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Sedentary behavior has been shown to be an independent predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). However, physicians have difficulty ascertaining patients’ activity levels because they tend to avoid shortness of breath. The reformed shortness of breath (SOB) in the daily activities questionnaire (SOBDA-Q) specifies the degree of SOB by measuring low-intensity activity behavior in everyday living. Therefore, we aimed to explore the utility of the SOBDA-Q in detecting sedentary COPD. We compared the modified Medical Research Council dyspnea scale (mMRC), COPD assessment test (CAT), and SOBDA-Q with physical activity levels (PAL) in 17 healthy patients, 32 non-sedentary COPD patients (PAL ≥ 1.5 METs·h), and 15 sedentary COPD patients (PAL < 1.5 METs·h) in this cross-sectional study. CAT and all domains of the SOBDA-Q in all patients are significantly correlated with PAL, even after adjusting for age. The dietary domain has the highest specificity, and the outdoor activity domain has the highest sensitivity for detecting sedentary COPD. Combining these domains helped determine patients with sedentary COPD (AUC = 0.829, sensitivity = 1.00, specificity = 0.55). The SOBDA-Q is associated with PAL and could be a useful tool for determining patients with sedentary COPD. Moreover, eating and outing inactivity claims reflect sedentary behavior in patients with COPD.

Background: Recent advances in biologics have provided new insights into the clinical course of asthma, including disease modification, clinical remission (CR), and deep remission (DR). However, the extent to which biologics achieve CR and DR in severe asthma patients is poorly understood. Methods: To assess the achievement rate and predictors of CR and DR using long-term biologics, we retrospectively evaluated 54 severe asthma patients recently started on biologics. “CR” denotes the achievement of all three criteria: (1) absence of asthma symptoms, (2) no asthma exacerbations, and (3) no use of oral corticosteroids. DR denoted CR plus (4) normalized pulmonary function and (5) suppressed type 2 inflammation. Results: CR and DR achievement rates were 68.5% and 31.5%, respectively. Compared with the non-deep remission group, the DR group had higher adult-onset asthma rates (94.1% vs. 70.3%, p = 0.078), shorter asthma duration (5 vs. 19 years, p = 0.006), and higher FEV1 (91.5% vs. 71.5%, p < 0.001). There were no significant differences in the Asthma Control Questionnaire scores, exacerbation frequency, or type 2 inflammation at baseline between groups. Asthma duration combined with FEV1 can stratify the achievement rates of CR and DR. Conclusions: the early introduction of biologics in severe asthma patients may help achieve CR and DR.

Background The role of the inflammatory secretory protein TNF-LIGHT (LIGHT) in the molecular mechanisms underlying persistent airflow limitation (PAL) in asthma remains unclear. We hypothesized that high airway LIGHT expression may be a feature of asthma with PAL associated with specific expression patterns of inflammatory molecules. Methods This hypothesis was tested in 16 patients with asthma on inhaled corticosteroid treatment. Induced sputum was collected, the expression of LIGHT and 3-nitrotyrosine (NT), which reflects the footprint of reactive nitrogen species content, was measured using immunohistochemical staining, and the inflammatory molecules in the sputum supernatant were analyzed using a magnetic bead array. Results LIGHT staining in the cells had a significantly higher intensity in participants with PAL than in participants without PAL (47.9 × 104/ml vs. 5.4 × 104/ml; p Conclusions The findings suggest that LIGHT is a key component in the association between airway inflammation and airflow limitation in patients with asthma, and its expression may be persistently correlated with the abundance of inflammatory cells and inflammatory and profibrogenic radical/molecules.

