Identification of patterns of factors preceding severe or life-threatening asthma exacerbations in a nationwide study.

BACKGROUND: Reducing near-fatal asthma exacerbations is a critical problem in asthma management. OBJECTIVES: To determine patterns of factors preceding asthma exacerbations in a real-world setting. METHODS: In a nationwide prospective study of 190 patients who had experienced near-fatal asthma exacerbation, cluster analysis was performed using asthma symptoms over the 2-week period before admission. RESULTS: Three distinct clusters of symptoms were defined employing the self-reporting of a visual analogue scale. Cluster A (42.1%): rapid worsening within 7.4 hours from moderate attack to admission, young to middle-aged patients with low Body mass index and tendency to depression who had stopped anti-asthma medications, smoked, and hypersensitive to environmental triggers and furred pets. Cluster B (40.0%): fairly rapid worsening within 48 hours, mostly middle-aged and older, relatively good inhaled corticosteroid (ICS) or ICS/long-acting beta-agonist (LABA) compliance, and low perception of dyspnea. Cluster C (17.9%): slow worsening over 10 days before admission, high perception of dyspnea, smokers, and chronic daily mild-moderate symptoms. There were no differences in overuse of short-acting beta-agonists, baseline asthma severity, or outcomes after admission for patients in these 3 clusters. CONCLUSION: To reduce severe or life-threatening asthma exacerbation, personalized asthma management plans should be considered for each cluster. Improvement of ICS and ICS/LABA compliance and cessation of smoking are important in cluster A. To compensate for low perception of dyspnea, asthma monitoring of peak expiratory flow rate and/or exhaled nitric oxide would be useful for patients in cluster B. Avoidance of environmental triggers, increase usual therapy, or new anti-type 2 response-targeted therapies should be considered for cluster C.

Severe or life-threatening asthma exacerbation: patient heterogeneity identified by cluster analysis.

BACKGROUND: Severe or life-threatening asthma exacerbation is one of the worst outcomes of asthma because of the risk of death. To date, few studies have explored the potential heterogeneity of this condition. OBJECTIVES: To examine the clinical characteristics and heterogeneity of patients with severe or life-threatening asthma exacerbation. METHODS: This was a multicentre, prospective study of patients with severe or life-threatening asthma exacerbation and pulse oxygen saturation < 90% who were admitted to 17 institutions across Japan. Cluster analysis was performed using variables from patient- and physician-orientated structured questionnaires. RESULTS: Analysis of data from 175 patients with severe or life-threatening asthma exacerbation revealed five distinct clusters. Cluster 1 (n = 27) was younger-onset asthma with severe symptoms at baseline, including limitation of activities, a higher frequency of treatment with oral corticosteroids and short-acting beta-agonists, and a higher frequency of asthma hospitalizations in the past year. Cluster 2 (n = 35) was predominantly composed of elderly females, with the highest frequency of comorbid, chronic hyperplastic rhinosinusitis/nasal polyposis, and a long disease duration. Cluster 3 (n = 40) was allergic asthma without inhaled corticosteroid use at baseline. Patients in this cluster had a higher frequency of atopy, including allergic rhinitis and furred pet hypersensitivity, and a better prognosis during hospitalization compared with the other clusters. Cluster 4 (n = 34) was characterized by elderly males with concomitant chronic obstructive pulmonary disease (COPD). Although cluster 5 (n = 39) had very mild symptoms at baseline according to the patient questionnaires, 41% had previously been hospitalized for asthma. CONCLUSIONS & CLINICAL RELEVANCE: This study demonstrated that significant heterogeneity exists among patients with severe or life-threatening asthma exacerbation. Differences were observed in the severity of asthma symptoms and use of inhaled corticosteroids at baseline, and the presence of comorbid COPD. These findings may contribute to a deeper understanding and better management of this patient population.

The prevalence of primary neck and shoulder pain, and its related factors in Japanese postpartum women.

