jensen (LJ) and the Mycobacterium Growth Indicator Tube (MGIT) culture systems in respiratory specimens obtained from 105 suspected TB cases that applied to our service.

RESULTS

Using either the LJ or MGIT method, the reproduction rates of TB cultures from 91 positively diagnosed cases were determined to be 69.2% and 92.3% (p=0.116), respectively. The reproduction period for these same cultures was determined to be 29.7±10.0 days and 12.1±6.1 days (p<0.0001), respectively. The culture positivity rate determined using both the LJ and MGIT methods together was found to be significantly higher than the rate determined using either LJ or MGIT separately (p<0.0001).

CONCLUSION

For the early diagnosis of pulmonary tuberculosis, which is essential for controlling the spread of TB, the routine use of the MGIT system, which is a rapid, automated and non-radiometric method, combined with the LJ method would effectively increase the diagnosis rate in order to control tuberculosis outbreaks.

Recurrent postpartum eosinophilic pneumonia presenting as acute respiratory distress syndrome

Eosinophilic pneumonia (EP) is a rare disease of the lung. We aimed to present atypical course of two EP cases. They were admitted to our hospital because of acute respiratory distress syndrome (ARDS) in postpartum period. Eosinophilia was detected in bronchoscopic bronchoalveolar lavage and laboratory examination. In these cases, no spesific cause for eosinophilic pneumonia was determined and steroid treatment was started. After the treatment, the patients were in full recovery which were confirmed by clinical and radiological investigations, readmitted to our clinic with relapses of ARDS. The patients have received regular treatment for 1 year. Our cases were neither fitting the classic definitions of acute eosinophilic pneumonia nor chronic eosinophilic pneumonia. Therefore, we wanted to contribute additional data in the literature by sharing these interesting cases.

Co-existence of tuberculous meningitis and pulmonary tuberculosis in a denim sandblaster

Silicosis is a well-known occupational lung disease that was discovered by the ancient Greeks and Romans. In 2001, it has emerged again in an unexpected occupation: denim sandblasting. Exposure to crystalline silica, with or without clinical disease, is one of the most important predisposing factors for the development of tuberculosis; however, there has been no previous report of tuberculosis among cases of silicosis due to denim sandblasting. Herein, we report the first case of a denim sandblaster with silicosis who developed both pulmonary tuberculosis and tuberculous meningitis.

A rare thymoma type presenting as a giant intrathoracic tumor: lipofibroadenoma

Type B1 thymoma (lipofibroadenoma) is extremely rare. The tumor is characterized by an organoid appearance rich in lymphocytes with medullary differentiation and perivascular spaces. A twenty-three-year-old female patient was admitted to our clinic with complaints of chest pain and dyspnea for six months. Chest computed tomography showed solid and fatty components of masses 21×7 and 5×7 cm with clear borders in the right thoracic cavity. The patient underwent a posterolateral thoracotomy in which the mass, arising from the anterior mediastinum, was resected. Histopathological examination showed that the mass was Type B1 thymoma, and the patient was presented in light of the literature.

Roles of Ki-67, p53, transforming growth factor-β and lysyl oxidase in the metastasis of lung cancer

BACKGROUND AND OBJECTIVE

Most lung cancer (LC) patients have metastatic disease at time of diagnosis, which influence the treatment regimen and is the most important prognostic factor. The main purpose of our study was to evaluate the relationship between cell proliferation (Ki-67 label index), p53, transforming growth factor-β (TGF-β) and lysyl oxidase (LOX), and the metastatic stages of different lung cancers. The secondary aim was to correlate these parameters with the standardized uptake value (SUVmax) of the primary lesion during positron emission tomography-computed tomography (PET-CT).

METHODS

Eighty-five treatment-naive patients with LC were enrolled. All patients were examined with PET-CT. Ki-67, p53, TGF-β and LOX were evaluated histopathologically.