Invasive thymomas with intraluminal tumor thrombi are rare. Removal of the thymoma and infiltration of the superior vena cava (SVC) is a curative alternative. We report an autopsy case of invasive thymoma with intraluminal growth into the intracardiac right atrium extension. Furthermore, the patient died of massive intracardiac thrombosis 5 days after the start of chemotherapy. A 66-year-old man with SVC syndrome was referred to our hospital. He had been aware of swelling of the face for 6 months. The patient was diagnosed with invasive thymoma by a CT-guided needle biopsy of the anterior mediastinal mass. Contrast-enhanced chest computed tomography showed a mass in the anterior mediastinum extending to the SVC and right atrium. As a result of discussion with surgeons and radiotherapists, we planned a multidisciplinary treatment in which neoadjuvant chemotherapy would reduce the tumor size, and surgery and postoperative radiotherapy were followed by chemotherapy. He was administered neo-adjuvant chemotherapy with CBDCA + PTX (carboplatin, area under the curve = 6, and paclitaxel, 200 mg/m(2)). On the 4th day of chemotherapy, he suddenly developed obstructive shock due to intracardiac thrombosis in the right ventricle. We believe that chemotherapy may trigger rapid thrombus formation. If an invasive thymoma spreads into a large vessel or the right atrium, surgical treatment should be considered if possible. However, if surgery is impossible, administration of anticoagulants should be considered to prevent thrombus formation before chemotherapy.

Hidekazu Tanaka,1 Taiki Ono,1 Yuki Manabe,1 Miki Kajima,1 Koya Fujimoto,1 Yuki Yuasa,1 Takehiro Shiinoki,1 Yoshikazu Yamaji,2 Kazuto Matsunaga2 1Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Japan; 2Department of Respiratory Medicine and Infectious Disease, Yamaguchi University Graduate School of Medicine, Ube, JapanCorrespondence: Hidekazu Tanaka 1-1-1 Minamikogushi, Ube, 755-8505, JapanTel +81 836 22 2966Fax +81 836 22 2471Email h-tanaka@yamaguchi-u.ac.jpPurpose: Anemia has been associated with poor prognosis in patients with cancer across several cancer types. It has been identified as a prognostic factor in patients with non-small cell lung cancer (NSCLC) who have undergone surgery or chemoradiotherapy. However, there are only a few reports that have evaluated the prognostic significance of anemia in patients with NSCLC undergoing stereotactic body radiation therapy (SBRT).Patients and Methods: A total of 77 patients were enrolled in this study. The pretreatment hemoglobin (Hb) levels, within 2 weeks before SBRT, were available for all patients. The median age of the participants (56 men, 21 women) was 80 (range, 50– 90) years. The median Hb level was 12.8 (range, 7.8– 18.3) g/dL. The median follow-up period was 24 (range, 1– 87) months.Results: Local recurrence was observed in 8 (10.4%) cases during the follow-up period. The 1- and 2-year local control (LC) rates were 94.8% and 86.4%, respectively. Seventeen (22.1%) patients died during the follow-up period. The 1- and 2-year overall survival (OS) rates were 93.1% and 85.2%, respectively. Univariate analysis identified anemia and body mass index as significant prognostic factors for predicting OS. On multivariate analysis, anemia was confirmed to be the only significant factor (p = 0.02469).Conclusion: Our data suggest that anemia is a prognostic factor for predicting the OS rate in patients with early-stage NSCLC treated with SBRT.Keywords: anemia, hemoglobin, non-small cell lung cancer, stereotactic body radiation therapy, stereotactic ablative body radiotherapy

Brain frailty may be related to the pathophysiology of poor clinical outcomes in chronic obstructive pulmonary disease (COPD). This study examines the relationship between hippocampal subfield volumes and frailty and depressive symptoms, and their combined association with quality of life (QOL) in patients with COPD. The study involved 40 patients with COPD. Frailty, depressive symptoms and QOL were assessed using Kihon Checklist (KCL), Hospital Anxiety and Depression Scale (HADS), and World Health Organization Quality of Life Assessment (WHO/QOL-26). Anatomical MRI data were acquired, and volumes of the hippocampal subfields were obtained using FreeSurfer (version 6.0) (Harvard University, Boston, MA, USA). Statistically, HADS score had significant association with WHO/QOL-26 and KCL scores. KCL scores were significantly associated with volumes of left and right whole hippocampi, presubiculum and subiculum, but HADS score had no significant association with whole hippocampi or hippocampal subfield volumes. Meanwhile, WHO/QOL-26 score was significantly associated with volume of the left CA1. There was a significant association between frailty, depression, and QOL. Hippocampal pathology was related to frailty and, to some extent, with QOL in patients with COPD. Our results suggest the impact of frailty on hippocampal volume and their combined associations with poor QOL in COPD.

