Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 105
Filtrar
1.
Immunotherapy ; 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34758635

RESUMO

Case presentation: A 72-year-old man with non-small-cell lung cancer received four cycles of pembrolizumab-containing chemotherapy. He developed multiple immune-related adverse events (irAEs) and discontinued immune checkpoint inhibitors (ICIs); however, he developed immune-related hepatitis and grade 4 neutropenia at 92 days and 118 days, respectively, from discontinuation. He received G-CSF and methylprednisolone pulse therapy and recovered from neutropenia 12 days later. Discussion & conclusion: ICI-induced neutropenia is a life-threatening condition. The longest recorded onset in one study cohort is 26 days after the final administration of ICIs. This case developed strikingly delayed immune-related neutropenia manifesting as a delayed irAE. Clinicians should pay close attention to delayed immune-related neutropenia as a possible life-threatening irAE after ICI treatment.

2.
Radiology ; : 211254, 2021 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-34846203

RESUMO

Background Pulmonary MRI with ultrashort echo time (UTE) has been compared with chest CT for nodule detection and classification. However, direct comparisons of these methods' capabilities for Lung CT Screening Reporting and Data System (Lung-RADS) evaluation remain lacking. Purpose To compare the capabilities of pulmonary MRI with UTE with those of standard- or low-dose thin-section CT for Lung-RADS classification. Materials and Methods In this prospective study, standard- and low-dose chest CT (270 mA and 60 mA, respectively) and MRI with UTE were used to examine consecutive participants enrolled between January 2017 and December 2020 who met American College of Radiology Appropriateness Criteria for lung cancer screening with low-dose CT. Probability of nodule presence was assessed for all methods with a five-point visual scoring system by two board-certified radiologists. All nodules were then evaluated in terms of their Lung-RADS classification using each method. To compare nodule detection capability of the three methods, consensus for performances was rated by using jackknife free-response receiver operating characteristic analysis, and sensitivity was compared by means of the McNemar test. In addition, weighted κ statistics were used to determine the agreement between Lung-RADS classification obtained with each method and the reference standard generated from standard-dose CT evaluated by two radiologists who were not included in the image analysis session. Results A total of 205 participants (mean age: 64 years ± 7 [standard deviation], 106 men) with 1073 nodules were enrolled. Figure of merit (FOM) (P < .001) had significant differences among three modalities (standard-dose CT: FOM = 0.91, low-dose CT: FOM = 0.89, pulmonary MRI with UTE: FOM = 0.94), with no evidence of false-positive findings in participants with all modalities (P > .05). Agreements for Lung-RADS classification between all modalities and the reference standard were almost perfect (standard-dose CT: κ = 0.82, P < .001; low-dose CT: κ = 0.82, P < .001; pulmonary MRI with UTE: κ = 0.82, P < .001). Conclusion In a lung cancer screening population, ultrashort echo time pulmonary MRI was comparable to standard- or low-dose CT for Lung CT Screening Reporting and Data System classification. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Wielpütz in this issue.

3.
Acta Radiol ; : 2841851211044973, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34636644

RESUMO

BACKGROUND: The need for quantitative assessment of interstitial lung involvement on thin-section computed tomography (CT) has arisen in interstitial lung diseases including connective tissue disease (CTD). PURPOSE: To evaluate the capability of machine learning (ML)-based CT texture analysis for disease severity and treatment response assessments in comparison with qualitatively assessed thin-section CT for patients with CTD. MATERIAL AND METHODS: A total of 149 patients with CTD-related ILD (CTD-ILD) underwent initial and follow-up CT scans (total 364 paired serial CT examinations), pulmonary function tests, and serum KL-6 level tests. Based on all follow-up examination results, all paired serial CT examinations were assessed as "Stable" (n = 188), "Worse" (n = 98) and "Improved" (n = 78). Next, quantitative index changes were determined by software, and qualitative disease severity scores were assessed by consensus of two radiologists. To evaluate differences in each quantitative index as well as in disease severity score between paired serial CT examinations, Tukey's honestly significant difference (HSD) test was performed among the three statuses. Stepwise regression analyses were performed to determine changes in each pulmonary functional parameter and all quantitative indexes between paired serial CT scans. RESULTS: Δ% normal lung, Δ% consolidation, Δ% ground glass opacity, Δ% reticulation, and Δdisease severity score showed significant differences among the three statuses (P < 0.05). All differences in pulmonary functional parameters were significantly affected by Δ% normal lung, Δ% reticulation, and Δ% honeycomb (0.16 ≤r2 ≤0.42; P < 0.05). CONCLUSION: ML-based CT texture analysis has better potential than qualitatively assessed thin-section CT for disease severity assessment and treatment response evaluation for CTD-ILD.

