Brinkman Index Research Articles

Immune profile analysis of peripheral blood and tumors of lung cancer patients treated with immune checkpoint inhibitors.

Immune checkpoint inhibitors (ICIs) have become central to lung cancer drug therapy, and establishing biomarkers that can predict effects and adverse events (AEs) is awaited. We prospectively analyzed the association between the immune-related molecular expression in peripheral blood mononuclear cells (PBMCs) and lung cancer tissues, and the effects of ICI monotherapy. Twenty-one patients with advanced non-small cell lung cancer (NSCLC) who received ICI monotherapy were included. Changes in the expression of immune-related molecules in PBMCs before and after the administration of ICI were analyzed by flow cytometry. The major histocompatibility complex (MHC) class I and programmed cell death-ligand 1 (PD-L1) expression of cancer cells, and the PD-L1, CD8 and CD103 expression of tumor infiltrating immune cells in lung cancer tissue before the administration of ICI were confirmed by immunohistochemistry (IHC). Twenty-one patients were investigated, including 11 adenocarcinoma and 10 squamous cell carcinoma cases. Anti-programmed cell death protein-1 (PD-1) antibody (n=18) and anti-PD-L1 antibody (n=3) were administered. The clinical responses were graded as follows: complete response (CR) (n=1), partial response (PR) (n=7), stable disease (SD) (n=10) and progressive disease (PD) (n=3). Among immune-related molecules expressed in PBMCs, the CD103+ CD39+ CD8+ T cell change after administration closely correlated with the clinical response. In the univariate analyses of the factors associated with progression-free survival (PFS), CD103+ CD39+ CD8+ cell change after administration was identified as a significant prognostic factor, while the CD103+ CD39+ CD8+ cell change after administration and Brinkman index were independent prognostic factors in a multivariate analysis of the factors associated with PFS. The CD103+ CD39+ CD8+ cell change after administration may predict the efficacy of ICIs.

Postoperative respiratory morbidity can adversely affect prognosis in thoracoscopic esophagectomy for esophageal cancer: a retrospective study.

Esophagectomy for esophageal cancer is associated with frequent respiratory morbidities, which may deteriorate postoperative survival outcomes. Thoracoscopic esophagectomy (TE) is less invasive and is associated with fewer respiratory morbidities than open esophagectomy. However, the relationship between post-TE respiratory morbidity and prognosis has not been well established. This study included 378 patients who underwent TE for esophageal cancer between May 2011 and November 2020. Patients were divided into two groups based on the presence of respiratory morbidity. Short-term and long-term outcomes of the groups were retrospectively compared. Respiratory morbidity was significantly associated with heavy past smoking habits (Brinkman index, p = 0.0039), short duration of smoking cessation (p = 0.0012), worse American Society of Anesthesiologists physical status (p = 0.016), frequent cardiovascular comorbidities (p = 0.0085), and long hospital stay (p < 0.001). Respiratory morbidity significantly deteriorated overall survival (OS) (p = 0.011) and relapse-free survival (p = 0.062) and could be an independent prognostic factor for OS (hazard ratio = 1.90, 95% confidence interval = 1.093-3.311, p = 0.023) along with clinical stage. Respiratory morbidity can adversely affect prognosis after TE. Various prophylaxes for respiratory morbidity are required to improve the short-term and long-term outcomes of TE for esophageal cancer.

The Relationship Between Clinical Risk Factors and Patient’s Survival Rate in Non-Small Cell Lung Carcinoma Cases: A Cross-Sectional Study

