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Chronic obstructive pulmonary disease as a risk factor for lung cancer

World Journal of Clinical Oncology 2014年第4期5卷 660-666页

作者： Yuichi Takiguchi Ikuo Sekine Shunichiro Iwasawa Ryota Kurimoto koichiro tatsumi Department of Medical Oncology Graduate School of Medicine Chiba University Department of Respirology Graduate School of Medicine Chiba University

The association between chronic obstructive pulmonary disease(COPD) and lung cancer has long been a subject of intense debate. The high prevalence of COPD in elderly smokers inevitably strengthens their coincidence. In addition to this contingent coincidence, recent studies have revealed a close association between the two diseases that is independent of the smoking history; that is, the existence of COPD is an independent risk factor for the development of lung cancer. Molecular-based evidence has been accumulating as a result of the efforts to explain the underlying mechanisms of this association. These mechanisms may include the following: the retention of airborne carcinogens followed by the activation of oncogenes and the suppression of tumor suppressor genes; the complex molecular mechanism associated with chronic inflammation in the distal airways of patients with COPD; the possible in-volvement of putative distal airway stem cells; and gel netic factors that are common to both COPD and lung cancer. The existence of COPD in patients with lung l cancer may potentially affect the process of diagnosis, surgical resection, radiotherapy, chemotherapy, and end-of-life care. The comprehensive management of COPD is extremely important for the appropriate treatment of lung cancer. Surgical resections with the aid of early interventions for COPD are often possible, even for patients with mild-to-moderate COPD. New challenges, such as lung cancer CT screening for individuals t at high risk, are now in the process of being implemented. Evaluating the risk of lung cancer in patients with COPD may be warranted in community-based lung cancer screening.

关键词： Chronic obstructive pulmonary disease Airflow limitation Inflammation Lung cancer Carcinogenesis Cancer screening Computed tomography screening Early intervention

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The Concept Study of Recombinant Human Soluble Thrombomodulin in Patients with Acute Respiratory Distress Syndrome

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International Journal of Clinical Medicine 2013年第11期4卷 488-495页

作者： Kenji Tsushima Toshiki Yokoyama Tomonobu Koizumi Keishi Kubo koichiro tatsumi Department of Pulmonary Medicine Shinonoi General Hospital Nagano Japan Department of Respirology Graduate School of Medicine Chiba Uni-versity Chiba Japan Department of Respirology Graduate School of Medicine Chiba Uni-versity Chiba Japan First Department of Internal Medicine Shinshu University School of Medicine Nagano Japan

Background: Recombinant human soluble thrombomodulin (rhTM) was approved for the treatment of disseminated intravascular coagulation in Japan, and rhTM has anti-inflammatory effects. Disordered coagulation is a part of the acute respiratory distress syndrome (ARDS) pathophysiology and thus we hypothesize that anticoagulant therapy may help. This preliminary study was to observe the safety of rhTM administration and the improvement on biomarker levels after the therapy for ARDS-patients. Objectives: Case series of ARDS-patients. Methods: Seventeen ARDS-patients that required ventilatory management were treated with rhTM and clinical and laboratory data were collected including platelets, thrombin-antithrombin complex (TAT), fibrinogen degradation products, oxygen saturation/the fraction of inspired oxygen (SpO2/FIO2), and high-mobility group-1 (HMG-1). The administration of rhTM was started during 6 days at a bolus dose of 0.06 mg/kg/day immediately after the diagnosis of ARDS. Results: Eleven of the 17 ARDS-patients were alive at 28 days after the beginning of the administration of rhTM. The serial pattern of the SpO2/FIO2 showed remarkable differences between the survivors and nonsurvivors from day 5 to day 7. The TAT in the survivors significantly decreased after treatment, and there were significantly lower levels in the TAT on day 7 in comparison to that of the nonsurvivors. The serial changes of HMG-1 showed increased levels in the nonsurvivors until day 5 after the administration of rhTM. Conclusions: Additional rhTM administration can safely improve the parameters in survival ARDS-patients, as demonstrated by significant improvements in the SpO2/FIO2, HMG-1 and TAT.

关键词： Acute Respiratory Distress Syndrome Recombinant Human Soluble Thrombomodulin Thrombin-Antithrombin Complex SpO2/FIO2 High-Mobility Group-1

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