4.
Sci Rep ; 11(1): 19562, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34599218

RESUMO

Carbon nanotubes (CNTs) are cylindrical nanostructures and have unique properties, including flexibility, electrical conductivity, and biocompatibility. We focused on CNTs fabricated with the carbon nanotube yarns (cYarn) as a possible substrate promoting peripheral nerve regeneration with these properties. We bridged a 15 mm rat sciatic nerve defect with five different densities of cYarn. Eight weeks after the surgery, the regenerated axons crossing the CNTs, electromyographical findings, and muscle weight ratio of the lower leg showed recovery of the nerve function by interfacing with cYarn. Furthermore, the sciatic nerve functional index (SFI) at 16 weeks showed improvement in gait function. A 2% CNT density tended to be the most effective for nerve regeneration as measured by both histological axonal regeneration and motor function. We confirmed that CNT yarn promotes peripheral nerve regeneration by using it as a scaffold for repairing nerve defects. Our results support the future clinical application of CNTs for bridging nerve defects as an off-the-shelf material.

5.
Plants (Basel) ; 10(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34371623

RESUMO

Environmental light conditions influence the biosynthesis of monoterpenes in the mint plant. Cyclic terpenes, such as menthol, menthone, pulegone, and menthofuran, are major odor components synthesized in mint leaves. However, it is unclear how light for cultivation affects the contents of these compounds. Artificial lighting using light-emitting diodes (LEDs) for plant cultivation has the advantage of preferential wavelength control. Here, we monitored monoterpene contents in hydroponically cultivated Japanese mint leaves under blue, red, or far-red wavelengths of LED light supplements. Volatile cyclic monoterpenes, pulegone, menthone, menthol, and menthofuran were quantified using the head-space solid phase microextraction method. As a result, all light wavelengths promoted the biosynthesis of the compounds. Remarkably, two weeks of blue-light supplement increased all compounds: pulegone (362% increase compared to the control), menthofuran (285%), menthone (223%), and menthol (389%). Red light slightly promoted pulegone (256%), menthofuran (178%), and menthol (197%). Interestingly, the accumulation of menthone (229%) or menthofuran (339%) was observed with far-red light treatment. The quantification of glandular trichomes density revealed that no increase under light supplement was confirmed. Blue light treatment even suppressed the glandular trichome formation. No promotion of photosynthesis was observed by pulse-amplitude-modulation (PAM) fluorometry. The present result indicates that light supplements directly promoted the biosynthetic pathways of cyclic monoterpenes.

6.
World J Surg Oncol ; 19(1): 169, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116698

RESUMO

BACKGROUND: Interstitial lung disease (ILD) is a rare adverse event in patients receiving adjuvant or neoadjuvant chemotherapy (NAC) for breast cancer. Few studies have reported the frequency of ILD in detail, and only small numbers of cases have been described in the literature. Given these previous findings concerning ILD, we retrospectively examined the clinicopathological characteristics of five cases of ILD who had received epirubicin and cyclophosphamide (EC) and compared their findings with non-ILD cases. METHODS: The present single-center retrospective study included breast cancer patients who underwent adjuvant chemotherapy or NAC at our hospital between January 2014 and January 2021. RESULTS: Thirty-nine patients who had received EC for operable breast cancer were enrolled in this study. ILD developed 5 out of 39 patients (12.8%). The incidence of ILD in patients with non-dose-dense (dd) or dd chemotherapy was statistically significantly different (p = 0.0149). ILD occurred in three patients during dd EC treatment and two during weekly paclitaxel (wPTX) after dd EC. ILD was detected in one patient with high Krebs von den Lungen-6 (KL-6) levels, in two patients with continuous pyrexia, and in two patients from computed tomography imaging, which was taken to estimate the efficacy of chemotherapy, in two patients. Three of the 5 ILD patients underwent bronchoalveolar lavage, and 2 of these patients were diagnosed with Pneumocystis jirovecii pneumonia (PCP). There were no cases of serious ILD that required steroid pulse therapy. CONCLUSIONS: Dd chemotherapy may be associated with an increased ILD frequency, which may reflect developing PCP. Careful monitoring and a timely diagnosis are useful for detecting early-stage ILD.