Background: Non-small cell carcinoma (NSCLC) is the most common type of lung cancer. Risk factors for lung cancer include smoking, genetic factors, chronic lung disease, lung infections, radon exposure, air pollution, exposure to carcinogenic substances in the workplace and other risk factors. The significance of each of these risk factors differs by sex, race and region in a given country. Purpose: The study was conducted to assess the analysis of risk factors, treatment response and survival of NSCLC patients. Methods: Cross sectional and survival analysis, patients undergoing diagnostic and treatment at Dr. Wahidin Sudirohusodo Makassar period January 2017-December 2019. Anamnesis of risk factors and survival by telephone and patient medical record data. Results: There are 100 patients who fulfill the inclusion criteria; Subject characteristics were mostly male (64%), age &gt;45 years (84%), Bugis ethnicity (50%), farmer occupation (27%), active smokers (60%), consume filter cigarettes (75%), and has severe brinkman index (BI) (51.6%). About 40% of the subjects were non-smokers, 50% of whom were passive smokers. Severe IB and high-risk occupations by type of KPKBSK were significant (p = 0.02 and p = 0.01). Age &lt;45 years, median survival was better than age 45 years (8 months versus 4 months), p = 0.002. Subjects receiving EGFR-TKI had a better median survival of 7 months, platinum doublet 6 months, did not receive treatment for 2 months, p = &lt;0.05. Conclusion: Brinkman Index (BI) and high-risk occupation based on NSCLC type are significant. Age &lt; 45 years had a good median survival. Subjects who received TKI had a better median survival. Keywords: Non-small cell lung carcinoma, clinical risk factors, survival rate.

Factors Related to Complaints of Lung Function Disorders In UPN Veteran Jakarta Employees

Background: One characteristic of lung dysfunction is obstruction of airflow in the respiratory tract. The prevalence of COPD as lung function disorder among men in Indonesia is 3.7% and 2.7% in DKI Jakarta. One of the causes of decreased lung function is smoking. A large portion of UPN Veteran Jakarta employees is smoker. This research was aimed to determine risk factors of lung dysfunction among employees in UPN Veteran Jakarta. Method: A cross sectional study was conducted from April to May 2019 in UPN Veteran Jakarta. Total 102 samples of employees who work at UPN includes staff, lecturers, cooperative officers, office boys, and security guards were selected using purposive sampling. Measuring instruments used in this study were questionnaires, scales, microtoise and spirometer. Spirometer was used to measure lung function. Questionnaires to obtain data on gender, age, body mass index (BMI), employment status, education, allergies, history of lung disease, family history, Brinkman index, physical activity, vehicle emissions exposure and smoking environment. The data was analysed using the chi square test and logistic regression test Results: The results of the logistic regression test showed risk factors of lung dysfunction were BMI (POR: 4.718; 95% CI 1.673-13.305), history of lung disease (POR: 3,424; 95% CI 0.836-14.028) and smoking environment (POR: 2.956; 95% CI 0.953-9.168). Conclusion: The most influencing factors for lung dysfunction were BMI, history of lung disease, and smoking environment.

Giant bronchopleural fistula and empyema in a tuberculosis patient with diabetes mellitus: Vista from a high tuberculosis burden country in Southeast Asia.

Bronchopleural fistula is a pathological tract between the bronchial tree and the pleural space, which can be life-threatening due to tension pneumothorax. It is a rare complication in tuberculosis cases with highly variable in clinical manifestations and persistent air leaks which might lead to complications such as empyema. Herein, we present a tuberculosis and diabetic patient complicated with giant bronchopleural fistula and empyema. A 48-year-old man presented with shortness of breath for two weeks and cough with phlegm for two months. The patient was a smoker with severe Brinkman Index and diabetes. Physical examination revealed hyper resonant percussion and vesicular diminished on the left hemithorax. Laboratory results indicated the patient had anemia, leukocytosis, and hypoalbuminemia. GeneXpert sputum confirmed the presence of Mycobacterium tuberculosis and chest X-ray indicated a collapsed left lung. The patient was diagnosed with left secondary spontaneous pneumothorax, pulmonary tuberculosis, and diabetes. The patient was treated with chest tube drainage and anti- tuberculosis drugs. There was no improvement based on serial chest X-ray, and empyema appeared from the chest tube. CT-scan showed tuberculosis lesion, the collapsed of the left lung and fistula in segments 7-8 inferior lobe. Exploratory thoracostomy was performed, in which a giant bronchopleural fistula was detected and then repaired with BioGlue surgical adhesive. Unfortunately, the thoracostomy led to extensive subcutaneous emphysema and was treated by cervical mediastinotomy. The drainage was unable to be removed, and the patient was discharged with Heimlich-type drainage valves on day 28 of treatment. The empyema fluid was cultured and revealed Staphylococcus haemolyticus. This case highlights that tuberculosis could cause a bronchopleural fistula and empyema may occur secondary to late diagnosis that needs immediate surgery.

