Denosumab-induced hypocalcemia in patients with solid tumors and renal dysfunction: a multicenter, retrospective, observational study

BACKGROUND

Bone metastases are frequently observed in advanced cancer, and bone modifying agents are used to prevent or treat skeletal-related events. Zoledronic acid is contraindicated in patients with severe renal impairment (Ccr < 30 mL/min), but it is not completely known whether denosumab can be used in them. We aimed to determine the association between renal function and hypocalcemia development during denosumab treatment.

METHODS

We included patients with solid cancer and bone metastases who started denosumab treatment between April 2017 and March 2019. They were classified into four groups based on creatinine clearance (Ccr; mL/min): normal (Ccr ≥ 80), mild (50 ≤ Ccr ˂80), moderate (30 ≤ Ccr ˂50), and severe (Ccr ˂30). Hypocalcemia was evaluated using the Common Terminology Criteria for Adverse Events (v5.0) based on the albumin-adjusted serum calcium levels; its incidence (stratified by renal function) and risk factors were investigated using a Chi-square test and logistic regression analysis.

RESULTS

Of 524 patients (age: 69 ± 11 years; 303 men), 153 had a normal renal function and 222, 117, and 32 had mild, moderate, and severe renal dysfunction. The albumin-adjusted serum calcium level was higher than the measured (total) calcium level in most patients. The incidence of grade ≥ 1 hypocalcemia was 32.0% in the normal group and 37.4%, 29.9%, and 62.5% in the mild, moderate, and severe renal dysfunction groups, respectively. It was, therefore, higher in the severe renal dysfunction groups than in the normal group (P = 0.002). The incidence of grade ≥ 3 hypocalcemia did not differ significantly among the groups. Pre-treatment low serum calcium levels and severe renal dysfunction were risk factors for hypocalcemia.

CONCLUSIONS

Evaluating denosumab-induced hypocalcemia required albumin adjustment, and its incidence was high among patients with severe renal dysfunction. Reduced serum calcium levels and severely impaired renal function were associated with an elevated hypocalcemia risk.

Retrospective multicentre study on the effectiveness of first-line direct-acting antivirals against hepatitis C virus genotype-1

What is known and objective

In Japan, ledipasvir/sofosbuvir, elbasvir/grazoprevir and glecaprevir/pibrentasvir are recommended as first‐line treatments for patients with untreated hepatitis C virus genotype 1. Although they have demonstrated a high efficacy in clinical trials, there are no direct comparative studies. Clarification of their effectiveness and safety in real‐world clinical practice is required. Therefore, we conducted a retrospective multicentre study on the effectiveness of these direct‐acting antivirals in real‐world clinical practice.

Methods

We retrospectively evaluated the clinical data of untreated patients with persistent HCV genotype 1 infection who started first‐line treatment with ledipasvir/sofosbuvir, elbasvir/grazoprevir or glecaprevir/pibrentasvir between September 2015 and January 2019 at 11 medical institutions in Japan. The primary efficacy endpoint was a sustained virologic response after 12 weeks of treatment. The secondary endpoints included sustained virologic response after 24 weeks of treatment and end of treatment response. The safety endpoint was treatment completion rate.

Results and discussion

During the study, 420 patients (median age, 70 years; 181 males) received ledipasvir/sofosbuvir, 48 (median age 72, years; 29 males) received elbasvir/grazoprevir and 63 (median age 66, years; 35 males) received glecaprevir/pibrentasvir. For ledipasvir/sofosbuvir, elbasvir/grazoprevir and glecaprevir/pibrentasvir, the sustained virologic response after 12 weeks of treatment was 98.6%, 97.9% and 100%; the sustained virologic response after 24 weeks of treatment was 99.0%, 97.7% and 100%; the end of treatment response was 99.8%, 97.9% and 98.4%; and the treatment completion rate was 98.3%, 91.7% and 100% respectively.

