Association between cytokine removal by polymyxin B hemoperfusion and improved pulmonary oxygenation in patients with acute exacerbation of idiopathic pulmonary fibrosis.

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is characterized by severe worsening dyspnea of unknown etiology and high mortality without effective treatment. Recently, direct hemoperfusion with polymyxin B (PMX)-immobilized fiber cartridge (PMX-DHP) has been reported to improve pulmonary oxygenation and survival in patients with AE-IPF although its mechanism of action remains unknown. To gain insights into the pathobiology of AE-IPF through the beneficial effects of PMX-DHP, we analyzed the profile of cytokines adsorbed onto PMX-fibers used in 9 AE-IPF patients. In addition, the sera of these AE-IPF patients collected immediately before and after PMX-DHP, 9 stable IPF patients and 8 healthy individuals were also analyzed. The serum levels of cytokines including IL-9, IL-12, IL-17, PDGF and VEGF were significantly decreased immediately after PMX-DHP (P<0.02), and VEGF and IL-12 were most prominently reduced. In addition to PDGF and VEGF, IL-1ß, IL-1ra, IL-8, IL-23, FGF basic, GM-CSF, IP-10, RANTES and TGF-ß were eluted from used PMX-fibers. Interestingly, improved pulmonary oxygenation after PMX-DHP was correlated well with the quantities of eluted VEGF. These results suggest that adsorption of proinflammatory, profibrotic and proangiogenic cytokines onto PMX-fibers is one of the mechanisms of action of PMX-DHP in AE-IPF. Notably, removal of VEGF by PMX-DHP may contribute to the rapid improvement in oxygenation by suppressing vascular permeability in the lung.

Is adenosine deaminase in pleural fluid a useful marker for differentiating tuberculosis from lung cancer or mesothelioma in Japan, a country with intermediate incidence of tuberculosis?

The objective of this study was to evaluate the utility of the determination of adenosine deaminase (ADA) level in pleural fluid for the differential diagnosis between tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) in Japan, a country with intermediate incidence of tuberculosis (TB). We retrospectively reviewed the clinical records of 435 patients with pleural effusion and investigated their pleural ADA levels as determined by an auto analyzer. ROC analysis was also performed. The study included patients with MPE (n＝188), TPE (n＝124), benign nontuberculous pleural effusion (n＝94), and pleural effusion of unknown etiology (n＝29). The median ADA level in the TPE group was 70.8U/L, which was significantly higher than that in any other groups (p＜0.05). The area under the curve (AUC) in ROC analysis was 0.895. With a cut-off level for ADA of 36U/L, the sensitivity, specificity, positive predictive value, and negative predictive value were 85.5%, 86.5%, 69.7%, and 93.6%, respectively. As many as 9% of patients with lung cancer and 15% of those with mesothelioma were false-positive with this ADA cutoff setting. Although the ADA activity in pleural fluid can help in the diagnosis of TPE, it should be noted that some cases of lung cancer or mesothelioma show high ADA activity in geographical regions with intermediate incidence of TB, in contrast to high prevalence areas.

Statistical analysis of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography ground-glass nodule findings.

18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG-PET/CT) is important in lung cancer diagnosis; false negatives are often caused by ground-glass nodules (GGNs). PET/CT utility in GGN diagnosis is unknown. The associations between GGN CT findings (size, properties), the pathological diagnosis and maximum standardized uptake value (SUVmax) were explored. Sixty-six patients with pathological stage IA1-IIA lung adenocarcinoma underwent surgical resection and PET/CT between January 2010 and December 2014. Clinical characteristics, CT findings, pathological diagnoses and PET/CT findings were retrospectively examined. The age range was 47-86 years (median, 69 years), the female/male ratio was 38:28 and the pathological stage was IA1, IA2, IA3, IB and IIA in 5, 30, 21, 9 and 1, respectively. Total and solid-part lesion diameters ranged from 7.00-41.13 mm (median, 19.43 mm) and 0.00-23.23 mm (median, 4.55 mm), respectively; the solid-part ratio (solid-part diameter/total diameter) was 0-77% (median, 20%). SUVmax ranged from a value too low for evaluation to 3.9 (median, 1.0). Pathological diagnoses were adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), lepidic-predominant adenocarcinoma (LPA) and papillary predominant adenocarcinoma (PPA) in 17, 15, 32 and 2, respectively. Correlation coefficients for each factor and SUVmax for total and solid-part diameters were 0.513 (p<0.0001) and 0.461 (p<0.0001), respectively. All pure GGNs showed clinically unimportant SUVmax<2.5, even though some large GGNs were included (maximum, 40.0 mm). A total diameter ≥20 mm was significantly associated with FDG uptake (p<0.0001). SUVmax were <2.5 when the solid-part diameter was <4.55 mm. The AIS-MIA group showed significantly lower SUVmax than the LPA-PPA group (p=0.0008). There was no clinically important SUVmax with diagnostic value for pure or small part-solid GGNs. There were medium correlations for GGN total diameter, solid-part diameter, and SUVmax. We should note PET/CT's limitations in GGN diagnosis.