We herein report an immunocompromised patient familiar with gardening admitted to our hospital suffering from severe pneumonia caused by Legionella longbeachae. We suspected non‐pneumophila Legionella species pneumonia because of gardening habits, the negative urine antigen test and the non‐significant Gram staining results of orange‐coloured sputum. The pathogen was identified using mass spectrometry analysis of bronchoalveolar lavage fluid. It is important to perform the medical interview carefully, noting the colour of sputum and gardening habits, for diagnosis and targeted therapy of non‐pneumophila Legionella species pneumonia, even if the urine Legionella antigen test is negative., In non‐endemic countries such as Japan, Legionella longbeachae pneumonia is thought to be underdiagnosed due to inadequate recognition. We report a case of the orange‐coloured sputum and bronchoalveolar lavage fluid and the detailed medical interview about recent gardening activity and exposure to compost or potting mix, which might be signs for rapid diagnosis of non‐pneumophila Legionella species pneumonia with a negative urinary antigen test.

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.

Background Assist use of inhaled short-acting beta 2 agonists (SABAs) is reportedly effective for preventing shortness of breath on exertion in chronic obstructive pulmonary disease (COPD) patients. However, it is unclear what strategy would be useful for improving physical activity in such patients. The aim is to investigate the effects of assisted use of SABA (procaterol) on physical activity in Japanese COPD patients targeting patient-specific restrictions in daily behavior. Methods Fourteen patients with stable COPD (age: 72.1±1.5, %FEV1: 55.6±4.5%) were asked to inhale 20 μg of procaterol 15 minutes before patient-specific daily physical activity that had been identified as limited by a questionnaire and document their usage in a diary. Physical activity was measured using a triaxial accelerometer and the results were collected every month for 2 months. In the first month, a clinician assessed whether inhalation of SABA was appropriate based on a usage diary and coached patients to conduct adequate assist use of SABA for limited physical activity. Results The strategy significantly improved the physical activity level, assessed using the values of the metabolic equivalents (METs) multiplied by physical activity endurance, at ≥3.0 METs (p Conclusions Assist use of SABA targeting patient-specific restrictions, particularly when better lung function is still preserved, could be a useful approach for improving physical activity in patients with COPD.

Keiji Oishi,1 Tsunahiko Hirano,2 Kazuki Hamada,2 Sho Uehara,2 Ryo Suetake,2 Yoshikazu Yamaji,2 Kosuke Ito,2 Maki Asami-Noyama,2 Nobutaka Edakuni,2 Kazuto Matsunaga2 1Department of Medicine and Clinical Science, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan; 2Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan Purpose: The 2017 GOLD ABCD classification shifts patients from groups C–D to A–B. Group A was the most widely distributed group in several studies. It would be useful to understand the characteristics for group A patients, but little has been reported concerning these issues. Patients and methods: This was a multicenter cross-sectional study using the COPD Assessment in Practice study database from 15 primary or secondary care facilities in Japan. We investigated the clinical characteristics of group A by stratification according to a mMRC grade 0 or 1. Results: In 1,168 COPD patients, group A patients accounted for approximately half of the patients. Compared with the groups B–D, group A was younger and had a higher proportion of males, higher pulmonary function, and higher proportion of monotherapy with long-acting muscarinic antagonist or long-acting β-agonist. The prevalence of mMRC grade 1 patients was about two-thirds of group A. Compared with the mMRC 0 patients, mMRC 1 patients showed a tendency to have a higher proportion of exacerbations (P=0.054) and had a significantly lower pulmonary function. Regardless of the mMRC grade, 60% of group A patients were treated with monotherapy of long-acting muscarinic antagonist or long-acting β-agonist. Conclusion: Group A patients accounted for approximately half of the patients, and they were younger, had higher pulmonary function, and had lower pharmacotherapy intensity compared with groups B–D. By stratifying according to the mMRC grade 0 or 1 in group A patients, there were differences in the exacerbation risk and airflow limitation. Keywords: COPD, GOLD, mMRC, exacerbation