What is new and conclusion

In real‐world clinical practice, hepatitis C virus treatment with ledipasvir/sofosbuvir, elbasvir/grazoprevir and glecaprevir/pibrentasvir was effective with safety.

Late acquired words in childhood are lost earlier in primary progressive aphasia

The psycholinguistic nature of the dissolution of the mental lexicon in a primary progressive aphasic patient was investigated in light of the general regression hypothesis that language dissolution is the inverse of language acquisition. Four years after onset of the symptoms, the patient scored 60% correct on a picture naming test, exhibiting some effects of lexical and sublexical age-of-acquisition, but 7 years after onset, he scored only 15% correct. While even a weak form of the regression hypothesis is not fully supported, age-of-acquisition effects seem to be preserved throughout the course of the lexical dissolution. Some implications are briefly discussed for future research.

A successful case of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle

Chronic thromboembolism is a frequent cause of progressive hypertension and carries a poor prognosis. Medical treatment is not effective and surgery provides the only potential for a cure at present. We herein report a successful case of thromboendarterectomy treated via a median sternotomy with intermittent circulatory arrest. A 43-year-old man was admitted to our hospital complaining of progressive dyspnea, edema of the lower extremities, and a fever with an unknown origin. A subsequent definitive evaluation showed him to be suffering from surgically accessible chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle. He underwent a pulmonary thromboendarterectomy and thrombectomy via a median sternotomy with intermittent circulatory arrest on November 24, 1994. Postoperatively he showed a marked improvement in his hemodynamic status and blood gas analysis. He has also returned to work with no trouble. Deep vein thrombosis appeared to be the pathogenesis of this case, but we could not find the origin of his unknown fever. He is currently being controlled by treatment with methylprednisolone as before.

[Induction of apoptosis through NGF/p75NTR in human glioma cells treated with propentofylline]

Propentofylline (PPF) is a xanthine derivative and it has been reported that PPF stimulated the synthesis/secretion of nerve growth factor (NGF) by cultured astroglial cells. We have reported that PPF induced apoptosis in human glioma cells and as its mechanism, up-regulation of NGF, Fas, Bax beta and down-regulation of Bcl-2 were assumed. Recent studies demonstrated the presence of apoptosis induced via NGF/p75NTR in developmental neuron, oligodendroglia. In the present study, to examine whether signal cascade via NGF/p75NTR participates the apoptosis in human glioma cells treated with PPF, we investigated the immunohistochemical study using anti-mouse monoclonal antibody, immunoprecipitation and northern blot analysis for p75NTR, NF-kappa B in human glioma cells (U251MG, T98G, U87) treated with PPF. We observed the up-regulation of p75NTR, translocation of NF-kappa B to the nucleus after treatment with PPF in these cell lines. According to above results, it is assumed that apoptosis in human glioma cells treated with PPF was induced via NGF/p75NTR.

Alternatively spliced forms of cyclin D1 modulate entry into the cell cycle in an inverse manner

Alternative splicing of cyclin D1 gene mRNA has recently been demonstrated. The novel transcript shows no splicing at the downstream exon 4 boundary and encodes a protein with an altered carboxyl-terminal domain that is a cyclin D1 variant; exon 5 is not included in the coding sequence which terminates downstream of exon 4. We here produced cells that exogenously express each form of cyclin D1 and analysed their cell cycle regulation. We found that (1) alternative splicing forms of cyclin D1 modulated entry into the cell cycle in an inverse manner; (2) both splicing forms suppressed cell growth; and (3) cells overexpressing form [a] were inhibited from entry into and completion of the S phase, although form [b]-expressing cells showed no reduction of G1- to S transition. We also found that overexpression of either cyclin D1 form upregulated Rb gene products, suggesting that this upregulation may be one of the causes of growth suppression in cyclin D1 overexpressing cells.

