Risk of developing active tuberculosis in rheumatoid arthritis patients on adalimumab in Japan.

SETTING: Nationwide study in Japan. OBJECTIVE: To identify the clinical characteristics of and risk factors for tuberculosis (TB) in rheumatoid arthritis (RA) patients receiving adalimumab. DESIGN: A post hoc case-control study involving 7755 RA patients evaluated in an all-case post-marketing surveillance of adalimumab from 18 June 2008 to 20 January 2011 and spontaneous report of TB during adalimumab treatment. RESULTS: The analysis included 22 TB cases and 7733 non-TB controls. Despite the high frequency of extra-pulmonary TB (17/22, 77.3%), all 22 TB cases had pulmonary signs or symptoms. Of patients enrolled in all-case post-marketing surveillance, there were relatively high percentages of patients who had latent tuberculous infection (LTBI) at baseline. The percentage of patients who received prophylaxis was about six times higher in patients with LTBI than those without. Of those patients who received prophylaxis, none developed TB after treatment with adalimumab. Multivariate (non-matched and age-matched) and propensity score analyses identified age ⩾65 years (OR 4.59, 95%CI 1.52-13.89, P = 0.0070), moderate to severe RA (OR 4.61, 95%CI 1.07-20.00, P = 0.0408], past or current renal dysfunction (OR 4.65, 95%CI 1.47-14.71, P = 0.0089) and diabetes mellitus (OR 3.30, 95%CI 1.31-8.26, P = 0.0110) as potential risk factors for TB. CONCLUSION: Screening, prophylaxis and monitoring for TB are essential to ensure the safety of adalimumab treatment.

Effect of iodothyronine hormone status on doxorubicin related cardiotoxicity.

The anthracycline anticancer agent doxorubicin has been recognised to induce a dose-dependent cardiotoxicity. The chronic form of such complication is characterized by an irreversible cardiac damage and congestive heart failure. Although the pathogenesis of anthracycline cardiotoxicity seems to be multifactorial, the pivotal role has been attributed to reactive oxygen species formation. Because redox equilibrium in cardiomyocytes may be regulated via iodothyronine hormones, the aim of the study was to appraise the effect of hypothyroidism on heart damages induced by doxorubicin. The rats received methimazole in drinking water (0.001 and 0.025%) after doxorubicin administration (2.0, 5.0 and 15 mg/kg). The cardiac morphology and blood biochemical markers of heart damage were assessed. Decreased levels of iodothyronine hormones had not significant impact on cardiac morphological changes and no effect on the level of B-type natriuretic peptide in rats receiving doxorubicin. Lower hormonal levels had sporadic, diverse effect on blood transaminases, lactate dehydrogenase and creatine kinase levels, but any relation to time, doxorubicin doses and hypothyroid status was found. Hypothyreosis leads to increase in fatty acid binding protein in rats receiving higher dose of doxorubicin. Hypothyreosis had no effect on heart stretching and on necrosis at morphological level, but caused biochemical symptoms of cardiomyocyte necrosis in rats receiving doxorubicin.

Ovarian endometrioma in an 11-year-old girl before menarche: a case study with literature review.

BACKGROUND: To date, a limited number of endometriosis cases occurring before or around the time of menarche have been documented. CASE: An 11-year-old adolescent underwent an emergency operation for left ovarian endometrioma. Her menarche occurred spontaneously 6 months after surgery. RESULTS AND CONCLUSIONS: We discuss the above mentioned case and consider data published in the literature. Endometrioma should be considered even in premenarcheal girls with ovarian cysts, regardless of their size.

Clinical and morphological analysis of 143 cases of "pulmonary peripheral shades" in patients treated in the department of thoracic surgery of Medical Academy in Lublin.

In spite of a constant development of various diagnostic methods, in many cases of "peripheral shades" the exploratory opening of the chest appears to be the only way leading to a correct diagnosis. In this study, 143 patients were examined. These patients were referred to the Thoracic Surgery Department because of peripheral shades in the lung areas observed, often accidentally; on regular checkup X rays. Our paper assessed the usefulness of endoscopic examinations in diagnosing the changes situated peripherally in the lungs. 83.2% of those shades were recognized as neoplasms on the basis of histopathological examinations. Moreover , we evaluated the concordance of histopathological diagnosis before and after the operation.

[A consideration for indexes of global improvement rating by physicians in bronchial asthma].