RESULTS

Small cell lung cancer (SCLC) showed the most intense staining in all parameters. A well-differentiated adenocarcinoma (AC) demonstrated a more diffuse and intense staining than squamous cell carcinoma (SCC). There was no statistically significant relationship between the four parameters and metastases of SCLC and SCC. However, a significant relationship between TGF-β, LOX and metastatic AC was demonstrated with regards to diffusivity and intensity. p53 and Ki-67 did not show a significant relationship. No correlation between SCLC and SCC and SUVmax was found. However, in AC, the diffusivity and intensity of the LOX and p53 staining showed a statistically significant relationship to the SUVmax.

CONCLUSIONS

LOX and TGF-β may play roles in metastatic AC. LOX and TGF-β may become markers of metastatic disease and inhibition could be explored for treatment.

Is atmospheric pressure change an Independent risk factor for hemoptysis?

Objective: Hemoptysis is one of the most important and challenging symptoms in pulmonary medicine. Because of the increased number of patients with hemoptysis in certain periods of the year, we aimed to investigate whether atmospheric changes have an effect on the development of hemoptysis with or without a secondary cause.

Methods: The data of patients presenting with hemoptysis between January 2006 and December 2011 were analyzed. Data on the daily atmospheric pressure (hectopascal, hPa), relative humidity (%), and temperature (^o C) during that time were obtained.

Results: A total of 232 patients with hemoptysis, 145 male (62.5%) and 87 female (37.5%) with an average age of 48.1(±17.6), were admitted to our hospital between 2006 and 2011. The highest admission rates were in the spring season, the highest in May (n=37, 15.9%), and the lowest admission rates were in December (n=10, 4.3%). A statistically significant negative correlation was found between the number of hemoptysis cases and mean atmospheric pressure but no relative humidity or outdoor temperature.

Conclusion: Hemoptysis is very much influenced by weather factors; in particular, low atmospheric pressures significantly affect the development of hemoptysis. Fluctuations in atmospheric pressure may also play a role in hemoptysis.

Serum and bronchial aspiration fluid HE-4 levels in lung cancer

Human epididymis 4 (HE-4) protein has been proposed as a tumor marker for lung and ovarian cancer. This study was designed to measure HE-4 levels in bronchial aspiration fluid (BAF) of patients with lung cancer and to describe the relationship of BAF HE-4 with known systemic increase in serum HE-4 levels. Sixty-four patients with lung cancer, 38 with benign lung disease and 19 healthy subjects, were enrolled in our study. The BAF was obtained during routine bronchoscopic procedure in patient groups. HE-4 levels in serum and BAF were measured with the commercially available kit by an enzyme-linked immunosorbent assay. Serum HE-4 levels were significantly higher in patients with lung cancer group (204.2 ± 22.9 pmol/L) than in benign lung disease group (135 ± 26.9 pmol/L, p = 0.001) and healthy subjects (14.8 ± 7.0 pmol/L, p < 0.0001). No significant difference was observed in terms of BAF HE-4 values in two patient groups. BAF HE-4 levels were significantly higher than those of serum levels in both patient groups (p < 0.0001). Serum HE-4 level was correlated with tumor stage (p = 0.001) and age (p < 0.0001) in the lung cancer group. The areas under the receiver operating characteristic (ROC) curve of serum HE-4 was 0.784 (95 % confidence interval (CI), 0.701-0.867) and that of BAF HE-4 was 0.496 (95 % CI, 0.382-0.610). This study shows that a systemic increase in serum of HE-4 is more prominent than a local increase of HE-4 (BAF), so this may suggest the feasibility of using serum instead of BAF samples for HE-4 measurements in lung cancer cases.

Frequency of Class I and II HLA alleles in patients with lung cancer according to chemotherapy response and 5-year survival

INTRODUCTION

Lung cancer is the most common cause of cancer death in the world, and the most common type is non-small-cell lung cancer (NSCLC). At present, surgical resection, chemotherapy, and radiation therapy are the main treatments for patients with NSCLC, but unfortunately outcome remains unsatisfactory.

OBJECTIVES

This study aimed to determine whether Class I and II histocompatibility leukocyte antigen (HLA) alleles are related with response to chemotherapy and survival of lung cancer.