[Three adults with mild varicella and bronchial mucosal lesions]

We encountered three adults with varicella and bronchial mucosal lesions. Respiratory symptoms were minimal in all three. Chest X-ray films showed bilateral, diffuse, small, nodular shadows. Small, elevated lesions with white plaque's were seen on the bronchial mucosa bronchoscopically. Transbronchial lung biopsy, bronchial mucosal biopsy, and bronchoalveolar lavage were also done. The lung-biopsy specimen showed infiltration of lymphocytes into the interstitial space: VZV antigen was found by immunohistochemical staining of the lesion in one case. Analysis of bronchoalveolar lavage fluid revealed abnormally low CD 4/8 ratios in three cases. These findings suggest a high incidence of respiratory complications, especially bronchial lesions, despite the lack of respiratory symptoms, in adults with varicella.

[Neural protective agents, propentofylline (PPF) could induce apoptotic cell death in the human glioma cells: analysis of Bcl-2 and Bax alpha/Bax beta expressions]

In the previous study, we have shown that propentofylline (PPF) could induce the cellular differentiation and apoptosis-related growth regression in the human glioma cell lines. Its biological functions were partly due to the increasing endogeneous NGF and its high affinity receptor, trk A productions. Although little has been known about the precise machinary regulating the propentofylline induced apoptosis. Recently, we have found that propentofylline could modulate some apoptosis related genes products in the glioma cell lines, i.e. NGF, trk A mRNA levels and Fas protein expressions were increased, whereas bcl-2 mRNA level was decreased. In the present study, we examined the apoptotic signal cascade, especially focusing on the expressing pattern of Bcl-2/Bax gene products. In the normal human astrocyte cells, Bax-beta was markedly expressed, whereas Bcl-2 and Bax-alpha proteins and mRNA were weakly or even nondetectable. Accordingly, Bax beta might be a dominant variant in the normal glial cells, which could have the appropriate balance of proapoptotic (Bax beta) and anti-apoptotic proteins (Bcl-2). In the glioma cells, we showed the over-expressions of Bcl-2 and Bax alpha compared with the normal counterparts. According to Bax dominant theory, Bax, not Bcl-2 may have a major role in regulating apoptosis by means of homodimerization. In might be implied that in the glioma cells, excessive expressions of Bcl-2 and Bax alpha would favor the formation of the Bax alpha/Bax beta heterodimer or the Bax beta/Bcl-2 heterodimer rather than the Bax beta/Bax beta homodimer, which might be presumed to be functional proteins. And finally the increasing relative ratio of Bax alpha/ Bax beta or Bax beta/Bcl-2 to Bax beta/Bax beta could allow the tumor cells to survive. Thus over-expression of the bcl-2 and bax alpha gene renders the glioma cells resistant to apoptosis. In the present study, PPF could promote Bax beta over-expression and Bcl-2 retardative expression in the glioma cells, whereas had no effect on Bax alpha expression. Therefore, PPF might promote apoptotic cell death through the mechanism that restore the glioma cells to the appropriate balance of proapoptotic and anti-apoptotic proteins like as normal astrocytes. Our results indicated that propentofylline might have a potential role as apoptotic modulators in the human glioma cell lines, not only its protective activities against neuronal ischemic damages.

Bronchogenic cyst with high carbohydrate antigen 19-9 in the cyst fluid and the serum

A mass of 8 cm in diameter was revealed in the right upper lung field of a 46-year-old female patient. The chest X-ray film taken one year previously revealed only a linear shadow in the same position, which was thought to be a vacant cyst. The levels of carbohydrate antigen (CA) 19-9 in cyst fluid and serum were elevated, at 410,000 and 130 U/ml, respectively. After surgical resection, serum CA19-9 returned to normal. Pathologically, the cyst wall was lined with bronchial epithelium with no evidence of malignancy. Immunohistochemical study revealed CA19-9 positivity in the bronchial epithelium of the cyst wall.