Assuntos
Neoplasias da Mama , Doenças Pulmonares Intersticiais , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante/efeitos adversos , Feminino , Humanos , Doenças Pulmonares Intersticiais/induzido quimicamente , Terapia Neoadjuvante/efeitos adversos , Prognóstico , Estudos Retrospectivos
7.
J Cent Nerv Syst Dis ; 13: 11795735211011786, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104032

RESUMO

Background: Clinicians may choose to administer antiplatelet medications to patients with cerebral aneurysms following endovascular coiling to prevent thrombus formation and vascular occlusion, if they fear a thrombus will form on the platinum wire where it diverges into the vessel from the aneurysm sac. However, the mechanism by which vascular endothelial cells repair a vessel in the living body in the event of a coil deviation and the effects of antiplatelet drugs on these cells have not been fully elucidated. We aimed to investigate the association between endothelial progenitor cells (EPCs) and endothelium formation at the surface of the platinum coils deployed in the carotid artery of rats, and to determine the effects of different antiplatelet drugs on this process. Subjects and Methods: We established an experimental model using normal and diabetic rats at 12 months of age. The diabetic rats were assigned to 4 different diet groups, distinguished by whether they were fed plain rat feed, or the same feed supplemented by 1 of 3 antiplatelet drugs (cilostazol, aspirin, or clopidogrel: all 0.1%) for 2 weeks, and the carotid artery was perforated by an embolization coil ("carotid coil model"). We monitored the process by which vascular endothelial cells formed the new endothelium on the surface of the coil by sampling and evaluating the region at 1, 2, and 4 weeks after placement. This repair process was also compared among 3 groups treated with different antiplatelet drugs (i.e. aspirin, clopidogrel, and cilostazol). One-way analysis of variance tests were performed to evaluate the differences in vascular thickness between groups, and P < .05 was considered statistically significant. Results: The diabetic rats showed delayed neoendothelialization and marked intimal hyperplasia. Cilostazol and clopidogrel effectively counteracted this delayed endothelial repair process. Flk1 immunostaining revealed greater expression in the diabetic rats administered cilostazol, second only to normal rats, suggesting that this agent acted to recruit EPCs. Conclusion: Neoendothelialization is delayed when vascular endothelial cells fail to function normally, which consequently leads to the formation of hyperplastic tissue. Cilostazol may remedy this dysfunction by recruiting EPCs to the site of injury.

8.
Magn Reson Med Sci ; 2021 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-33952785

RESUMO

Since thoracic MR imaging was first used in a clinical setting, it has been suggested that MR imaging has limited clinical utility for thoracic diseases, especially lung diseases, in comparison with x-ray CT and positron emission tomography (PET)/CT. However, in many countries and states and for specific indications, MR imaging has recently become practicable. In addition, recently developed pulmonary MR imaging with ultra-short TE (UTE) and zero TE (ZTE) has enhanced the utility of MR imaging for thoracic diseases in routine clinical practice. Furthermore, MR imaging has been introduced as being capable of assessing pulmonary function. It should be borne in mind, however, that these applications have so far been academically and clinically used only for healthy volunteers, but not for patients with various pulmonary diseases in Japan or other countries. In 2020, the Fleischner Society published a new report, which provides consensus expert opinions regarding appropriate clinical indications of pulmonary MR imaging for not only oncologic but also pulmonary diseases. This review article presents a brief history of MR imaging for thoracic diseases regarding its technical aspects and major clinical indications in Japan 1) in terms of what is currently available, 2) promising but requiring further validation or evaluation, and 3) developments warranting research investigations in preclinical or patient studies. State-of-the-art MR imaging can non-invasively visualize lung structural and functional abnormalities without ionizing radiation and thus provide an alternative to CT. MR imaging is considered as a tool for providing unique information. Moreover, prospective, randomized, and multi-center trials should be conducted to directly compare MR imaging with conventional methods to determine whether the former has equal or superior clinical relevance. The results of these trials together with continued improvements are expected to update or modify recommendations for the use of MRI in near future.