Background: As much as there are unmet needs for brief frailty assessment in patients with chronic obstructive pulmonary disease (COPD), the lack of a simplified and comprehensive dyspnea evaluation system that focuses on the patients&rsquo, perceptions of dyspnea and their COPD living disabilities remains a major challenge. We developed patient-reported outcome measures for dyspnea-related behavior and activity limitation (PROMs-D), which consisted of the Activity-limit Dyspnea Scale (ADS) and Self-Limit Dyspnea Scale (SDS), while investigated the usefulness of PROMs-D in identifying frailty. Methods: We administered PROMs-D and frailty status evaluations in 128 outpatients. Results: We classified 30 (23.4%), 50 (39.0%), and 48 (37.5%) patients as robust, prefrail, and frail, respectively. There was a positive correlation between SDS and ADS (&rho, = 0.67, p &lt, 0.001), and both ADS and SDS had high accuracies for detecting frailty (AUC, 0.82 and 0.78, respectively). Moreover, a PROMs-D score that consisted of the sum of ADS and SDS was more effective in stratifying frailty (cutoff value, 2, AUC, 0.85, sensitivity, 60%, specificity, 95%). Conclusions: PROMs-D could be used as the first step for frailty screening in patients with COPD, and we propose the importance of capturing the troublesome nature of living behaviors due to dyspnea in daily clinical practice.

Introduction: We have reported that the rate of physician-patient discordance in the perception of asthma control was 35.4% and the periodic use of Asthma Control Questionnaire (ACQ) could have a pivotal role in attenuating the discordance. However, it is well known that adherence by physicians to the use of composite measure that assess asthma condition is not sufficient. Aims and Objectives: To investigating which asthma symptoms should be captured for preventing physician’s underestimation of asthma control without sacrificing reliability. Methods: In patients judged by physicians to be well-controlled asthma, we compared the average score per symptom of ACQ. In addition, we dichotomized the patients into two groups based on the presence or absence of the discordance, and each group was examined for the proportion of patients with symptoms per intensity to determine the relevance with the discordance. Results: In 1350 patients, the average symptom scores were as follows: Nocturnal awaking (0.59), Morning symptoms (0.61), Activity limitation (0.59), Dyspnea (0.86), and Wheeze (0.79). Dyspnea and Wheeze were identified as significant residual symptoms (p Conclusion: By capturing the occasional dyspnea or wheeze, it is possible to reduce physician-patient discordance in asthma management.

Sedentary behavior and cognitive impairment have a direct impact on patients&rsquo, outcomes. An energy metabolic disorder may be involved in the overlap of these comorbid conditions (motoric cognitive risk (MCR)) in patients with chronic obstructive pulmonary disease (COPD). We aimed to explore the linkage between a proapoptotic protein, growth differentiation factor (GDF)-15, and MCR. Physical activity (PA), cognitive function (Japanese version of the Montreal Cognitive Assessment: MOCA-J), and the serum GDF-15 levels were assessed in healthy subjects (n = 14), asthmatics (n = 22), and COPD patients (n = 28). In the entire cohort, serum GDF-15 had negative correlations with exercise (Ex) (&rho, = &minus, 0.43, p &lt, 0.001) and MoCA-J (&rho, 0.44, p &lt, 0.001), and Ex and MOCA-J showed a positive correlation (&rho, = 0.52, p &lt, 0.0001). Compared to healthy subjects and asthmatics, COPD patients showed the highest serum GDF-15 levels and had a significantly higher proportion of subjects with MCR (both sedentary lifestyle (EX &lt, 1.5) and cognitive risk (MoCA-J &le, 25)). Also, we found that serum GDF-15 has a screening potential (100% sensitivity) greater than aging (67% sensitivity) for detecting MCR in COPD patients. In conclusion, higher serum GDF-15 had interrelationships with a sedentary lifestyle and cognitive risk. This protein was not disease-specific but could be a screening biomarker to detect MCR related to poor health outcomes of COPD patients.