Can the Brinkman Index Predict the Need for Treatment in Patients With COVID-19?

Can the Brinkman Index Predict the Need for Treatment in Patients With COVID-19?

Factors Affecting the Treatment Success of Short-Term Regimen for Drug Resistant Tuberculosis (DR TB) Patients at Dr. Saiful Anwar General Hospital Malang

Background: Epidermal growth factor (EGFR) is a transmembrane receptor that plays an important role in the development of cancer phenotypes. Some patients with lung cancer have genetic mutations. Several studies have found a close correlation of EGFR gene mutation with 15-20% of lung adenocarcinoma cases. This study aimed to determine the EGFR profile in adenocarcinoma lung cancer patients at Haji Adam Malik General Hospital.Methods: This was a prospective cohort study conducted at Haji Adam Malik General Hospital, Medan. This study used patients data for 3 years, starting from January 1, 2014 to D1ecember 31, 2016. The sample size in this study was 34 patients. The data were then analyzed using SPSS.Results: All patients were adenocarcinoma lung cancer patients with positive EGFR mutation. There were 9 subjects with EGFR mutation in exon 19; 11 subjects with exon 21 L858R mutation; and 3 subjects with exon 21 L861Q mutation. Meanwhile, there were 3 subjects with uncommon EGFR mutations, namely exon 18 mutation. Majority of subjects with exon 19 mutation were male, aged &gt;60 years, smokers with mixed types of cigarettes and severe brinkmann index. In subjects with exon 21 L858R mutation, most of the patients were male, aged 50-60 years, smokers with mixed cigarette types and severe brinkmann index. The same characteristics were also observed in subjects with exon 18 mutation. However, for exon 21 L861Q mutation, the majority of subjects were female with varying ages, and were not smokers. Conclusion: Most of the study subjects profiles were male, aged over 60 years, smokers, with mixed types of cigarettes, and with severe Brinkman Index. The EGFR mutations most commonly occured in exon 21, followed by exon 19 (ins/del exon 19), exon 18, and a combination of 2 exons.

Age-related Changes in Renal Arterio-Arteriolosclerosis in Kidney Disease: Renal Biopsy-based Study

Age-related Changes in Renal Arterio-Arteriolosclerosis in Kidney Disease: Renal Biopsy-based Study