METHODS

A total of 65 NSCLC patients (56 men and 9 women, mean age 58.4 ± 11 years) were included in the study. Patient groups were compared with a control group of 88 unrelated healthy kidney or bone marrow donors in order to clearly identify susceptible and protective HLA alleles in lung cancer. Target lesions and tumor response were assessed using the Response Evaluation Criteria for Solid Tumors (RECIST) guidelines. Results were classified into two groups: complete-partial response and stable-progressive disease.

RESULTS

We found that expression of HLA-A32, HLA-B41, HLA-B57, HLA-DRB1*13, and HLA-DQ5 were more frequent in the complete and partial response groups to chemotherapy than in the control group. The frequency of HLA-A11, HLA-A29, HLA-BW6, HLA-CW3, HLA-DR1*1, and HLA-DRB1*3 were determined to be higher in the stable and progressive disease groups taking chemotherapy than in the control group. Additionally, expressions of HLA-A2 and HLA-B49 were statistically related with 5-year survival.

CONCLUSION

Our results suggested that expressions of HLA-BW6 and HLA-DRB1*13 alleles may be predictable markers for response to chemotherapy in lung cancer patients.

Two different dosages of nebulized steroid versus parenteral steroid in the management of COPD exacerbations: a randomized control trial

BACKGROUND

The study aimed to compare the efficacy and safety of nebulized steroid (NS) with systemic corticosteroids (SC) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization.

MATERIAL AND METHODS

The study was a randomized, parallel design trial. Eligible patients (n=86) were randomly allocated to 1 of the 3 treatment groups: parenteral corticosteroid (PS) (n=33), 4 mg (NB) (n=27), or 8 mg NB (n=26). Partial pressure of arterial oxygen (PaO2), carbon dioxide (PaCO2), pH, and oxygen saturation (SaO2) were evaluated at baseline, 24 h, 48 h, and discharge. Airway obstruction (forced vital capacity [FVC] and forced expiratory volume 1 s [FEV1]) was evaluated at admission and discharge.

RESULTS

There were no significant differences between the groups for all parameters at all time periods, except for higher FEV1 value in the 8-mg NB group at baseline. In groups, significant differences were determined for FVC, FEV1, PaO2, and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison to their baseline values. As adverse events, hyperglycemia and oral moniliasis were observed in the PS group (n=4) and in the NB groups (n=5), respectively, and treatment change was required in 9 patients (2 patients in the PS group and 7 patients in the NB groups) (p=0.57).

CONCLUSIONS

Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects. The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage. However, there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the 3 arms.

The association of human leukocyte antigen polymorphisms with disease severity and latency period in patients with silicosis

Background: Denim sandblasting may cause silicosis as a result of free crystalline silica inhalation. Its pathogenesis remains unclear, but autoimmunity may play a role in the development of silicosis. The present study aimed to investigate the relationships between human leukocyte antigen (HLA) and the severity and latency period of silicosis. Methods: 48 silicotic patients in the Eastern part of Turkey were classified according to their latency period and disease severity. The distribution of HLAs according to disease severity and latency period was assessed. Results: A23 (7.5%), B49 (7.5%), and B51 (25%) were more common in the mild group than in the severe group, and B55 (8.9%) and DR4 (17.9%) were more common in the severe group than in the mild one. Only B51 was significantly more common in the mild group than in the severe one (25%, n = 10 vs. 7.1%, n = 4; p = 0.016). Conclusions: This study suggests that HLA antigens may play a particular role in the severity of silica-induced lung disease, but there was no association between HLA and progression time of the disease.

The association of human leukocyte antigen polymorphisms with disease severity and latency period in patients with silicosis

Background

Denim sandblasting may cause silicosis as a result of free crystalline silica inhalation. Its pathogenesis remains unclear, but autoimmunity may play a role in the development of silicosis. The present study aimed to investigate the relationships between human leukocyte antigen (HLA) and the severity and latency period of silicosis.

Methods

48 silicotic patients in the Eastern part of Turkey were classified according to their latency period and disease severity. The distribution of HLAs according to disease severity and latency period was assessed.

Results

A23 (7.5%), B49 (7.5%), and B51 (25%) were more common in the mild group than in the severe group, and B55 (8.9%) and DR4 (17.9%) were more common in the severe group than in the mild one. Only B51 was significantly more common in the mild group than in the severe one (25%, n = 10 vs. 7.1%, n = 4; p = 0.016).