Purpose/Objective(s) The monocyte-to-lymphocyte ratio (MLR), a kind of systemic inflammation biomarker, has been evaluated in relation to several types of cancer and has been found to predict responses to therapy and patient outcomes. Determining the MLR is inexpensive and can be easily derived from complete blood counts. The purpose of this study was to determine whether there are association between the MLR and local control rates (LC) and cause-specific survival rates (CSS) of patients with lung cancer treated with stereotactic body radiation therapy (SBRT). Materials/Methods Patients treated in two hospitals were enrolled in this study. The inclusion criteria were as follows: patients with localized non-small-cell lung cancer (NSCLC), with N0M0 disease, who were medically inoperable or refused to undergo surgery, were treated with SBRT, and for whom blood count data were available within 2 weeks prior to SBRT. In total, 194 patients met these criteria. Univariate and multivariate Cox proportional hazard regression models were used to estimate LC and CSS. Variables of which the P-values Results The median age of the 194 participants (144 male, 50 female) was 80 (range, 50-96) years. Patients presented with performance status (PS) 0/1/2/3 were 92/86/14/2. The median diameter of the tumor was 20 (range, 7-52) mm. The number of patients with pathological confirmation of lung cancer was 89 (45.9%). The remaining patients were diagnosed based on the observation of increasing size and abnormal uptake on PET. In principle, the prescribed dose to peripheral tumors was 48 Gy in 4 fractions (n = 130) or 50 Gy in 5 fractions (n = 51). The tumors with central lesions located near organs at risk were treated with 60 Gy in 8 fractions (n = 11). The calculated median MLR was 0.2605 (0.095-1.113). The optimal cut-off values for the MLR in LC and CSS rates were 0.198 and 0.340, respectively. Univariate Cox proportional hazards regression analysis determined the MLR, PS and tumor diameter as significant factor for LC. Multivariate analysis determined the MLR and tumor diameter as significant factor (P = 0.04105 and 0.03071), respectively. Although the MLR tends to predict the CSS in univariate analysis (P = 0.08616), none of the parameters was a significant factor to predict the CSS. However, the MLR as a continuous variable was a significant factor for CSS in univariate analysis (P = 0.003693). Conclusion Our data suggest that the MLR is correlated with LC and CSS rates in patients with NSCLC treated by SBRT.

Introduction The fraction of exhaled nitric oxide (FeNO) and blood eosinophils, markers of local and systemic eosinophilic inflammation, respectively, are increased in asthmatic patients. Little is known concerning the relationship between the FeNO levels and blood eosinophils in asthmatics. Methods Twenty severe asthmatics with persistent FeNO elevation (≥40 ppb) and blood eosinophilia (≥3%) despite maintenance therapy including high-daily-dose inhaled corticosteroids were analyzed. We investigated the response of FeNO and blood eosinophils to systemic corticosteroids treatment and the change in Asthma Control Questionnaire (ACQ) according to differences in the response of FeNO and blood eosinophils to steroid. Results The changes in blood eosinophils were not correlated with the changes in FeNO levels by systemic steroid treatment (r = 0.37, P = 0.11). 50% of the subjects showed both ≥20% reductions in FeNO levels and blood eosinophils. There were significant differences in the ACQ score between the steroid response group and poor response group (P

We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy.