Gefitinib ('Iressa', ZD1839) may restore chemosensitivity in NSCLC patients?

Gefitinib ('Iressa, ZD1839) has promising antitumor activity in non-small cell lung cancer (NSCLC). However, patients with advanced NSCLC have few treatment options available if they are refractory to gefitinib. We describe four cases of patients with advanced NSCLC who previously responded to gefitinib and obtained significant tumor regression through retreatment with other cytotoxic agents. Gefitinib might restore chemosensitivity to previously chemorefractory patients.

Root surface temperature increase during Er:YAG laser irradiation of root canals.

The authors measured the temperature of the root surface during root canal preparation using Er:YAG laser irradiation and evaluated the thermal effect on the periodontal region. Twenty extracted human teeth with single roots were divided into two groups of 10. These were irradiated using an Er: YAG laser at 2 Hz and 136 to 184 or 170 to 230 mJ/pulse for 1 min with a water spray. The temperature of the root surface was monitored using thermocouples throughout the procedure. The teeth were longitudinally bisected and observed by stereoscopy and scanning electron microscopy. The temperature on the root surface increased by less than 6 degrees C at the apical area and by less than 3 degrees C at the central area. A morphological evaluation revealed no carbonization or melting. These results suggest that the thermal effect on periodontal tissues during root canal preparation using an Er: YAG laser at less than 230 mJ/pulse for 1 min is minimal.

Nonequilibrium properties in the transverse XX chain.

We investigate the nonequilibrium properties of the transverse XX chain. The steady state can be interpreted as the equilibrium state or the ground state of the effective Hamiltonian, which depends on the initial state. We also study the physical properties of the state at various temperatures, in particular, the effects of quantum phase transition.

Diffusion of the magnetization profile in the XX model.

We investigate the magnetization profile in the intermediate time of diffusion by using the C*-algebraic method. We observe a transition from monotone profile to nonmonotone profile. This transition is purely thermal.

[A case of idiopathic bronchiolitis obliterans accompanied with pneumothorax and pulmonary atypical mycobacteriosis].

A 22-year-old man was urgently admitted for pneumothorax. He continued complaining of exertional dyspnea and dry cough after the pneumothorax healed. About three months later, an atypical pulmonary mycobacteriosis by mycobacterium kansasii was identified. Exertional dyspnea increased after chemotherapy was administered, and the patient was readmitted because of difficulty in daily life activities. Chest radiographs and CT scans showed bilateral pulmonary hyperinflation and a narrowed heart shadow. There was also marked combined ventilatory impairment, as identified by a respiratory function test. Furthermore, the histological findings of surgically removed lung tissue revealed accumulation of lymphocytes in the wall of a small bronchus. Idiopathic bronchiolitis obliterans was diagnosed from the clinical course and clinical findings. The patient is now being monitored and is awaiting lung transplantation.

An outbreak of histoplasmosis among healthy young Japanese women after traveling to Southeast Asia.

Histoplasmosis, caused by Histoplasma capsulatum, is an endemic mycosis in many countries of the world except for Japan. Outbreaks of histoplasmosis among Japanese people are very rare and are mainly imported by travelers. We report an outbreak of histoplasmosis among healthy Japanese people who traveled to a resort area in Southeast Asia. Three young Japanese women traveled to Langkawi island, Malaysia and stayed on the island for five days without visiting caves, a known reservoir of H. capsulatum. All three individuals developed flu-like symptoms with multiple nodule shadows on chest X rays or chest CT scans at around ten days after their return to Japan. Serum samples obtained from the three subjects were positive for anti-Histoplasma antibody and specific PCR for H. capsulatum on lung biopsy specimens and the serum from one patient was positive. The clinical course of all three patients improved without the use of anti-fungal agents and no recurrence has been confirmed. Clinical attendants should consider histoplasmosis when they see patients with flu-like symptoms with abnormal chest X-rays after visiting H. capsulatum endemic areas, especially Southeast Asia.