Conclusions

This study suggests that HLA antigens may play a particular role in the severity of silica-induced lung disease, but there was no association between HLA and progression time of the disease.

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic

BACKGROUND

Pharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic.

METHODS

This retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients' smoking status at one year was assessed by telephone interview.

RESULTS

The patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p > 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p > 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse.

CONCLUSION

Nicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic

Background: Pharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic. Methods: This retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients’ smoking status at one year was assessed by telephone interview. Results: The patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).  The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p < 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p < 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse. Conclusion: Nicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

Comparison of reducing effect on lung injury of dexamethasone and bosentan in acute lung injury: an experimental study

Background: Different medical therapies are employed in acute lung injury (ALI) but there is still a debate about the efficacy of these drugs. Among these therapies steroids are clinically applied and bosentan is experimentally studied. The aim of this study was to evaluate the efficacy of these two drugs to treat inflammation in ALI by histopathological comparison. Methods: The five experimental groups (n = 5 per group) were: saline control (Group I); lipopolysaccharide (LPS) + saline (Group II); LPS + dexamethasone (Group III); LPS + 50 mg/kg bosentan (Group IV); and LPS + 100 mg/kg bosentan (Group V). Bosentan was administered orally one hour before and 12 hours after LPS treatment. Dexamethasone was administered intraperitoneally in three doses of 1 mg/kg; one dose was co-administered with LPS and the other two doses were given respectively 30 minutes before and after LPS treatment. Vasodilation-congestion, hemorrhage, polymorphonuclear leukocyte (PMN) infiltration, mononuclear leukocyte (MNL) infiltration, alveolar wall thickening, alveolar destruction/emphysematous appearance, and focal organization were the parameters used as criteria for evaluating inflammation and efficacy of treatment. Results: Compared to the LPS-only group (Group II), dexamethasone treatment (Group III) resulted in significant improvements in vasodilation-congestion, hemorrhage, PMN and MNL infiltration, alveolar wall thickening and emphysematous areas. Treatment with 50 mg/kg dose of bosentan (Group IV) also resulted in significant improvements in hemorrhage, PMN and MNL infiltration, alveolar wall thickening and alveolar destruction. Reducing lung injury and reparative effects of 100 mg/kg bosentan were significant in all parameters. Conclusions: Bosentan is as effective as dexamethasone for treating lung injury in ALI. Bosentan at 100 mg/kg can be recommended as a first treatment choice based on its significant reducing lung injury and reparative effects.

The incidence and severity of pulmonary hypertension in obstructive sleep apnea with hypothyroidism

Background

Hypothyroidism and obstructive sleep apnea (OSA) are both common health problems and can be seen together. Each of these 2 diseases can cause pulmonary hypertension (PH). We aimed to determine whether hypothyroidism with OSA has a significant effect on the frequency and severity of PH.

Material/Methods

A total of 236 patients were included in the study. Patients were divided into 3 groups: Group I, Obstructive Sleep Apnea (n=149); Group II, Hypothyroidism (n=56); and Group III, Obstructive Sleep Apnea-Hypothyroidism (n=31). All patients underwent polysomnography and echocardiography and serum levels of thyroid-stimulating hormone (TSH) and free thyroxine 4 (FT₄) were analyzed.

Results

There were 167 male and 69 female participants, and the mean age was 47.8±11.5 (Group I: 81.9% male, 18.1% female; Group II: 44.6% male, 55.4% female; Group III: 64.6% male, 35.4% female). Distribution of mean pulmonary arterial pressure on echocardiography was statistically different among the 3 groups (x²=14.99, p=0.006). When adjusted according to the apnea-hypopnea index (AHI), age, and body mass index (BMI), a significant relation with PH was determined (p=0.002).

Conclusions

The combination of hypothyroidism with OSA is associated with an increased frequency and severity of PH. When PH is found out of line with the severity of OSA, thyroid dysfunction should be investigated.

Pre-school children with hydatid lung disease

BACKGROUND

Hydatid cyst disease is a major health problem in developing countries and it usually settles in the lungs in children. This study aimed to present pre-school children with lung hydatid cysts cases that underwent surgical treatment.