Background: In patients with severe uncontrolled asthma, it is important to identify the T2-high and T2-low endotype and stratify the treatment approach. Aims: We clarify the prevalence and clinical characteristics of T2-high and T2-low endotype of severe uncontrolled asthma distinguished by combining popular type-2 biomarkers in practice. Methods: This retrospective study examined clinical data of 161 patients with severe uncontrolled asthma defined by ERS/ATS guidelines. T2-high was determined by the presence of atopy (RAST +) and/or FeNO > 25 ppb and/or B-Eos > 300 /μL, while T2-low was determined by the absence of all these characteristics. Moreover, patients were divided into following uncontrolled features subtypes; Exacerbation (EXA), Poor symptom control (SYM), and Airflow limitation (AFL). Results: The prevalence of T2-high patients was 89%, while that of T2-low patients was 11%. The majority (47%) of patients overlapped to all three type-2 biomarkers. By contrast, overlapped patients in all three uncontrolled features were classified in only 6%, while patients in AFL alone features accounted for the most (31%). Although the prevalence of patients with EXA or SYM showed no significant differences between T2-high and T2-low group, the presence of AFL in the T2-high group had higher than that in the T2-low group (65% vs 24%). Regardless of whether Atopy or high B-Eos exists, high FeNO were found to be the risk factor of AFL according to the multivariate analysis. Conclusions: Most patients were classified into the T2-high endotype. The T2-high endotype group had the feature of AFL. Among them, high FeNO had a large impact on AFL.

Rationale: Although the development of CT imaging can help us to understand the complex pathophysiology of lung diseases, the association with physical activity (PA) and multiple CT metrics remain unknown. The aim of the study is to investigate whether inspiratory-to-expiratory CT imaging show promise for use as biomarkers in PA. Methods: Parametric response mapping(PRM), expiratory/inspiratory mean lung density ratio (E/I) and expiratory/inspiratory mean normal lung density ratio (ND-E/I) through the use of inspiratory and expiratory CT scan and PA by use of a triaxial accelerometer was evaluated in healthy(n=6), asthmatics(n=27) and COPD(n=14). PRM classifies lung as normal, functional small airway disease (PRMfSAD), and emphysema (PRMEMPH). Exercise (Ex) was calculated by metabolic equivalents (METs) multiplied by PA duration and low activity (LA) was defined exercise as Ex below 1.5. Results: 6 patients were classified as the LA group and 41 patients as the activity maintenance (MA) group. LA group was more likely to be heavy smokers, have low pulmonary function and hyperinflation. Moreover, LA group show higher PRMfSAD (41.6 vs 29.8, p Conclusion: Quantitative inspiratory-to-expiratory CT imaging can be biomarker to detect physical activity levels.

Background: In patients with idiopathic pulmonary fibrosis (IPF), continuing treatment with antifibrotic agents is crucial to decrease the reduction of forced vital capacity and mortality rate. However, predictive factors for the discontinuation of antifibrotic agents are unknown. This study aims to investigate the clinical characteristics and predictive factors for the discontinuation of antifibrotic agents in patients with IPF. Methods: This was a double-center retrospective study that enrolled patients with IPF treated with pirfenidone or nintedanib between 2009 and 2017. We compared clinical parameters between the medication-continuing group and the discontinued group. The predictive factors were determined using Cox proportional hazards analyses. Results: A total of 66 subjects were included: 43 received pirfenidone and 23 received nintedanib. At 1 year, 23 of 66 patients had discontinued due to adverse events ( n = 12), disease progression ( n = 9), or death ( n = 2). The characteristics of the discontinuation group were poor performance status (PS) and delay from diagnosis to treatment. In the receiver operating characteristic (ROC) analysis associated with the discontinuation of antifibrotic agents, PS was the highest area under the ROC curve (AUC) value (cut-off value, 2; AUC, 0.83; specificity, 63%; sensitivity, 87%). This finding was consistent even when analyzing, except for examples of death and adjusting for the type of antifibrotic agent. The treatment persistence rate by PS was PS 0–1 = 90%, PS 2 = 65%, and PS 3 = 19%. Analysis of the relationship between PS and administration period of antifibrotic agents revealed that delays from diagnosis to treatment led to worsening of dyspnea, a decline in lung function, and deterioration of PS. Conclusions: PS may be informative for predicting discontinuation of medication. Our data reinforced the importance of early initiation of antifibrotic treatment, and we suggest PS should be used as a guide for starting antifibrotic agents in everyday practice. The reviews of this paper are available via the supplementary material section.