As the minimum items required for GIR evaluation, morning Peak Respiratory Flow Rate (PEFR), evening PEFR, asthma scores and symptom scores were selected based on Cronbach's alpha, an index of internal consistency. Optimum categorization of total improvement scores (TS), or principal component scores (PCS) was conducted based on agreement with the physician's evaluation of GIR. Good agreement was observed between optimally categorized moderate and marked improvement rate in TS or PCS and moderate and marked improvement rate in the physician's evaluation of GIR. The rate of agreement between optimally categorized TS or PCS and distribution of GIR was about 93% if allowance is made for discrepancy of one stage. Our assessment that TS which is objective and practical was useful as criteria for evaluating GIR.

[Peak flow values in assessment of global improvement rating in bronchial asthma].

The results suggest a marked correlation between Global Improvement Rating (GIR) and change from baseline in PEFRs and that increase from baseline in PEFR was practicable as an evaluation index. Best categorization was determined based on weighted agreement (kappa *) between the increase from baseline in morning and evening PEFRs or mean PEFR (in l/min). For categorization of increase from baseline, maximum agreement with the physician's global improvement rating (GIR) was achieved by categorizing the increase in PEFR into 5 categories using Akaike's Information Criterion (AIC). Categorization into the 5 grades of > or = 50, 50-> or = 35, 35-> or = 10, 10-> or = -5 and < -5 for morning PEFR & mean PEFR and > or = 45, 45-> or = 10, 10-> or = -10, -10-> or = -45 and < -45 for increase in evening PEFR was optimal. Improvement scores (a tentative name) were prepared by maximization of agreement rate between total of scores and GIR.

Pulmonary lymphangioleiomyomatosis--a case report.

Lymphangioleiomyomatosis is a rare disease entity. A case of a 51-year-old man treated for respiratory insufficiency has been reported. Due to disseminated lesions in the pulmonary tissue the patient was assessed for the presence of sarcoidosis. Histopathological examination of the lung specimen obtained during videothoracoscopy revealed lesions of the lymphangioleiomyomatosis type.

Long-term effects of dietary fiber supplementation on serum glucose and lipoprotein levels in diabetic rats fed a high cholesterol diet.

We have shown that cholesterol-fed diabetic rats developed atheromatous lesions in the aorta and coronary arteries, which were not observed in cholesterol-fed diabetic rats receiving concomitant supplementation with 15% glucomannan, a soluble dietary fiber concentrate. The present study was designed to examine the effects of the dietary fiber supplementation on serum levels of glucose and lipoproteins in cholesterol-fed diabetic rats. Feeding a diet containing 1.5% cholesterol (wt/wt) and 0.37% cholic acid for 18 weeks to rats made diabetic by streptozotocin (35 mg/kg body weight, iv) produced moderate hyperglycemia and moderate hypercholesterolemia, the latter being characterized by high concentrations not only of low density lipoproteins but also intermediate density lipoproteins and very low density lipoproteins. These changes in serum lipoproteins and hyperglycemia were substantially reduced by 18 weeks of supplementation with glucomannan but high density lipoprotein cholesterol and triglyceride levels did not change after feeding a cholesterol-rich diet in the presence or absence of glucomannan supplementation. These results suggest that amelioration in hyperlipoproteinemia and hyperglycemia induced by the dietary fiber supplementation may help retard or prevent the atheromatous formation found in cholesterol-fed diabetic rats.

Effects of long-term high-fiber diet on macrovascular changes and lipid and glucose levels in STZ-induced diabetic SD rats.

The effects of long-term high-fiber diet on lipid and glucose levels and the histological changes in the coronary arteries and thoracic aorta in STZ-induced diabetic SD rats were investigated. During the first 4 weeks of the study period, all diabetic rats were given regular chow plus water after which, all were grouped according to the following diet regimen: group II, no added cholesterol and glucomannan; group III, no added cholesterol but with glucomannan supplement, group IV, with added cholesterol but no glucomannan supplement; and group V, with both cholesterol and glucomannan supplements. 15% weight of glucomannan and 1.5% weight of cholesterol in regular rat chow were used as supplements when indicated. Non-diabetic rats which received only regular chow served as the control group (group I). In the 18th week all rats were sacrificed and weight gain, glucose, total cholesterol, HDL-cholesterol, triglyceride and lipid peroxidase concentrations were determined. Selected portions of the heart and thoracic aorta were histologically examined. Weight gain was higher in rats supplemented with glucomannan than in those without glucomannan supplements, but the difference is not significant. A lowering tendency in glucose levels was likewise observed. Furthermore, total cholesterol and HDL-cholesterol levels were lower and higher, respectively in diabetic rats receiving glucomannan. Although the triglyceride levels were similar in all rats, lipid peroxidase levels were significantly lower in rats with high-fiber diet.(ABSTRACT TRUNCATED AT 250 WORDS)

The posterior portion of the cerebral arterial circle in postnatal life.

