BackgroundRed cell distribution width (RDW), one of many routinely examined parameters, shows the heterogeneity in erythrocyte size. We investigated the association of RDW levels with clinical parameters and prognosis of lung cancer patients.MethodsClinical and laboratory data from 332 patients with lung cancer in a single institution were retrospectively studied by univariate analysis. Kaplan-Meier survival analysis and Cox proportional hazard models were used to examine the effect of RDW on survival.ResultsThe RDW levels were divided into two groups: high RDW (>=15%), n=73 vs. low RDW, n=259 (<15%). Univariate analysis showed that there were significant associations of high RDW values with cancer stage, performance status, presence of other disease, white blood cell count, hemoglobin, mean corpuscular volume, platelet count, albumin level, C-reactive protein level, and cytokeratin 19 fragment level. Kruskal-Wallis tests revealed an association of RDW values with cancer stage in patients irrespective of comorbidity (patient with/without comorbidity: p<0.0001, patient without comorbidity: p<0.0001). Stages I-IV lung cancer patients with higher RDW values had poorer prognoses than those with lower RDW values (Wilcoxon test: p=0.002). In particular, the survival rates of stage I and II patients (n=141) were lower in the high RDW group (n=19) than in the low RDW group (n=122) (Wilcoxon test: p<0.001). Moreover, multivariate analysis showed higher RDW is a significant prognostic factor (p=0.040).ConclusionRDW is associated with several factors that reflect inflammation and malnutrition in lung cancer patients. Moreover, high levels of RDW are associated with poor survival. RDW might be used as a new and convenient marker to determine a patient’s general condition and to predict the mortality risk of lung cancer patients.

Half of patients with empyema were HCAE patients, who had comorbidities, bacteriological profile and outcome different from CAE patients. The patient with HCAE should be differentiated from CAE patient, and the stratification of patients based on risk factors may be useful for treatment strategy.

It is possible that asthma tends to involve autoimmunity associated with antinuclear antibody more frequently than COPD because asthma is the more robust factor for antinuclear antibody positivity. Antinuclear antibody and rheumatoid factor are associated with eosinophilic responses, but they do not work as biomarkers for disease severity.

The concurrent diagnosis of chronic obstructive pulmonary disease (COPD) and sleep apnoea-hypopnoea syndrome (SAHS) (overlap syndrome), can contribute to worsening respiratory symptoms, but whether the severity of COPD is associated with co-morbid SAHS is unknown. We investigated whether the severity of COPD is associated with the complication of SAHS by examination of nocturnal oximetry as an alternative to polysomnography. Patients with COPD concurrently completed nocturnal oximetry, pulmonary function tests, a COPD assessment test, an Epworth sleepiness scale and a hospital anxiety and depression scale to evaluate the severity of COPD and possible concurrent presence of SAHS. We retrospectively analysed the data to assess correlation between the oxygen desaturation index (ODI) and each clinical variables and evaluated the predictors of ODI ≥ 15. This study included 103 patients (91 males, 88%) with a mean age of 72 ± 8 years and body mass index of 22 ± 3 kg/m(2). ODI was positively correlated with FEV1, FEV1/FVC and FEV1% predicted, which meant that ODI was inversely correlated with airflow limitation. Univariate logistic regression analysis revealed that FEV1% predicted and FEV1/FVC were predictors of ODI ≥ 15. ODI is inversely correlated with airflow limitation and milder COPD patients may have co-morbid SAHS.

IntroductionPulmonary alveolar proteinosis is characterized by accumulation of surfactant and phospholipids in the pulmonary alveoli. Whole lung lavage is considered the first-line therapy, which requires special techniques. To the best of our knowledge, there have only been limited reports that have demonstrated the effectiveness of ambroxol on a mild case of pulmonary alveolar proteinosis.Case presentationA 72-year-old Japanese woman presented to our hospital with a one-year history of productive cough and progressive dyspnea. Her chest computed tomography scan showed a bilateral crazy-paving pattern in both of her lungs. She was diagnosed with autoimmune pulmonary alveolar proteinosis based on bronchoalveolar lavage findings and the presence of serum anti-granulocyte macrophage colony-stimulating factor antibodies. She was severely hypoxemic, so we recommended whole lung lavage or inhaled granulocyte macrophage colony-stimulating factor treatment, which she refused. We initiated treatment with ambroxol and her symptoms markedly improved.ConclusionsAlthough whole lung lavage is the first-line therapy for pulmonary alveolar proteinosis, oral ambroxol could be an alternative treatment option, even in patients with severe respiratory compromise.