Crossed cerebellar diaschisis in chronic Broca's aphasia

The cerebellum has anatomical connections to the cerebral cortex, through which it can affect language function. To study these connections, we investigated patients with chronic Broca's aphasia using MRI and single-photon emission computed tomography (SPECT). We selected 15 such patients (9 male, 6 female, aged 17-64 years, mean age 56 years) from 30 chronically aphasic patients. Using the results of SPECT, we divided them into patients with (group 1) and without (group 2) crossed cerebellar diaschisis (CCD). We compared the language function of the two groups. Patients in group 1 showed classical Broca's aphasia, while patients in group 2 showed mainly word-finding difficulty. Patients with CCD hat infarcts involving the lower part of the frontal gyrus but patients without CCD did not, which suggests that this region may have functional and anatomical connections with the cerebellum. Our findings support the notion that the cerebellum contributes to language.

Imaging in primary progressive aphasia

Primary progressive aphasia (PPA) presents with aphasia, with or without other minor cognitive dysfunction. We report five patients with PPA to show the correlation between their clinical signs and imaging findings. The patients can be divided into those with nonfluent (group 1) and those with fluent (group 2) aphasia. The characteristic speech impairment was bradylalia in group 1 and word amnesia in group 2. Impairment of comprehension was common but mild in both groups. On MRI, patients in group 1 showed predominantly left frontal and perisylvian atrophy with reduced uptake in the same region on single photon emission computed tomography (SPECT) using technetium-99m hexamethyl propyleneamine oxime (99mTc HMPAO). Patients in group 2 showed left temporal atrophy involving the superior, middle and inferior temporal gyri, hippocampus and parahippocampal gyrus on MRI and reduced uptake in the same region on SPECT. These findings correlated well with the functional anatomy of speech impairment.

Spatiotemporal expression of C-CAM in the rat placenta

We investigated the expression of the immunoglobulin superfamily cell adhesion molecule, C-CAM, in developing and mature rat placenta. By immunohistochemical staining at the light microscopic level, no C-CAM-expression was seen before Day 9 of gestation, when it appeared in the trophoblasts of ectoplacental cones. On Day 10.5, spongiotrophoblasts and invasive trophoblasts around the maternal vessels of the decidua basalis were stained positively. On Day 12.5, C-CAM was detected in the spongiotrophoblasts of the junctional layer, but labyrinth trophoblasts and secondary giant trophoblasts were not stained. On Day 17.5, C-CAM was found only in the labyrinth and lacunae of the junctional layer. At this stage, both the labyrinth cytotrophoblasts of the maternal blood vessels and the endothelial cells of the embryonic capillaries were strongly stained. Placental tissues from gestational Days 12.5 and 17.5 were analyzed by immunoelectron microscopy to determine the location of C-CAM at the subcellular level. On Day 12.5, positive staining of the spongiotrophoblasts was observed, mainly on surface membranes and microvilli between loosely associated cells. On Day 17.5, staining was found primarily on the microvilli of the maternal luminal surfaces of the labyrinth cytotrophoblasts, and both on the luminal surface and in the cytoplasm of endothelial cells of the embryonic vessels. RT-PCR analysis and Southern blotting of the PCR products revealed expression of mRNA species for both of the major isoforms, C-CAM1 and C-CAM2. Immunoblotting analysis of C-CAM isolated from 12.5-day and 14.5-day placentae showed that it appeared as a broad band with an apparent molecular mass of 110-170 kD. In summary, C-CAM was strongly expressed in a specific spatiotemporal pattern in trophoblasts actively involved in formation of the placental tissue, suggesting an important role in placental development. In the mature placenta, C-CAM expression was confined to the trophoblastic and endothelial cells lining the maternal and embryonic vessels, respectively, suggesting important functions in placental physiology.