White matter fiber-specific degeneration in older adults with metabolic syndrome

ObjectiveMetabolic syndrome (MetS) is defined as a complex of interrelated risk factors for type 2 diabetes and cardiovascular disease, including glucose intolerance, abdominal obesity, hypertension, and dyslipidemia. Studies using diffusion tensor imaging (DTI) have reported white matter (WM) microstructural abnormalities in MetS. However, interpretation of DTI metrics is limited primarily due to the challenges of modeling complex WM structures. The present study used fixel-based analysis (FBA) to assess the effect of MetS on the fiber tract-specific WM microstructure in older adults and its relationship with MetS-related measurements and cognitive and locomotor functions to better understand the pathophysiology of MetS. MethodsFixel-based metrics, including microstructural fiber density (FD), macrostructural fiber-bundle cross-section (FC), and a combination of FD and FC (FDC), were evaluated in 16 healthy controls (no components of MetS; four men; mean age, 71.31 ± 5.06 years), 57 individuals with premetabolic syndrome (preMetS; one or two components of MetS; 29 men; mean age, 72.44 ± 5.82 years), and 46 individuals with MetS (three to five components of MetS; 27 men; mean age, 72.15 ± 4.97 years) using whole-brain exploratory FBA. Tract of interest (TOI) analysis was then performed using TractSeg across 14 selected WM tracts previously associated with MetS. The associations between fixel-based metrics and MetS-related measurements, neuropsychological, and locomotor function tests were also analyzed in individuals with preMetS and MetS combined. In addition, tensor-based metrics (i.e., fractional anisotropy [FA] and mean diffusivity [MD]) were compared among the groups using tract-based spatial statistics (TBSS) analysis. ResultsIn whole-brain FBA, individuals with MetS showed significantly lower FD, FC, and FDC compared with healthy controls in WM areas, such as the splenium of the corpus callosum (CC), corticospinal tract (CST), middle cerebellar peduncle (MCP), and superior cerebellar peduncle (SCP). Meanwhile, in fixel-based TOI, significantly reduced FD was observed in individuals with preMetS and MetS in the anterior thalamic radiation, CST, SCP, and splenium of the CC compared with healthy controls, with relatively greater effect sizes observed in individuals with MetS. Compared with healthy controls, significantly reduced FC and FDC were only demonstrated in individuals with MetS, including regions with loss of FD, inferior cerebellar peduncle, inferior fronto-occipital fasciculus, MCP, and superior longitudinal fasciculus part I. Furthermore, negative correlations were observed between FD and Brinkman index of cigarette consumption cumulative amount and between FC or FDC and the Trail Making Test (parts B–A), which is a measure of executive function, waist circumference, or low-density lipoprotein cholesterol. Finally, TBSS analysis revealed that FA and MD were not significantly different among all groups. ConclusionsThe FBA results demonstrate that substantial axonal loss and atrophy in individuals with MetS and early axonal loss without fiber-bundle morphological changes in those with preMetS within the WM tracts are crucial to cognitive and motor function. FBA also clarified the association between executive dysfunction, abdominal obesity, hyper-low-density lipoprotein cholesterolemia, smoking habit, and compromised WM neural tissue microstructure in MetS.

Respiratory Bronchiolitis-Interstitial Lung Disease in Chronic Kidney Disease Mimicking Uremic Lung: A Case Report

Introduction: Uremic lung is a frequent complication of chronic kidney disease (CKD), while interstitial lung is an inflammation of the parenchyma which impairs its capacity. These two conditions manifest similar radiological features with bilateral diffuse infiltrates. Therefore, their clinical appearance and radiological lesions are often mistaken. Case: This study reported a case of a 55-year-old male patient with shortness of breath for 1 month and worsening 1 week before hospitalization. The patient had a smoking history for 30 years with severe Brinkman index, hypertension (HT), and diabetes mellitus (DM). Auscultation examination showed crackles in both lungs, while laboratory results showed anemia, leukocytosis, increased urea and creatinine levels, and radiological features of bilateral infiltrate suggesting a uremic lung. Furthermore, the ultrasonography showed bilateral chronic pyelonephritis and was diagnosed with CKD, uremic lung, pneumonia, anemia, hypoalbuminemia, mild hypokalemia, DM, and HT. The patient was treated with regular hemodialysis three times a week, and the serial chest X-ray after hemodialysis showed persistent bilateral infiltrates. An MSCT examination was also performed, and the results showed respiratory bronchiolitis-interstitial lung disease (RB-ILD). The patient was treated with antibiotic therapy, inhaled salbutamol, systemic steroids, and mucolytics. The patient was discharged from the hospital after the respiratory complaint were improved. Conclusion: In uremia patients with bilateral infiltrates resembling uremic lung and unresponsive to hemodialysis or other therapies, interstitial illness should be explored. To improve patient management, risk factors for suspected interstitial lung disease should always be examined.