PURPOSE: This study investigated the prevalence, location, and severity of neck and shoulder pain (NSP), its disturbance of quality of life (QOL), and the factors related to NSP in Japanese postpartum women. MATERIALS AND METHODS: The study involved 308 postpartum women who had a medical examination one month after delivery. The questionnaire consisted of the background and details of NSP. Mood states were evaluated using the Profile of Mood States-Brief (POMS-B), Japanese Version. RESULTS: The prevalence of NSP was 73.1%, one-fourth of which occurred after birth. The most common area was the superior part of the trapezium muscles. Prevalence was associated with past history of premenstrual syndrome (PMS), anemia during pregnancy, time per breastfeeding, and the mean POMS-B Fatigue score. Total breastfeeding time a day, the mean POMS-B score for Fatigue, Confusion, Anger-Hostility, and Depression were significantly higher for "worse" after birth than those for "no-change/relief". The disturbance of daily life due to NSP in postpartum women with past history of PMS and Hiesho were significant higher than that for women without those. CONCLUSIONS: The prevalence of NSP in postpartum women was very high. The factors which affect NSP were the mental states, breastfeeding, past history of PMS, and anemia during pregnancy.

In vivo time-resolved DOT measurement and image reconstruction of human forearm under exercises.

In vivo measurement of time-resolved diffuse optical tomography (TR-DOT) were performed for human forearms under the exercises. The DOT images of oxygenation state were reconstructed, and the activities of the inner muscles were assessed.

The influx of serum albumin to enamel matrix in rat incisors after trauma.

The most frequent results of trauma to tooth germs are enamel hypoplasia and enamel hypocalcification. These differing results may be due to the stage of amelogenesis at which trauma occurs. The cellular and biomolecullar events involved in the genesis of these defects are poorly understood. We hypothesized that one factor involved is the possibility that relatively high levels of serum albumin enter the enamel matrix through the damaged enamel organ, and impair mineralization of the matrix. The present study was undertaken to immunohistochemically and autoradiographically localize serum albumin in the enamel organs of rat incisors after trauma was inflicted to the mandibular incisor region of 4-day-old rats. Hemorrhage was seen surrounding the enamel organ and between the detached secretory-stage ameloblasts. One day after trauma, the most intense immunohistochemical (IHC) staining for albumin was localized in the outer layer of the enamel matrix adjacent to the detached secretory-stage ameloblasts. Albumin was also detected autoradiographically in the secretory-stage ameloblasts layer and enamel matrix. These findings indicate that serum albumin can leak between the detached ameloblasts and penetrate the enamel matrix after trauma. Leaked albumin was still present in the matrix during the maturation stage. Leaked albumin in the developing enamel could inhibit crystal growth and result in hypocalcification.

[A survival case of severe Legionella longbeachae pneumonia].

A 56-year-old Japanese male was admitted to Toyohashi Municipal Hospital because of fever, cough, and dyspnea. Chest X-ray film showed bilateral alveolar infiltrates. He suffered from severe hypoxemia and was given a diagnosis of acute respiratory distress syndrome. He was also complicated with disseminated intravascular coagulation and pseudomembranous colitis. He fully recovered by intensive treatment with antibiotics, mechanical ventilation and endotoxin eliminating therapy. Legionella longbeachae was isolated from his respiratory specimens and was regarded as the etiologic agent of his pneumonia.

The immunohistochemical localization of phospholipase Cgamma and the epidermal growth-factor, platelet-derived growth-factor and fibroblast growth-factor receptors in the cells of the rat molar enamel organ during early amelogenesis.

Findings on the localization and possible roles of the major growth factors, epidermal (EGF), platelet-derived (PDGF) and fibroblast (FGF) in early amelogenesis are contradictory and inconclusive. This study sought to localize immunohistochemically phospholipase (PLCgamma) and the EGF, PDGF and FGF receptors in the cells of the enamel organ during the events leading directly to early enamel formation in rat molars. PLCgamma is an immediate, downstream, signal-transduction pathway effector unique to the three receptors. A whole-head, freeze-dried sectioning method was used to reduce the possibilities of false-negative staining. A modification of the avidin/biotin complex method of immunohistochemical localization was used. Anti-PLCgamma and antibodies to each of EGF, PDGF and FGF receptors colocalized in the preameloblasts of the cervical loop, adjacent to the undifferentiated mesenchymal cells of the dental pulp. This staining disappeared shortly after the beginning of dentine mineralization. Staining for all four antibodies appeared on the proximal ends of the differentiating presecretory ameloblasts at the level of the beginning of predentine matrix deposition and continued in the secretory ameloblasts. It appears that EGF, PDGF and FGF have roles in the differentiation of ameloblasts and in control of cellular functions in presecretory and secretory ameloblasts. Their roles may represent redundancy of the kind seen in highly conserved tissues.