[Expression of HGF and c-met/HGF receptor mRNA in brains of normal rats and in phaeochromocytoma cells PC-12 of rats treated with NGF]

Gene expression of HGF and c-met proto-oncogene was examined during rat brain development and in cultured PC-12 cells, using reverse-transcriptase (RT)-polymerase chain reaction (PCR) technique. The both mRNAs of HGF and c-met proto-oncogene were remained at low levels in the middle and late stages of gestation (E-13 and E-18). After birth, and the level of both mRNA expression suddenly increased. During P-1 and P-12, their high level of expression continued and then decreased in P-20 and adult brain. Both HGF mRNA and c-met photo-oncogene mRNA were transiently expressed between day 2 and day 5, and disappeared in cultured PC-12 cells treated with NGF. The neurites of PC-12 cells that were treated with anti-sense oligonucleotides of HGF and c-met proto-oncogene, were shorter and fewer in number than untreated control cells. We conclude that neurite extension of PC-12 cells treated with NGF may ensue by way of c-MET protein activation and signal transduction pathways. Thus, c-MET protein activation and up-regulation of the two mRNAs may also play an important role in neuronal maturation in the developing rat brain.

[Up-regulation of NGF, trkA, Fas, down-regulation of bcl-2, and induction of apoptosis by propentofylline in human glioma cell lines]

Propentofylline (PPF) has been reported to stimulate the synthesis/secretion of nerve growth factor (NGF) by cultured mouse astroglial cells. In the present study, we examined whether PPF stimulates NGF synthesis in human glioma cell lines, the same as in mouse astroglial cells, and if so, whether NGF has a biological effect on glioma cells. After administration of PPF into the glioma cell lines, we investigated morphological changes and gene and protein expression of NGF, trkA, Fas and bcl-2 by using GFAP staining. Western blotting, and RT-PCR. Glioma cells showed definite morphological changes, including expansion of astrocytic processes, cytoplasmic enlargement and increases in GFAP staining. Interestingly, apoptosis was identified by DNA ladder formation in each of the cell lines. The mRNA and protein expression of NGF, trkA and Fas increased, but expression of bcl-2 decreased. These findings suggest that PPF works as a transcriptional modulator and induces apoptosis in glioma cells.

Increased susceptibility to silicosis and TNF-alpha production in C57BL/6J mice

Toxic oxygen species and several proinflammatory cytokines are involved in the pathogenesis of silicosis. In order to understand whether factors that lead to susceptibility to ozone are also important in silicosis or not, we examined ozone-sensitive C57BL/6J mice and ozone-resistant C3H/HeJ mice as models of silicosis. We also analyzed the production of proinflammatory cytokines in both the acute and the chronic phases. On Day 2 after silica injection, the ozone-resistant C3H/HeJ mice showed significantly higher cellular responses as recognized by bronchoalveolar lavage (BAL) cell counts than did the C57BL/6J mice. In the chronic phase (Day 28 after silica injection), the ozone-sensitive C57BL/6J mice showed significantly greater responses to instilled silica judged by total protein and cell number in BAL fluid, hydroxyproline content, and histology than the ozone-resistant C3H/HeJ mice. TNF-alpha production by BAL cells after silica exposure was significantly higher in C57BL/6J mice than in C3H/HeJ mice in the chronic phase, whereas there was no significant difference in IL-1 alpha production between both strains of silica-injected mice. Also, the control C57BL/6J mice had significantly higher secretions of TNF-alpha than did the control C3H/HeJ mice in the acute phase. These results suggest that ozone-sensitive C57BL/6J mice are also more susceptible to silicosis than are ozone-resistant C3H/HeJ mice, and that the initial lower cellular responses and increase in TNF-alpha production may be related to the higher level of inflammatory and fibrotic response in the C57BL/6J mice.

Smoking promotes insidious and chronic farmer's lung disease, and deteriorates the clinical outcome