Abstract:The aim of this study was to consolidate oral health management systems in the acute stages. The practical status of oral health in perioperative patients and improvements achieved through coordinated oral health care were investigated. Subjects of the present study were 87 patients who underwent oral intubation in the intensive care unit (ICU). These patients attended an oral health care center from October 2010 to March 2011. Dentists rated the oral status of subjects within 24 h of admission to the ICU on a three-point scale by assessing the lips, teeth, mucous membrane, gingiva, tongue, and saliva. In addition, the number of Candida colonies detected on the tongue was noted at initial assessment. At initial assessment, 70% of participants with respiratory diseases were classifi ed as having oral problems. However, few subjects showed presence of dental plaque or reported problems involving the mucous membrane. The proportion of Candida-positive participants was higher in those with respiratory diseases than those with cardiovascular diseases. When comparing the Candida-positive and -negative subjects, a greater proportion of the former had problems with the lips, saliva, mucous membrane, and tongue. With regard to the time-dependent changes recorded on these problems, improvement in the condition of the lips tended to occur earlier than the conditions of the tongue. As it has been suggested that maintaining a clean tongue can be critical in patients undergoing oral intubation, it is important to continue appropriate oral health care in the acute stages.

Plasmablastic lymphoma (PBL) is an aggressive subtype of DLBCL, first reported in HIV-infected patients 1 and subsequently recognized in the WHO 2008 classification. 2 PBL often arises in the oral cavity, but other sites include the nasal cavity, GI tract, skin, bone, and lungs. 3-5 PBL mainly affects those with immunodeficiency, 3-5 but can affect some immunocompetent individuals. 6 Histologically, PBL presents as dense proliferation of immature cells like Burkitt's lymphoma. 2,5,7 The immunophenotype of PBL, however, resembles myeloma cells: CD38 + , CD138 + , cyIg + , MUM1 + , CD45-, CD20-, and smIg-. 3-5 EBV is mostly positive. 3-5,7 A 53-year-old HIV-negative and immunocompetent woman was admitted because of chest pain and dyspnea. CT scanning revealed a large tumor in the right chest wall (Figure 1A), pleural effusion, para-aortic lymph node swelling, and a tumor in the sacral bone (Figure 1B and 1C, respectively). Laboratory findings are shown in Table 1. Serum IgG was 7,633 mg/dL, and revealed to be IgG-λ monoclonal protein. Many atypical plasma cell-like cells with CD38 + , CD56 + , CD138 + , cyIgG + , and cyλ + phenotype were observed in the pleural effusion (Figure 2). The karyotype was abnormal, with a complex involving chromosomes 1 and 3 (Table 1). 8-10 Furthermore, FISH analysis demonstrated t(4;14). 11 The chest tumor histologically exhibited dense proliferation of large immature cells (Figure 3A, B), and these cells were positive for CD138 and λ light chain (Figure 3C and 3D, respectively). A tentative diagnosis of multiple myeloma was made. She refused treatment with conventional anti-cancer agents. We therefore treated her with novel agents for myeloma, which were available in 2015 without any obvious response. Then, we performed radiotherapy for the chest tumor and other tumoral lesions. However, she died four months after admission. Histopathological re-examination of the chest tumor revealed it to be PBL. Immunostaining for myc was strongly positive as reported in PBL, 4,5 and FISH split signal analyses for c-myc, but not for Bcl-2 or Bcl-6, yielded split signals and amplification of this gene (Figure 3F). Serum virus genomes for EBV and HHV-8 were not detected by PCR. This patient appeared to have a borderline feature between plasmablastic plasma cell myeloma (PBPCM) 12 because the tumor-involvement site was atypical for PBL 3-5 and this patient carried multiple chromosomal abnormalities related with aggressive multiple myeloma. 8-11 The genetic background of PBL has not yet fully understood 5 ; therefore, accumulation of PBL cases and further molecular studies are required regarding clinical features and molecular profiles of PBPCM.

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