Lung Function and Respiratory Symptoms Features of Smoker among University Students

Introduction: Smoking habit still becomes one of the problems in Indonesia with the high number of active smokers in university students. Smoking is one of the causes of several conditions of respiratory symptoms and risk factor of multiple case of lung function impairment. This study aimed to examine characteristic of lung function and respiratory symptoms and its relationship in active smokers among university student in Depok, Indonesia. Methods: This was a cross-sectional study using American Thoracic Society (ATS) questionnaire for respiratory symptoms and Brinkman index for smoking habits. Lung function was examined using EasyOne® Air Spirometer. Results: This study was participated by 116 male university students who are active smokers. This study found that majority of respondents fell into the mild category of smoking habit (96.56%) and complained of respiratory symptoms (74.14%). This study found lung function impairment in 15.5% respondents (8.6% obstructive and 6.9% restrictive disorder). There was no significant relationship between smoking habits with respiratory symptoms and lung function impairment among respondents. Conclusion: This study found the characteristics of smoking habits in male university students were categorized as mild smoking habit, followed by the appearance of respiratory symptoms and lung function impairment. However, there was no significant relationship between smoking habits and respiratory symptoms or lung function. This issue needs to be paid attention to strengthen the campaign to prevent smoking initiation and to help smoking cessation among young adults as early as possible.

Clinical impact of cigarette smoking on the outcomes of allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study.

Smoking is associated with a high risk for different diseases including respiratory tract infections in immunocompetent patients. However, data about the effects of cigarette smoking on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are limited. Therefore, we retrospectively investigated 608 patients aged ≥20 years with hematological disorders who received their first allo-HSCT at our group of hospitals between 2000 and 2015, and evaluated the impact of cigarette smoking before allo-HSCT on clinical outcomes by dividing patients into two groups according to the Brinkman index (BI) (nonsmokers or light smokers [BI: 0-500] and heavy smokers [BI: ≥ 500]). Multivariate analyses showed that heavy smoking was associated with a high 5-year cumulative incidence of chronic graft-versus-host disease (cGVHD) (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.15-2.61, p < 0.01). The 5-year overall survival (HR: 1.16, 95% CI: 0.86-1.58, p = 0.33) and disease-free survival (HR: 1.12, 95% CI: 0.83-1.52, p = 0.45) were similar between the two groups. Hence, cigarette smoking is correlated with cGVHD, although prospective studies must be conducted to further verify this result.

Survival Rate in Lung Adenocarcinoma with Mutation of the EGFR Gene with Tyrosine Kinase Inhibitor Treatment

Background: EGFR mutation is a genetic disorder that is often observed and examined in Non-Small Cell Lung Carcinoma. EGFR mutation detection aims to predict sensitivity to EGFR-TKI and acts as first-line therapy. Targeted therapy with EGFR-TKI can increase the survival rate of patients with Non-Small Cell Lung Cancer compared to chemotherapy. This study aims to obtain data on the survival rate of patients with Non-Small Cell Lung Carcinoma who received targeted therapy at H. Adam Malik Hospital. &#x0D; Methods: This study is a descriptive study with a retrospective cohort design carried out at the Oncology Polyclinic at RSUP H Adam Malik Medan for 5 years, from January 2014 to December 2018. The subjects of this study were all patients with lung cancer type adenocarcinoma who had received therapy with generation 1 or 2 EGFR TKI. &#x0D; Results: 99 patients were included as subjects of this study. From the study, the most influential factors on lung cancer were gender, age, and smoking addiction. The study consisted of 60.6% male, 92.9% of the respondents aged 40 years and over, 56.5% active, and 43.4% passive smokers and 41.4% of the respondents with severe Brinkman index. The 30-month survival rate of EGFR-TKI (Gefitinib) patients treated with NSCLC Adenocarcinoma (Gefitinib) from 2014 to 2018 at H. Adam Malik Hospital Medan was 6.3% with a median survival of 7 months. The duration of progression-free survival in patients receiving Erlotinib therapy was 6.6 months (6.6 ± 2.51 months), while the length of progression-free survival for patients treated with Gefitinib was 9.1 months (9.1 ± 6.9 months). The results of statistical tests showed that there was no difference in progression-free survival rate between those who received Erlotinib and Gefitinib (P = 0.82). &#x0D; Conclusion: The 30-month survival rate of lung adenocarcinoma patients treated with EGFR-TKI from 2014 to 2018 was 6.1% with a median survival of 7 months. Those who received Erlotinib therapy experienced Progression-Free Survival for 6.6 months and those who received Gefitinib experienced Progression-Free Survival for 9.1 months.