Although the prevalence of serum precipitating antibodies for farmer's lung disease (FLD) is lower in smokers than in nonsmokers and FLD predominates in nonsmokers, the affects of smoking on the clinical course of the disease is not known. We compared the clinical findings and the prognosis between 12 smokers (SM-FLD) and 31 non-smokers with FLD (NS-FLD). There was no difference in age, sex, working years on farm, clinical symptoms, laboratory findings, radiographic findings, between the two groups. However, for the type of onset on the first visit for FLD, "acute single episode" type was less common, and "recurrent" and "insidious onset" types were more common in SM-FLD than in NS-FLD (8.3 vs 58.1, 91.7 vs 41.9%, respectively, p < 0.05). Although working status and mask wearing status were not significantly different between the two groups after the diagnosis of FLD, patients with symptoms and/or radiographic abnormalities of FLD of more than 6 months were found more frequently in SM-FLD than in NS-FLD (66.7 vs 19.4%, p < 0.005). And also SM-FLD had more recurrences of FLD than NS-FLD after the initial diagnosis of FLD (1.58 +/- 1.56 vs 0.47 +/- 1.07, p < 0.05). SM-FLD tended to have lower % VC than NS-FLD (73.6 +/- 7.4 vs 88.5 +/- 3.9%, respectively, p = 0.06). Regarding the prognosis, the 10-year survival rates were 70.7% in SM-FLD, and 91.5% in NS-FLD (p < 0.05). These results suggest that smoking may make FLD insidious and chronic, and deteriorates the clinical outcome.

Optical trapping of low-refractive-index microfabricated objects using radiation pressure exerted on their inner walls

Optical trapping of transparent ring-shaped micrometer-sized objects with a refractive index lower than that of the surrounding medium has been demonstrated by use of a strongly focused TEM(00)-mode laser beam. Axial trapping of these objects is a result of the upward radiation pressure induced when the incident light strikes the inner wall and transmitted light leaves from the bottom. Transverse trapping of these objects occurs because the total repulsive radiation pressure exerted on the inner wall of the object is directed toward the laser beam axis. Three-dimensional manipulation of f luorinated polyimide micro-objects (refractive index n(1)= 1.525, outer diameter 10 microm, inner diameter 5 microm, and thickness 5.7 microm) in a high-refractive-index liquid (n(2)= 1.605) was experimentally shown to be possible by use of an objective lens with a wide range of numerical apertures from 1.25 to 0.5.

[A case report of acute pulmonary valve endocarditis caused by fungi]

A 42 years old female was admitted for evaluation of unrelenting fever and dyspnea on exertion in March, 1991. The patient had a VSD closure in 1968. After admission, serial blood cultures were found to be positive for Candida Parapsilosis and a massive vegetation on the pulmonary valve was demonstrated by echocardiography. Chest X-ray disclosed a wedge-shaped density in the right middle lung lobe that was a compatible finding with pulmonary infarction. At surgery, performed 3 days later the admission, pulmonary valve was entirely resected without replacing it with prosthesis. Antifungal treatment was intensively given afterwards. Her postoperative course was without event and she was sent home on the 51st postoperative day. Right heart catheterization done two years surgery, revealed the pulmonary vascular resistance was 216 dynes sec cm-5. We anticipate that this degree of pulmonary vascular resistance will allow the patient enough to do well without needing valve prosthesis in the near future.

Applications of an extremely short strong-feedback configuration of an external-cavity laser diode system fabricated with GaAs-based integration technology

A composite-cavity laser diode is used to monitor the reflectivity or the displacement of the external-cavity mirror for micromechanical photonics devices. Optical disk bits are read out in the near field from the difference in medium reflectivity with an antireflection-coated laser diode and a photodiode. Microbeam vibration is also detected in the near field from the phase difference with an uncoated laser diode and a photodiode. In both cases the carrier-to-noise ratio is very high (more than 45 dB) because of the lack of mode-hopping noise resulting from the extremely short (less than 3 µm) external-cavity length and strong light feedback. These composite-cavity laser diode microdevices are fabricated on a gallium arsenide substrate to eliminate the need for optical alignment.