9.
J Nippon Med Sch ; 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33692302

RESUMO

BACKGROUND: Children who survive traffic accidents, and their parents, may develop post-traumatic stress disorder (PTSD) or related symptoms (depression or anxiety), which can hinder the children's development and the parents' ability to provide effective care. In Japan, the PTSD incidence rate following traffic accidents and its related factors remain unclarified. METHOD: Participants were 79 children and 104 parents. The children were aged 3-18 years when injured. From August-December 2015, participants completed a self-reported questionnaire survey that comprised the 15-item Post-traumatic Stress Symptoms for Children and the Japanese version of the Impact of Event Scale-Revised. The children's Injury Severity Score (ISS) was also obtained from their medical records. Correlations, analyses of variance, and multiple regression analyses were conducted. RESULTS: Among the children and the parents, 10.2% and 22.1% were deemed to be at high risk of PTSD, respectively. Their stress scores were significantly positively correlated with each other and negatively correlated with children's age at the time of the accident. Parents who witnessed their children's accidents and those whose children were hospitalized were more stressed. Neither the children's nor the parents' risk for PTSD was associated with the ISS and the amount of time since the accident. CONCLUSIONS: A system that simultaneously works with children and parents, to support both parties' psychological recovery is required. To ensure psychological care post-injury, it is necessary to evaluate PTSD risk, regardless of injury severity. Implementing preventive and early interventions can prove more valuable than awaiting natural recovery.

10.
J Nippon Med Sch ; 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33692305

RESUMO

Clear cell sarcoma of the kidney (CCSK) is a rare aggressive pediatric renal tumor. Intratumoral hemorrhage and tumor rupture are considered as oncologic emergencies, requiring a quick and appropriate response. Herein, we report the case of an 11-year-old boy, who visited our hospital with abdominal distension that started a month earlier. Computed tomography (CT) revealed a tumor in the left kidney (size: 200 mm), and a diagnosis of CCSK was established with a biopsy. Chemotherapy was initiated to shrink the large and densely vascularized tumor before surgical removal. Two days after initiating chemotherapy, the patient developed abdominal and back pain, anemia, and hypotension. The CT scan showed intratumoral bleeding. Emergency transcatheter arterial embolization (TAE) was performed to control the bleeding. Three tumor feeding vessels were identified: an ascending branch from the celiac artery, an intermediate branch from the left renal artery, and a descending branch from the inferior mesenteric artery, of which the intermediate and descending branches were large and bleeding profusely; therefore, the intermediate branch was injected with ethanol and the descending branch was subjected to gel-foam embolization. Chemotherapy was resumed, and the patient's condition stabilized gradually. The tumor began to shrink, and subsequent chemotherapy progressed well. In week 12 of chemotherapy, the patient underwent tumor resection and left nephrectomy. Postoperative chemotherapy was completed without complications, and there was no recurrence during a 6-year follow-up. Therefore, TAE can effectively control intratumoral bleeding in pediatric solid tumors and consequently prevent an unnecessary high-risk open surgical procedure.

12.
Br J Radiol ; : 20201053, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33529053

RESUMO

Morphological evaluation of the lung is important in the clinical evaluation of pulmonary diseases. However, the disease process, especially in its early phases, may primarily result in changes in pulmonary function without changing the pulmonary structure. In such cases, the traditional imaging approaches to pulmonary morphology may not provide sufficient insight into the underlying pathophysiology. Pulmonary imaging community has therefore tried to assess pulmonary diseases and functions utilizing not only nuclear medicine, but also CT and MR imaging with various technical approaches. In this review, we overview state-of-the art MR methods and the future direction of: (1) ventilation imaging, (2) perfusion imaging and (3) biomechanical evaluation for pulmonary functional imaging.