METHODS

The authors retrospectively investigated 42 consecutive pre-school patients who were diagnosed and surgical treated for hydatid cysts in their clinic between January 1998 and December 2011.

RESULTS

Seventeen (40.5%) patients were female and 25 (59.5%) patients were male. The average age of the patients was 5.2 +/- 1.3 (between 2-7 years). The most common symptoms were cough (74%), chest pain (26.2%), and fever (26.2%). Twenty-eight cases had cysts in only one lung; in five cases, the cysts were in a single lung and the liver, in six cases, in bilateral lungs and liver, and in three cases, in bilateral lungs. The average cyst diameter was 6.2 +/- 2.4 (2-12) cm. In five cases, there were combined interventions to the right lung and liver cysts with a transdiaphragmatic approach. Nine patients with bilateral hydatid cysts underwent operations. Muscle protector thoracotomies were performed in eight cases. Cystotomy and capitonnage were applied to all lung cysts. One patient underwent a bronchoscopy for postoperative atelectasis. In one case, postoperative fever was observed. There was no postoperative mortality. Postoperative average hospital stay was 7.2 +/- 2.1 (3-13) days.

CONCLUSION

Surgery is the definitive treatment for lung hydatid cysts. The most important way to protect against the adverse effects of a thoracotomy is to eliminate the routes of transmission.

Low-molecular-weight heparin use with thrombolysis: is it effective and safe? Ten years' clinical experience

BACKGROUND

There is no data on the use of subcutaneous low-molecular-weight heparin (SC LMWH) in cases that require thrombolysis.

OBJECTIVE

Having used SC LMWH with thrombolytics for more than 10 years, we aimed to review our data, share our experiences and find out whether the use of SC LMWH with thrombolytics had been effective and safe.

METHOD

This is a retrospective cohort study. Patients who were diagnosed as acute pulmonary embolism (PE) and received either SC LMWH treatment or SC LMWH with thrombolytics in our hospital (a tertiary hospital) between 2000 and 2010 were included in the study. For both treatments, the rates of mortality and complications were calculated.

RESULTS

A total of 392 patients, 210 female (53.5%) and 182 male (46.5%) with an average age of 60 years, ±16 SD, with acute PE, were included in the study. Of these patients, 107 (27.2%) were massive and 285 (72.8%) were nonmassive and were administered SC LMWH plus thrombolytics and only SC LMWH, respectively. The mortality rate was 16.8% (18 of 107) in patients who were massive and 3.5% (10 of 285) for those who were nonmassive (p < 0.001). Major hemorrhage occurred in 3.7% (n = 4) and 0.7% (n = 2) and minor hemorrhage in 12.1% (n = 13) and in 3.8% (n = 11) of the cases who received SC LMWH plus thrombolytics and SC LMWH, respectively.

CONCLUSION

SC LMWH use with thrombolytics seems to be feasible and safe. Prospective, large, randomized control trials are still required in order to confirm these results.

Video-Assisted Thoracoscopic Surgery of Mediastinal Cysts: Report of 13 Cases

Mediastinal cysts are rare anomalies. The purposes of this study were to present our experience with mediastinal cysts, which were thoracoscopically treated in our clinic, and to discuss our findings along with those from the literature. We retrospectively investigated 13 patients who were diagnosed and thoracoscopically treated for mediastinal cysts in our clinic between January 2008 and December 2011. Seven patients were female and six were male. The average age of the patients was 41.3 ± 20.3 (7-82 years old). The mediastinal cysts comprised five pericardial cysts: four bronchogenic cysts, one hydatid cyst, one benign cystic teratoma, one thymic cyst, and one neurenteric cyst. In the case of a ruptured hydatid cyst, we passed it to thoracotomy intra-operatively due to the presence of advanced adhesion related to inflammation. Postoperative complications and mortality did not occur in any case. The average postoperative hospitalisation period was 3.8 days (2-7 days). Video-assisted thoracoscopic surgery in mediastinal cysts is a reliable and effective approach with low morbidity and a shorter hospital stay.