Gamma-interferon modifies guinea pig airway functions in vitro

Cytokines produced by T-lymphocytes may have significant roles in the airway inflammation seen in bronchial asthma. Gamma interferon (IFN-gamma), a T-cell derived cytokine, is known to modify functions of both immune and non-immune cells. In this study, we investigated whether IFN-gamma can modify guinea pig airway functions in vitro. The isometric tension of guinea pig airway strips was measured in a tissue bath filled with Krebs-Henseleit solution. Contracting responses to carbachol and KCl, and the relaxing response to isoproterenol (ISO) were examined. Effects of IFN-gamma were examined by comparing responses of the strips incubated with or without IFN-gamma (1000 U.ml-1; 25,000 U.ml-1). Contracting responses to carbachol and KCl were not affected by the incubation with IFN-gamma other than slight increased in maximum contraction by carbachol after 5 hours incubation with 25,000 U.ml-1 of IFN-gamma. Both 1 and 5 h incubation of strips with 25,000 U.ml-1 IFN-gamma significantly increased the sensitivity to ISO (p < 0.01 and p < 0.05, respectively) without affecting maximum relaxation. The effect of IFN-gamma on ISO relaxation was abolished by the denudation of airway epithelium from strips, indomethacin (2 microM), and cycloheximide (70 microM) but not by N omega-nitro-L-arginine methyl ester (30 microM). In addition, heat-inactivated IFN-gamma and bacterial endotoxin (LPS, 0.625 pg.ml-1) had no effect on ISO relaxation. These results suggest that IFN-gamma is able to modify airway smooth muscle response to beta-adrenergic agonist by inducing release of prostanoids from airway epithelium.

Clinical characteristics of idiopathic interstitial pneumonia (IIP) with bullae

Multiple bullae have often been observed in the lungs of patients with idiopathic interstitial pneumonia (IIP). The etiology of bullae has been considered to be distinct from that of interstitial pneumonia and honeycomb lesions seen in IIP. The incidence of bullae was evaluated in 27 IIP patients (male; 23 cases, female; 4 cases) and clinical factors which are related to the development of bulla were analyzed. Of the 27 patients, 16 (59%) had bullae. All 16 were male smokers, and had higher smoking indices (p < 0.01) than patients without bullae. Eleven of the 16 IIP patients with bullae had clubbed fingers (69%, p < 0.05). Roentgenologically, cysts (75%, p < 0.05), low attenuation area (56%, p = 0.06), and honeycomb appearance (94%, p = 0.07) were observed more often in IIP patients with bullae. These results suggest that smoking habits may have a close relationship to the development of bullae seen in patients with IIP.

[Bronchial asthma--airway inflammation and asthma--role of airway epithelium]

The importance of airway inflammation in the pathophysiology of bronchial asthma has been recognized recently. This inflammation is organized by the interaction between inflammatory cells and the cells which compose airway structures. We studied the role of airway epithelium in airway hyperresponsiveness and airway inflammation, which are the major characteristics of bronchial asthma, and demonstrated a close relationship between them. On the bases of these data and the data reported by many other researchers, and from the point of view of airway inflammation, we discussed the possible roles of airway epithelium in bronchial asthma.

A Photomicrodynamic System with a Mechanical Resonator Monolithically Integrated with Laser Diodes on Gallium Arsenide

A cantilever resonant microbeam, laser diodes, and a photodiode have been fabricated on the surface of a gallium arsenide substrate. The microbeam is excited photothermally by light from a laser diode. The vibration is detected with a photodiode as the variation in light output caused by the difference in optical length between the microbeam and another laser diode. A high carrier-to-noise ratio (45 decibels) is achieved with a short (3 micrometers) external cavity length. Such a small distance allows a lensless system, which increases the ease of fabrication. This work could lead to applications in which photomicrodynamic systems are monolithically integrated on a gallium arsenide substrate with surface micromachining technology.

Two-year follow up on the protective value of dust masks against farmer's lung disease

Some advocate moving away from the farm environment for farmers affected with farmer's lung disease (FLD), but most affected farmers still live on farms. In this study, we evaluated the practicality of dust masks and their effectiveness in prevention of FLD. The dust masks we chose were practically used and no new severe episodes of FLD developed in 20 of 21 farmers with FLD using the masks during a 2-year period. When the farmers took off the dust masks in a farming environmental provocation test, statistically significant reductions in FVC (mean 3.43 to 3.351, p < 0.01), DLco (mean 19.6 to 18.2 ml/torr/min, p < 0.01), and DL/VA (mean 5.1 to 4.8 (x10(-3)) 1/torr/min, p < 0.01) were observed several hours after exposure. These findings suggest that the dust masks were used practically during routine dairy farming and were effective in protection against FLD.

