Clinical and ultrasound features of difficult-to-treat rheumatoid arthritis: A multicenter RA ultrasound cohort study.

OBJECTIVE: The optimal strategy for difficult-to-treat (D2T) rheumatoid arthritis (RA) has not been identified, and the ultrasound characteristics of D2T RA have not been reported. We investigated the clinical characteristics and factors contributing to the outcome in D2T RA in a multicentre RA ultrasound observational cohort. METHOD: We reviewed 307 Japanese patients diagnosed with RA who underwent treatment with biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs). We compared the differences in patient characteristics between the D2T RA and non-D2T RA groups. We examined the factors contributing to a good response [defined as b/tsDMARD continuation and Clinical Disease Activity Index (CDAI) ≤ 10 at 12 months] in the D2T RA patient group. RESULTS: Forty-three patients (14%) were categorized as D2T RA and the remaining 264 (86%) as non-D2T RA at baseline. The grey-scale (GS) score, disease duration, and CDAI at the initiation of treatment were significantly higher in the D2T RA group than in the non-D2T RA group. In contrast, the power Doppler (PD) score was not significantly different between the two groups. Of the 43 D2T RA patients, 20 achieved a good response. The introduction of CTLA4-Ig (n = 5) was significantly associated with a good response in analysis based on inverse probability weighting with propensity score. GS and PD scores at baseline were not significantly associated with therapeutic response at 12 months in D2T RA patients. CONCLUSIONS: Patients with D2T RA had high clinical and ultrasound activity and poor responses to treatment with b/tsDMARDs. CTLA4-Ig was associated with a good response at 12 months in D2T RA patients.

Ultrasound efficacy of targeted-synthetic disease-modifying anti-rheumatic drug treatment in rheumatoid arthritis: a multicenter prospective cohort study in Japan.

OBJECTIVE: This study investigated the effectiveness of treatment with Janus kinase (JAK) inhibitors in rheumatoid arthritis (RA) assessed by ultrasonography (US) activity, and the influence of patient characteristics and previous treatments. METHOD: This prospective study assessed 60 treatment initiations among 53 Japanese patients diagnosed with RA who underwent treatment with JAK inhibitors during June 2013 to February 2020. Of the 53 patients, seven patients were enrolled in duplicate because they were treated with two different JAK inhibitors at different periods. For each case, the improvement rate on the power Doppler (PD) score was assessed at 6 month follow-up. Median improvement rate of PD score was used to classify cases as either US responders or non-responders, and patient characteristics were compared between the two groups. RESULTS: All indicators of clinical disease activity and US activity showed a significant improvement at 3 months compared with baseline. Although the JAK inhibitor-cycler group and the interleukin-6 (IL-6) inhibitor inadequate response (IR) group tended to show a later improvement for US activity, all indicators of clinical disease activity and US activity showed a significant improvement at 6 months compared with baseline for both groups. Multivariate analysis showed that concomitant methotrexate use and an IR to the previous biologic or targeted-synthetic disease-modifying anti-rheumatic drug (b/tsDMARD) treatment were independently and significantly associated with US responders. CONCLUSION: Use of a JAK inhibitor in combination with methotrexate and an absence of IR to any previous b/tsDMARDs demonstrated superior effectiveness for patients with RA.

[Prevalence rate of allergy to Japanese cedar pollen in Tokyo--from field investigation in 1996 by Tokyo Japanese Cedar Pollen Allergy Measurements and Review Committee].

Prevalence rate of allergy to Japanese cedar pollen was investigated by means of questionnaires and immunological examinations in residents of 3 regions in Tokyo (Akiruno city, Chofu city, and Ota ward). The results were as follows: 1) the prevalence rate of allergy to Japanese cedar pollen in Tokyo was 25.7% in Akiruno city, 21.1% in Chofu city, and 17.7% in Ota ward in 1996; 2) stratification by the age reveal that the prevalence rate was the highest in the age group of 30 to 44, and the group showed prevalence rate of above 40% in Akiruno city; 3) overall prevalence rate of Tokyo was 19.4% in 1996, which was approximately twice as much as that in 1985; 4) increase in prevalence rate in the recent decade was most significant in Akiruno city where the largest number of Japanese cedar pollen was detected in the air, and prevalence rate tended to rise in the young group of 14 or less.

[A case of inflammatory pseudotumor of the lung that extended to involve the mediastinum].

A 17-year-old woman was referred to our hospital because of cough and fever. The chest X-ray films revealed an anterior mediastinal mass shadow. Steroid drugs and antibiotics were administered and the shadow diminished slightly. To confirm diagnosis, open thoracotomy was performed. The tumor was extended to the mediastinum, thymus and heart as well as the right middle lobe and right lower lobe. Microscopic findings of the resected tumor showed proliferation of histiocytes with infiltration by inflammatory cells, lymphocytes and fibrous tissue.

[Prognostic implications of the ploidy pattern of the nuclear DNA in hepatocellular carcinomas].

The nuclear DNA contents of paraffin-embedded specimens of 41 cases of a hepatocellular carcinoma have been measured by means of flow cytometry. Results have indicated that 25 cases (61%) were diploid and 16 cases (39%) were aneuploid. In the aneuploid cases, the serum AFP level was found to be higher and stage more advanced. We also found that patients with aneuploid tumors had a poorer prognosis than those with diploid tumors, this fact uncovered by means of a Cox's proportional hazard model. In conclusion, the ploidy pattern of the nuclear DNA may serve as a useful prognostic marker for a hepatocellular carcinoma.