The Relation of Brinkman Index and Body Mass Index with Spirometry Result of Chronic Obstructive Pulmonary Disease (COPD) Outpatients in the Pulmonology and Respiratory Medicine Department of Zainoel Abidin General Hospital

Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the major health problems worldwide. Smoking is the main risk factor of the COPD development. Not only COPD has clinical manifestations in the lungs, it also manifest outside lungs called systemic effects.One of systemic effects found in COPD patients is weight loss leading to declining lung function. This study aims to determine the relation of Brinkman Index and Body Mass Index (BMI) with spirometry result of COPD outpatients in RSUDZA.&#x0D; Methods: The study was held in lung outpatients department in RSUDZA Banda Aceh on December 5th until 28th with cross sectional design The sampling method is nonprobability sampling with accidental sampling technique. Respondents consisted of 30 patients who had agreed to informed consent given. Medical record used to obtain Brinkman index, BMI, and spirometry result of the patients.&#x0D; Results: The results of analysis shows majority of respondents are male (83,3%), dominated by 56-65 years age range (40,0%) and had moderate Brinkman Index (46,7%). The majority of respondents (53,3%) had an abnormal BMI (severe underweight (13,3%), underweight (6,7%), overweight (23,3%), and obese (10,0%)) and severe spirometry result (53,3%). The data was analyzed by the Spearman Correlation. With the Spearman Correlation, there was no association between Brinkman Index and spirometry result with p value 0,412 (p value &gt;0,05). Meanwhile, there was an association between the BMI and spirometry result with p value 0,006 (p &lt; 0,05). The strength of the correlation is moderate (rs =-0,488).&#x0D; Conclusion: The lower the BMI, the more severe the spirometry result.&#x0D;

Multiple Possible Causes Of Dyspnea In An Unusual Pickwickian Syndrome On Covid-19 Pandemic: A Case Study

Introduction: Pickwickian Syndrome (PS) or obesity hypoventilation syndrome (OHS) is a diagnosis of exclusion with features of obesity, sleep disordered breathing, and chronic daytime hypercapnia. Patients with PS could present into general OSA or respiratory failure. We are presenting an unusual case of PS with acute respiratory failure resulting in organ failure and mortality.&#x0D; Case report: A 41-year-old male was admitted to hospital due to shortness of breath. He had a trouble sleeping; frequently awoke as the breathing briefly stopped and gasping. There were history of diabetes melitus (DM) and hypertension for &gt;10 years, smoking with moderate Brinkman Index. Patient appeared to have somnolence, tachypnea, hypoxemia, morbid obesity. We assessed him as PS, bronchopneumonia, respiratory failure, pulmonary edema, hypertensive heart disease (HHD), DM, acute on CKD. We managed him with pharmacotherapy, oxygen (BiPAP), and hemodialysis. After transferred from ICU to regular ward, patient was suddenly apneic and CPR was performed; ended in mortality.&#x0D; Discussion: This unusual case (malignant OHS) was a subgroup among OHS with greater morbidity and multiorgan system dysfunction. There were multiple causes of dyspnea on our patient which concluded to a death case. There are three modalities of management in stable PS: positive airway pressure (PAP), weight reduction, and pharmacotherapy. The management of respiratory failure in PS mainly involved oxygen therapy in positive pressure.&#x0D; Conclusion: There were multiple causes of dyspnea in this patient. Optimal management of patient ought to treat not only the PS but also all the comorbidities.

The impact of epidermal growth factor receptor mutation status on adjuvant chemotherapy for patients with high-risk stage I lung adenocarcinoma