The posterior cerebral arteries and posterior communicating arteries were dissected in 180 human brains. The origin and diameter of vessels were determined with consideration to age, sex and body side. In 30 brains of humans aged 0 to 60 years microscopic structure of arteries was described. There is no histological difference in the structure of arterial wall in different age periods.

[The basilar artery of humans]. / Tetnica podstawna u czlowieka.

The basilar artery in 44.4% of the cases came into being by joint of two vertebral arteries on the height of the inferior margin of the pont. However, in 40.4%--below, and in 15.1%--above of this margin. In 78.7% of the human the course of basilar artery was rectilinear. In 20.5% of the cases the bulge of this artery was observed on the right or left side, whereas in 0.8%--the S-shaped forms. In 56% of the persons the segmentation of the basilar artery on the posterior cerebral arteries takes place on the height of the superior margin of the pont, in 32.9%--above, and in 11.1%--below this one. The results of the investigations concerning the place of genesis, the height of segmentation and the direction of course of the particular artery, were permitted on separation of nine types of these blood vessels. The diameter of the initial and terminal section of the basilar artery at the new-born children was--respectively--1.9 and 1.8 mm, whereas at the adult persons it exceeded 4 mm. The length of this vessel ranged from 17.2 mm in the above-mentioned children to approximately 33 mm in persons over 20 years old. In all the examined cases the basilar artery was passing the arteries of the pont: medial and lateral and almost always the superior and the inferior anterior cerebellar arteries. In 12.4% of the persons the inferior posterior cerebellar arteries and, moreover, in 22.2%--the labyrinth arteries were beginning from this blood vessel.

Milk of northern fur seal: composition, especially carbohydrate and protein.

The milk of northern fur seal was analyzed with special interest in carbohydrate and protein. High solids (61%) and fat (45.6%) were characteristics of its gross composition. Fatty acid distribution showed that more than 22% of the fatty acids had carbon chains longer than 20 and that approximately 70% contained one or more double bonds. Analysis of free sugars showed no lactose but 123 mg/100 ml of myo-inositol. In carbohydrates bound to casein, .99% of sialic acid and .2% of glucosamine were determined. The amino acid composition of casein showed higher tryptophan, lysine, serine, and glycine than bovine casein, and lower arginine, proline, and leucine. In whey, arginine, threonine, and valine were higher, whereas lysine, aspartic acid, isoleucine, and leucine were lower than in bovine whey. Amino acid patterns in casein and whey were similar to those of cat milk. The appearance of casein micelles was similar to bovine casein micelles. The mean diameter, however, was larger (approximately 330 nm). Electrophoretic pattern of casein showed five major bands in addition to minor components. One of the minor components was a glycoprotein, probably kappa-casein-like protein. The major whey protein had a mobility similar to that of bovine beta-lactoglobulin. No alpha-lactalbumin-like protein was observed.

Comparison of efficacy of timiperone, a new butyrophenone derivative, and clocapramine in schizophrenia: a multiclinic double-blind study.

The clinical efficacy and safety of timiperone, a new butyrophenone derivative, on chronic schizophrenia was compared with clocapramine by the double-blind method using a total of eighty-eight patients, consisting of forty-four patients in each group. In the final global improvement rating, the global improvement rating in each week and the general usefulness rating, there were no statistically significant differences between the two groups. However, in the global improvement rating in each symptom, timiperone was significantly superior to clocapramine in delusion and showed a superior tendency to clocapramine in contact. Timiperone showed a higher improvement rate than clocapramine in hallucination and disturbance of self-consciousness. In the over-all safety rating, there were no significant differences between the two groups, but in accompanying symptoms and side-effects, timiperone showed significantly less tendency than clocapramine in dyskinesia, insomnia, constipation and nausea. From these results, including the analysis by stratification, it was considered that timiperone was a superior or equivalent neuroleptic in comparison with clocapramine against the negative symptoms as well as the positive ones of chronic schizophrenia, and was equally safe or safer than clocapramine.