14.
Curr Opin Allergy Clin Immunol ; 21(1): 1-7, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33186186

RESUMO

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19), a respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus), is a pandemic in over 120 countries worldwide. Risk factors for severe COVID-19 include older age, ethnicity, sex, comorbidities, and living conditions. Although asthmatics and those with allergies are susceptible to more severe outcomes to viral infections, interestingly, asthma has not been reported to be a major comorbidity of COVID-19. However, there are some conflicting reports on the impact of asthma on COVID-19. The underlying immunological and molecular mechanisms may explain at least in part these observations. Furthermore, environmental factors like air pollution that have detrimental effects on asthma and respiratory illnesses also have an impact on COVID-19. RECENT FINDINGS: Angiotensin-converting enzyme 2 (ACE2) is the receptor for the attachment and entry of SARS-CoV-2 into the host cells that is upregulated by Th1-mediated responses. In asthmatics, ACE2 gene expression is generally reduced and recent studies have shown a negative correlation between the levels of Th2 cytokines including IL-4, IL-5, and IL-13 in airway epithelial cells and other type 2 biomarkers with ACE2 expression. This may explain in part the potential protective role of asthma on COVID-19. Here, we review the relation of respiratory viral illnesses and asthma, the immune-molecular mechanisms of SARS-CoV-2 infection, the impact of asthma on COVID-19 and that of SARS-CoV-2 on asthma and allergic rhinitis, and the impact of environmental factors like air pollution on COVID-19. SUMMARY: Expression of ACE2 in airway epithelial cells in SARS-COV-2 is influenced by inflammatory profile. Respiratory allergic diseases like asthma appear to have a protective effect against SARS-COV-2 infection. However, the clinical association between asthma and SARS-COV-2 is not fully established and the underlying immune-molecular mechanisms may explain these observations.


Assuntos
Poluição do Ar/efeitos adversos , Asma/epidemiologia , Asma/imunologia , COVID-19/epidemiologia , COVID-19/imunologia , Pandemias , Rinite Alérgica/epidemiologia , Rinite Alérgica/imunologia , SARS-CoV-2/fisiologia , Enzima de Conversão de Angiotensina 2/genética , Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/virologia , Comorbidade , Citocinas/metabolismo , Humanos , Fatores de Risco , Células Th1/imunologia , Internalização do Vírus
15.
Eur J Radiol ; 134: 109430, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33276249

RESUMO

PURPOSE: To demonstrate the utility of compressed sensing with parallel imaging (Compressed SPEEDER) and AiCE compared with that of conventional parallel imaging (SPEEDER) for shortening examination time and improving image quality of women's pelvic MRI. METHOD: Thirty consecutive patients with women's pelvic diseases (mean age 50 years) underwent T2-weighted imaging using Compressed SPEEDER as well as conventional SPEEDER reconstructed with and without AiCE. The examination times were recorded, and signal-to-noise ratio (SNR) was calculated for every patient. Moreover, overall image quality was assessed using a 5-point scoring system, and final scores for all patients were determined by consensus of two readers. Mean examination time, SNR and overall image quality were compared among the four data sets by Wilcoxon signed-rank test. RESULTS: Examination times for Compressed SPEEDER with and without AiCE were significantly shorter than those for conventional SPEEDER with and without AiCE (with AiCE: p < 0.0001, without AiCE: p < 0.0001). SNR of Compressed SPEEDER and of SPEEDER with AiCE was significantly superior to that of Compressed SPEEDER without AiCE (vs. Compressed SPEEDER, p = 0.01; vs. SPEEDER, p = 0.009). Overall image quality of Compressed SPEEDER with AiCE and of SPEEDER with and without AiCE was significantly higher than that of Compressed SPEEDER without AiCE (vs. Compressed SPEEDER with AiCE, p < 0.0001; vs. SPEEDER with AiCE, p < 0.0001; SPEEDER without AiCE, p = 0.0003). CONCLUSION: Image quality and shorten examination time for T2-weighted imaging in women's pelvic MRI can be significantly improved by using Compressed SPEEDER with AiCE in comparison with conventional SPEEDER, although other sequences were not tested.