ObjectiveThe aim of this study was to evaluate the role and effect of adjuvant chemotherapy based on epidermal growth factor receptor mutation status in patients with stage I lung adenocarcinoma. MethodsBetween 2010 and 2016, of 1901 patients with pathologic stage I (8th edition) non–small cell lung cancer, we identified 475 with high-risk (pT1c/T2a or positive for lymphovascular invasion) stage I lung adenocarcinoma who underwent lobectomy. We estimated propensity scores to adjust for confounding variables, including age, sex, Brinkman index, pulmonary functions, comorbidities, surgical approach, invasive component tumor size, visceral pleural, lymphatic, and vascular invasion, adenocarcinoma subtype, epidermal growth factor receptor mutation status, postoperative complications, and institution associated with the administration of adjuvant chemotherapy. The primary end point was recurrence-free survival. ResultsOf 292 patients without/unknown epidermal growth factor receptor mutation, 105 (36.0%) received adjuvant chemotherapy and 187 (64.0%) did not. In 69 pairs of patients who were propensity score matched, the 5-year recurrence-free survival was significantly better in those who underwent adjuvant chemotherapy (88.4%) than in those who did not (63.6%; P = .001). Of 183 patients with epidermal growth factor receptor mutation, 78 (42.6%) received adjuvant chemotherapy and 105 (57.4%) did not. In 49 pairs of propensity score–matched patients, there was no significant difference in the 5-year recurrence-free survival between those who underwent adjuvant chemotherapy (74.3%) and those who did not (80.5%; P = .573). ConclusionsThe effect of adjuvant chemotherapy for high-risk stage I lung adenocarcinoma varied by epidermal growth factor receptor mutation status. Epidermal growth factor receptor mutation status may help to identify patients with high-risk stage I lung adenocarcinoma who may benefit from adjuvant chemotherapy.

The Effect of Inspiratory Breathing Muscle Exercise Using Respirometer on Changes in Lung Function and Dyspnea Severity in Tuberculosis Pleurisy Patients

Background: Respirometer has been commonly used to improve lung function, prevent atelectasis and respiratory complications after surgery. The effectiveness of respirometer to improve lung re-expansion in pleural effusion has not been well studied. So far there is no such study implemented to examine this association in pleural effusion particularly tuberculosis pleurisy in Aceh. Method: This was an experimental pretest-posttest controlled trial in patients with tuberculosis pleurisy hospitalized in dr. Zainoel Abidin Hospital between July and December 2019. Systematic random sampling was used to gather 40 samples, which then divided into intervention and control group consisted of 20 people in each group. All participants performed spirometry and were assessed for dyspnea severity using Borg scale after thoracocentesis and repeated 6 days later. Only intervention group received exercise using respirometer. Data were examined statistically using paired T-test and Mann Whitney Test. Results: The majority of participants were male (68%) with mean age of 42 years old. Around one-third of samples were smokers with mean Brinkman Index of 273 (moderate). The nutritional status was mostly good with mean BMI of 21 (normal). There were significant improvements of FEV1 and FVC values before and after 6 days in both groups. However, if the improvements were compared between intervention and control groups, only FVC improved significantly in intervention group (P= 0.019) whereas FEV1 improved in both groups without significant difference (P= 0.456). Similar result was seen in dyspnea severity where both groups experienced improvement after 6 days with or without intervention. Conclusion: Inspiratory muscle exercise using respirometer could improve lung function, particularly FVC value, significantly and could be an option for additional therapy to help lung re-expansion in tuberculosis pleurisy.

Expression of SATB2 in Neuroendocrine Carcinomas of the Lung: Frequent Immunopositivity of Large Cell Neuroendocrine Carcinoma with a Diagnostic Pitfall.

Small cell lung carcinoma (SCLC) and pulmonary large cell neuroendocrine carcinoma (LCNEC) are both classified as lung neuroendocrine carcinoma (NEC). It has recently been reported that the special AT-rich sequence-binding protein 2 (STAB2), known as a colorectal cancer marker, is also expressed in NECs occurring in various organs including the lung. However, few studies have examined any differences of SATB2 immunopositivity between SCLC and LCNEC. We investigated SATB2 expression in 45 SCLC and 14 LCNEC cases using immunohistochemistry as well as the expression of caudal-type homeobox 2 (CDX2) and keratin (KRT) 20. The LCNEC cases were more frequently positive for SATB2 (ten out of 14, 71%) than the SCLC ones (seventeen out of 45, 38%) with a statistically significance (P = 0.035). Furthermore, two LCNEC cases were positive for CDX2 while no positive findings were observed for any SCLC cases, the difference of which, however, was not statistically significant (P = 0.053). KRT20 was negative in all LCNEC and SCLC cases. These results require our attention when we use SATB2 and CDX2 as colorectal cancer markers because their expression in pulmonary NECs can lead to a misdiagnosis that the tumor is of metastatic colorectal adenocarcinoma, especially when the patient has a past history of colorectal cancer. Analyzing the relationship between the demographic/clinical variables and the SATB2 expression in the SCLC cases, just high Brinkman index (≥ 600) was significantly related to the positivity of SATB2 (P = 0.017), which is interesting considering the strong relationship between SCLC and smoking.