Application of the zooming method in near-infrared imaging.

Images of a tissue simulating phantom are obtained by inverting a limited number of continuous-wave relative transmission measurements. The diffusion approximation to the radiative transfer equation is used as a light propagation model. The inversion procedure is based on a quasi-Newton method and the Levenberg-Marquardt method, and the imaging parameter is the absorption coefficient of the phantom. It is shown that the resolution of the images can be improved using the zooming method. The image indicates the presence of an inhomogeneity in approximately the correct location, but the shape and size of the inhomogeneity in the reconstructed image differs from the shape and size of the actual inhomogeneity. Possible methods for further enhancement of the images are discussed.

[Clinicopathological analysis of leiomyosarcomas of the small intestine and a review of the Japanese literature].

An analysis has been made of 9 cases of a leiomyosarcoma of the small intestine that were treated from 1974 through 1989. In two patients (22.2%), a perforation was seen, and a case report of a 59-year-old woman is presented. Further, case reports of leiomyosarcomas in the Japanese literature from 1980 through 1989 were clinico-pathologically analyzed. The frequency of a perforation was found to be 8.6%, and the distribution of the perforated leiomyosarcomas was the same as for the non-perforated cases. The five-year postoperative survival rate was 41.2%. Of note is that 3 out of 10 patients that had survived for 5 years subsequently died of sarcomatosis.

Multidisciplinary treatment for advanced nasopharyngeal carcinoma.

Of 30 nasopharyngeal carcinoma (NPC) cases seen from Jan. 1976 through Mar. 1984 at Tokyo Metropolitan Komagome Hospital, 19 previously untreated patients with more than 1-year follow-up were retrospectively investigated to confirm the effective treatment modality. The average age was 51 years; the ratio of male to female was 3.5:1. Fifteen were in stage IV, 3 in stage III, and 1 in stage II. These 19 patients were grouped into three treatment modalities: a) radiation +/- unplanned chemotherapy (RT +/- CM); b) radiation+unplanned cis-diamminedichloroplatinum (II)(CDDP)-based chemotherapy (RT + unplanned CDDP); and c) radiation + planned CDDP-based chemotherapy (RT + planned CDDP). Planned CDDP-based chemotherapy consisted of 20-50 mg/M2 CDDP, i.v. for 1 hr, 7.5-15 mg/body bleomycin (BLM), i.v. and/or 20-30 mg/body MTX, i.v. at weekly intervals with diuresis for at least 4 courses. Plasma platinum (Pt) concentration before and 1 hr after CDDP administration revealed a gradual increase due to accumulated protein-bound Pt, while free Pt remained transient. This regimen could be safely administered for at least 4 courses. The survival rate of RT + planned CDDP (n = 8) was 100% at maximum follow-up of 55 months, while RT +/- CM (n = 6) at maximum follow-up of 54 months and RT + unplanned CDDP (n = 5) at maximum follow-up of 38 months were 17 and 0%, respectively. Thus, we concluded that the most effective treatment modality for advanced NPC was RT+planned CDDP.

[Combination chemotherapy with cis-diammine-di-chloro-platinum (II) and bleomycin in advanced head and neck cancer].

Combination chemotherapy of cis-diammine dichloro platinum (II) (CDDP) and bleomycin was given to 10 patients with advanced squamous cell carcinoma of the head and neck. Nine patients had received prior radical radiotherapy, 2 had major ablative surgical procedures, and one had been previously treated with chemotherapy. Responses were as follows (duration in months): 2 CRs (4,6+), 2 PRs (1.5,1.5), and 2 minors. Vomiting related to CDDP was observed in 5 patients, nephrotoxicity and hypocalcemia in one patient were also observed.