Assuntos
Aprendizado Profundo , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Radiografia , Razão Sinal-Ruído
16.
J Med Case Rep ; 14(1): 208, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33129357

RESUMO

BACKGROUND: Paravertebral compartment syndrome occurring without trauma is quite rare. We report a case of compartment syndrome that occurred after spinal exercises. CASE PRESENTATION: A 23-year-old Japanese rower developed severe back pain and was unable to move 1 day after performing exercises for the spinal muscles. Initial evaluation at a nearby hospital revealed hematuria and elevated creatine phosphokinase levels. He was transferred to our hospital, where magnetic resonance imaging revealed no hematoma but confirmed edema in the paravertebral muscles. The compartment pressure measurements were elevated bilaterally. Despite his pain being severe, his creatine phosphokinase levels were expected to peak and decline; his urine output was normal; and surgery was undesirable. Therefore, we opted for conservative management. The next day, the patient's compartment pressure diminished, and his pain levels decreased to 2/10. After 5 days, he was able to walk without medication. CONCLUSIONS: We present a rare case of compartment syndrome of the paravertebral muscles with good resolution following conservative management. We hope our case findings will help avoid unnecessary surgery in cases of paravertebral compartment syndrome.


Assuntos
Síndromes Compartimentais , Adulto , Síndromes Compartimentais/etiologia , Exercício Físico , Fasciotomia , Humanos , Imageamento por Ressonância Magnética , Masculino , Caminhada , Adulto Jovem
17.
Respir Med Case Rep ; 31: 101239, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072510

RESUMO

This case reports rare findings on computed tomography of a manifestation of malignant lymphoma, in which diffuse lung shadows appeared as miliary nodules distributed throughout the lungs bilaterally. The patient had a history of surgical treatment of rectal cancer and had received chemotherapy for suspicious liver metastasis. At her current presentation for evaluation suspected miliary tuberculosis on chest radiography, subsequent liver biopsy revealed a mass infiltration of atypical lymphocytes, which was diagnosed as follicular lymphoma. The miliary tuberculosis was suspected more than neoplastic lesions, such as metastatic rectal cancer or malignant lymphoma. Despite repeated bacteriologic tests of various samples, including sputum, urine, bronchial secretion, peripheral blood, bone marrow aspiration, and gastric lavage, all results were negative for mycobacterium tuberculosis. Finally, multiple, small, mass lesions of lymphocytes were demonstrated in the lung obtained from video-assisted thoracic surgery, and a diagnosis of follicular lymphoma was given. The final interpretations of liver mass and military lung lesions were tumor involvement by the follicular lymphoma. This radiologic findings of multiple miliary opacities throughout the whole lungs confused definite diagnosis because these images were remarkably similar with miliary tuberculous. This case reminds us to consider a wide variety of differential diagnoses even we assumed to be familiar with radiographic imaging at first glance.

18.
J Nippon Med Sch ; 87(3): 166-170, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32238729

RESUMO

Hemophagocytic lymphohistiocytosis (HLH) associated with Epstein-Barr virus (EBV) infection can be self-limiting, severe/aggressive, or fatal. We report a case of EBV-HLH with persistent fever, severe pancytopenia, hypertriglyceridemia, and hypofibrinogenemia in a 4-year-old boy. Levels of plasma cytokines and chemokines were measured with a Bio-Plex system at 1, 2, 3, 4, 5, and 8 days after hospital admission. Administration of steroid and high-dose intravenous immunoglobulin (1 g/kg) did not alleviate fever or reduce cytokine production; however, after administration of etoposide (an antineoplastic agent), fever decreased immediately, the patient's general condition improved, and levels of IL-6, IL-10, IL-8, MCP-1, IFN-γ, and TNF-α declined after etoposide administration. In particular, IFN-γ production sharply declined, from 1,104.1 pg/mL to 101.5 pg/mL, and IL-6 level decreased from 229.8 pg/mL to 11.0 pg/mL, on the day after initial etoposide administration. There was no later recurrence of symptoms during treatment with dexamethasone, etoposide, and cyclosporine A. This case suggests that early etoposide administration is critical for treatment success and indicates that etoposide promptly inhibits cytokine production.