Phytogrowth-inhibitory and antibacterial activities of 2,5-dihydroxy-1,4-dithiane and its derivatives.

2,5-Dihydroxy-1,4-dithiane (I) and its derivatives (II-IV) showed rather marked inhibitory activities on the growth of the roots of two plant species. All compounds tested had phytogrowth-inhibitory activities. These compounds markedly inhibited the growth of the two plant species at the concentration of 1.0 x 10(-3) M. Seeds of Brassica rapa treated with 2,5-dihydroxy-2,5-dimethyl-1,4-dithiane (III) and its diacetate (IV) at the same concentration failed to germinate. Among these compounds, IV showed the most potent inhibitory activity on the two plant species. The radicles of both plant species treated with these compounds at concentrations higher than 1.0 x 10(-4) M showed negative geotropism, even though germination occurred. The compounds except for 2,5-diacetoxy-1,4-dithiane (II) also had antibacterial activities. In particular, III had rather marked antibacterial activity and its minimal inhibitory concentration (MIC) for Staphylococcus aureus IFO-3060 and Escherichia coli IFO-12734 was 4.0 micrograms/ml.

The hypotensive effect and antifungal activity of 3,3'-dihydroxy-alpha,beta-diethyldiphenylethane.

3,3'-Dihydroxy-alpha,beta-diethyldiphenylethane (I), an isomer of hexestrol (II), was found to have a strong hypotensive effect on rats and antifungal activity against some pathogenic fungi. The hypotensive effect of I (-100.0 +/- 21.0 mmHg, 10 mg/kg, i.v.) was stronger than that of II (-40.0 +/- 2.60 mmHg, i.v.). Unlike II and other oxystilbene-related compounds already tested, I showed prolonged hypotensive action at the dose of 10 mg/kg, and the blood pressure was not restored to the original level within 20 min. I also showed antifungal activity against all fungi tested (minimal inhibitory concentration: 10-120 micrograms/ml). It should be emphasized that by shifting the phenolic hydroxyl group to m-position, the biological activities were greatly increased.

[A case of Behçet disease associated with hepatocellular carcinoma].

A 31-year-old man, suffering from Behçet disease, was admitted to our hospital because of a palpable mass in the right hypochondrium. On testing, laboratory data showed an abnormal liver function, positive HBs antigens, and a high AFP level. An abdominal CT and a SCAG revealed large tumors in the liver. The patient died of hepatic failure 6 months after the first admission and an autopsy was performed. At autopsy, hepatocellular carcinomas were found to occupy most of the entire liver. Histologically, the residual liver showed no remarkable changes, such as liver cirrhosis or chronic hepatitis. To date, few cases of Behçet disease complicating a malignant neoplasma have been reported. The possible relationship between Behçet disease and the occurrence of malignant tumors is described with a review of the literature.

[A case of HBs antigen negative hepatocellular carcinoma without liver cirrhosis in a young woman].

A 27-year-old woman, post parturition, was admitted to hospital because of epigastric pain. Ultrasonography and abdominal computerized tomography revealed a giant mass in the left lobe of the liver. Celiac angiography showed a hypervascular mass with irregular vascularity. Serum HBs antigen proved negative. A left hepatic lobectomy was performed in March, 1985. Histology of the tumor revealed the trabecular type of a hepatocellular carcinoma with Edmondson grade 2 atypism, whereas the non-cancerous region of the liver showed chronic inactive hepatitis. This case is presented, because of the rarity of a hepatocellular carcinoma developing in such a young patient. In addition, reported cases of a hepatocellular carcinoma in the young in Japan are reviewed.

[A study involving early carcinomas of the gall bladder].

In recent years, with the development of diagnostic procedures, the number of cases of early carcinoma of the gall bladder has been seen to gradually increase. In this paper, 8 cases of early gall bladder carcinoma have been evaluated, using a diagnostic approach. Cholecystolithiasis was the complication in 6 cases, and abdominal pain was seen as the most common symptom. Findings by various image diagnoses, such as ultrasonography, DIC, ERCP, and CT scan are described and discussed with a review of literature. Ultrasonography was considered to be the most useful tool for the detection and diagnosis of an early carcinoma of the gall bladder. A survey is thought to be required, involving the cases that have accumulated throughout the entire nation.

Reexamination of the conditions for processing and storing of blood for plasma renin assay.

Reexamination of conditions for processing and storing blood for plasma renin assay confirmed that plasma can be stored at -20 degrees C for at least 4 weeks without significant changes in active renin level. The active renin concentration is increased by storage at 4 degrees C because of conversion from inactive renin.

Nasal airway resistance in children.

Using anterior rhinomanometry, nasal resistance was measured in 397 Japanese children and students, aged 5 to 17 years. Thereafter the relationship between nasal resistance and age, sex, height and weight was studied. The results are as follows: 1. The nasal resistance of children and students significantly decreases with aging and it reaches almost the same as that of an adult at about 16 years of age. This decrease was confirmed statistically. However, the difference of sex was not significant in any age group. 2. There is no significant correlation among total nasal resistance, height and weight. So, it would be concluded that the growth of the frame-work of the nasal cavity does not follow the same course as that of the height or the weight. 3. Between ages 13 and 14, it seems that the nasal resistance increases slightly. The change in nasal resistance during this period may be attributed to unbalance of the growth between the nasal turbinates and the frame-work of the nasal cavity.