Impact of qualitative endoscopic ultrasonography on fatty pancreas at a referral medical center.

BackgroundTaking advantage of the current advances in diagnostic imaging modalities, including endoscopic ultrasonography (EUS), and due to the increased attention to ectopic fat accumulation in the pancreas following the rising trend of metabolic syndrome, we qualitatively assessed the clinical implication of pancreatic steatosis by EUS in this study.MethodsThe study included 243 patients that were divided into four groups. The correlation between the average echogenicity of the pancreas and that of the control organs and the key clinical data of all study patients were collectively analyzed. The cut‐off point of the pancreas‐control (PC) ratio in EUS and liver‐control (LC) ratio on abdominal ultrasound were determined from the population distribution and the obtained median values.ResultsWith the cut‐off point of 1.30 for the PC ratio and 1.20 for the LC ratio, sex, the Brinkman index, habitual alcohol drinkers, and fatty pancreas were significant factors. The associations between each relevant factor in fatty pancreas, metabolic syndrome in the fatty liver group, and age in the pancreatic cancer group were all significant in the analysis. In addition, we investigated whether the PC ratio differed according to age and staging in pancreatic cancer patients. Interestingly, the PC ratio was lower in the advanced stage group than in the early‐stage group.ConclusionOur results suggest that, irrespective of the degree, ectopic fat infiltration in the pancreas could be a specific clinical phenotype of serious pancreatic diseases, including pancreatic cancer, especially in high‐risk patients.

Factors that Influence 2-Year Progression-Free Survival Among Head and Neck Cancer Patients

ObjectivesThe majority of patients with head and neck cancer (HNC) come to the hospital at advanced stages. This research was conducted to determine the mortality, 2-year progression-free survival (PFS) and factors that influenced PFS of HNC patients.MethodsA retrospective cohort study was conducted among locally advanced HNC patients who underwent chemoradiation for the first time at RSCM from January 2015 to December 2017. Data were retrieved through medical records. Laboratory data were taken 2–4 weeks prior and 2–4 weeks after chemoradiation. PFS observation started from the first day of chemoradiation until disease progression or death. PFS data were recorded in two groups: ≤ 2 years and > 2 years. The Chi-square test was used for bivariate analysis with the Fischer-exact test as an alternative. Variables will be further tested using multivariate logistic regression tests.ResultsAmong 216 subjects, there were 103 (47.69%) patients who did not reach overall survival (OS) > 2 years. There were 108 (50%) patients who had PFS > 2 years. Based on the results of multivariate analysis, it was found that smoking, hemoglobin level ≤ 12 g/dl, ECOG (Eastern Cooperative Oncology Group) 1–2, and negative therapeutic response were associated with poor PFS. Hazard ratio (HR) for 2-year PFS for Brinkman index > 250 was 1.36 (95% CI 0.93–2.00; p = 0.02); HR for Hb ≤ 12 g/dl was 1.65 (95% CI 1.13–2.42; p = 0.01); HR for ECOG 1–2 was 4.05 (95% CI 1.49–11.00; p < 0.01); and HR for negative therapeutic response was 2.37 (95% CI 1.43–3.94; p < 0.01).ConclusionMortality of HNC patients within 2 years is 47.69%, with a 2-year PFS reaching 50%. Cigarette smoking, low hemoglobin levels, poor performance status, and negative therapeutic response (non-responders) negatively affect the 2-year PFS.