Assuntos
Citocinas/metabolismo , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Etoposídeo/administração & dosagem , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Pré-Escolar , Infecções por Vírus Epstein-Barr/metabolismo , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Imunoterapia , Linfo-Histiocitose Hemofagocítica/metabolismo , Masculino , Resultado do Tratamento
19.
ERJ Open Res ; 6(1)2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32010720

RESUMO

Very recently, a modest but significant efficacy of granulocyte-macrophage colony-stimulating factor (GM-CSF) inhalation therapy for the treatment of mild to moderate autoimmune pulmonary alveolar proteinosis (aPAP) has been reported. As the ability to measure the level of GM-CSF autoantibody (GMAb) in the serum is required to decide the indication for this therapy, we developed a high-performance GMAb testing kit for clinical use. As the kit succeeded in reducing nonspecific IgG binding to the ELISA plate, the predictive performance shown in the training study to discriminate aPAP patients from healthy subjects was perfect, providing a cut-off value of 1.65 U·mL-1 in 78 patients with aPAP and 90 healthy subjects in an operator-blinded manner using logistic regression analysis. As in the validation study, serum samples from another 213 patients with aPAP were also blinded and evaluated in an operator-blinded manner against external 207 samples from patients with other types of PAP and patients exhibiting various ground-glass opacities on chest high-resolution computed tomography that require discrimination from PAP. The logistic regression analysis of these validation data sets revealed values of 97.6% and 100% for specificity and sensitivity, respectively. Thus, this new GMAb testing kit is reliable for the diagnosis of aPAP and differential diagnosis of other lung diseases.

20.
Pediatr Int ; 62(1): 14-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31758839

RESUMO

BACKGROUND: Kawasaki disease (KD) is a systemic inflammatory disease resulting in an acute febrile syndrome commonly affecting children younger than 5 years. Coronary arteritis in KD is occasionally non-responsive to several treatments. Recently, adipose tissue-derived stem cells (ADSCs) have been shown to have anti-inflammatory, immunosuppressive, and tissue-repair characteristics and are considered a useful treatment for inflammatory disease. The present study aimed to elucidate whether the administration of ADSCs can suppress KD-associated vasculitis in vivo. METHODS: Candida albicans water-soluble fraction is often used to model KD via the induction of severe coronary arteritis. Kawasaki disease model mice were intravenously administered ADSCs and phosphate-buffered saline (PBS). On day 29, the mice were sacrificed and hearts from mice in each group were dissected. This was followed by serum collection. Cardiac tissue sections were subjected to histopathological examination to evaluate the inflammatory area. The levels of pro-inflammatory cytokines in the serum were analyzed at days 15 and 29. The survival rates of both groups were compared. RESULTS: The mean inflammatory area in coronary arteritis was significantly lower in the ADSC group compared to the PBS group (P < 0.01). Furthermore, the levels of pro-inflammatory cytokines, such as IL-1ß, IL-12, IL-17, RANTES, INF-γ, and TNF-α, in the ADSC group were significantly lower than those in the PBS group. Moreover, the ADSC group had a significantly higher survival rate than the PBS group. CONCLUSIONS: These findings highlight that ADSCs have anti-inflammatory and immune regulatory functions that could provide novel cell-based therapeutic strategies for severe KD.


Assuntos
Tecido Adiposo/citologia , Arterite/terapia , Síndrome de Linfonodos Mucocutâneos/terapia , Células-Tronco/citologia , Animais , Candida albicans , Doença da Artéria Coronariana/terapia , Vasos Coronários/patologia , Citocinas/sangue , Modelos Animais de Doenças , Masculino , Camundongos , Camundongos Endogâmicos DBA , Transplante de Células-Tronco/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...