In cases showing organizing pneumonia (OP) with radiologic findings and pathological images, it is necessary to differentiate between idiopathic and secondary diseases as the cause of OP. Cryptococcus infection as a cause of OP is not well known. We herein report two cases of secondary pulmonary cryptococcosis in immunocompromised patients who showed OP, and the usefulness of bronchoscopy and serum cryptococcal antigen test for an early diagnosis. Common to both cases was that antibiotic therapy and corticosteroid therapy were ineffective, while antifungal agents were effective. In cases of immunocompromised patients who present OP with radiologic findings or pathological images, prompt administration of antifungal treatment at an early stage is important when pulmonary cryptococcosis is identified by bronchoscopy and serum cryptococcal antigen test. Keywords: Cryptococcosis, Organizing pneumonia, Immunocompromised host, Bronchoscopy, Serum cryptococcal antigen test

We herein report the case of a 37-year-old immunocompetent man who died from Pneumocystis jirovecii pneumonia (PCP). He was initially treated for an acute exacerbation of interstitial pneumonia; however, the elevation of the patient’s serum (1-3) β-D glucan (BG) level suggested the possibility of PCP and sulfamethoxazole trimethoprim was added. A postmortem pathological examination and retrospective Grocott's methenamine silver (GMS) staining of the bronchoalveolar lavage fluid (BALF), which was obtained on the day of admission, revealed PCP. The present case suggests that it is essential to perform a BG assay and GMS staining of BALF specimens when patients show diffuse ground-glass opacity on chest computed tomography, regardless of their immune status.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous inflammatory lung disease. It is important to identify patients who would respond to anti-inflammatory treatment. This prospective study aims to determine how inflammatory biomarkers could be used to predict the potential effect of inhaled corticosteroids (ICS) in terms of symptoms and lung function. We evaluated the levels of blood eosinophils, exhaled nitric oxide fraction at a flow rate of 50 ml s−1 (FeNO), alveolar nitric oxide concentration (Calv), immunoglobulin E and atopy in 43 patients with symptomatic COPD and correlated these expression levels with the changes in the COPD Assessment Test (CAT) and lung function by 12 weeks of add-on therapy with ciclesonide 400 μg d−1 on bronchodilators. The mean changes in the CAT score and FEV1 were −1.4 points and +90 ml, respectively, with significant variation in the levels of change. The area under the receiver’s operating characteristic curve (AUC) for FeNO in predicting improvements in both the CAT score and FEV1 was 0.92. The AUC for Calv and blood eosinophils was 0.82 and 0.65. Two cutoffs were chosen, one corresponding to a high value of FeNO associated with certainty for response inclusion (FeNO = 35 ppb; sensitivity = 0.67, specificity = 0.94; positive predictive value = 0.80) and the other with certainty for response exclusion (FeNO = 20 ppb; sensitivity = 1.00, specificity = 0.58, negative predictive value = 1.00). Baseline FeNO values were significantly correlated with changes in FEV1 and CAT (all p

A 44-year-old man was referred to our hospital for the treatment of a pulmonary and deep sternal wound tuberculosis infection, which is an extremely rare type of extrapulmonary tuberculosis. Laboratory testing revealed a serum immunoglobulin (Ig) G level of 286 mg/dL, IgA of 22 mg/dL and IgM of 13 mg/dL. We therefore diagnosed him with hypo-gamma-globulinemia. He was treated with anti-tuberculosis medications and intravenous immunoglobulin. At present, the tuberculosis has not relapsed in the past six years. It may be useful to assess the humoral immunity status in tuberculosis patients with a normal T cell function, and immunoglobulin therapy may be beneficial for protecting such patients from reactivation of tuberculosis.