[Functional evaluation of possible cytokine receptors on airway smooth muscle: modification of airway smooth muscle responses by cytokines]

Recently, the role of activated T-cell derived cytokines in the pathophysiology of asthma has been recognized. In this study, we evaluated the effects of interleukin-2 (IL-2) and gamma interferon (IFN-gamma) on contractile and relaxing responses of guinea-pig tracheal strips in isometric tension measurement system. IL-2 enhanced carbachol (Carb)- and KCl-induced contraction, and attenuated isoproterenol (Iso)-induced relaxation. IFN-gamma had little effect on Carb and KCl contraction, but enhanced Iso relaxation. These effects of cytokines were abolished by denuding epithelium from tracheal strips. These results suggest that IL-2 and IFN-gamma are able to affect functions of non-immune cells in the airway, and that the airway epithelium has some role in the effects of cytokines on airway responses.

[A case of round atelectasis associated with spontaneous pneumothorax]

A 59-year-old female was admitted for spontaneous pneumothorax. After evacuation, the chest X-ray film showed a round mass lesion at the left hilum. Following curettage and bronchoalveolar lavage of the left B3c, the mass became smaller, suggesting the diagnosis of round atelectasis. This is the first report of round atelectasis complicated by spontaneous pneumothorax. The mechanism of this case is suggested to resemble that of round atelectasis associated with pleural effusion.

[Effect of almitrine in acute canine lung injury induced by paraquat]

The effects of intravenously administered almitrine (0.3 or 1.0 micrograms/kg/min, for 30 min) on hemodynamics and pulmonary gas exchange were assessed in eight dogs with acute lung injury induced by paraquat under controlled ventilation. Arterial blood gases, pulmonary and systemic hemodynamics, and ventilation-perfusion distribution (VA/Q) using the multiple inert gas elimination technique were examined before (control) and during infusion of almitrine. Almitrine produced significant increases in mean pulmonary arterial pressure from 17.4 +/- 3.3 (control, mean +/- SD) to 20.4 +/- 1.5 mmHg (1.0 micrograms/kg/min), and in total pulmonary vascular resistance. There was no change in other hemodynamic parameters, arterial gas tensions, or VA/Q distribution. These results indicate that almitrine causes pulmonary vasoconstriction without changing ventilation-perfusion distribution in dogs with paraquat-induced lung injury.

[Characterization of childhood onset asthma in the adult asthmatic population]

Adult asthma is composed of two groups; childhood type in which asthma begins in childhood, and adult type which starts in adult life. To characterize childhood-onset asthma in the adult asthmatic population, we selected 171 patients with asthma who were treated at Hokkaido University Hospital and examined the time of onset, atopic factors (family history of asthma, skin tests, IgE (RIST, RAST], eosinophil counts, and clinical severity. We then compared these factors between childhood type and adult type. Thirty-three patients out of 171 (19.3%) developed asthma during childhood, mostly before the age of 5. The age of onset in the rest of the 138 patients was equally distributed from 20 to 60 years. Asthma rarely begun between 10 and 15 years. In childhood type, 15 of 33 patients (45%) had continuous symptoms from childhood, and 18 of 33 patients (55%) experienced remission of their asthma and recurrence at an adult age. The group with childhood-type asthma was younger than that with adult-type asthma (32.5 +/- 13.9 (SD) and 49.7 +/- 14.2 years (mean +/- SD), respectively, p less than 0.001). There were no significant differences in atopic factors except for a higher incidence of positive skin reaction and high IgE (RAST) score in childhood type than in adult type. Steroid dependent asthma was less frequent in childhood type than in adult type (10.5% and 37.7%, respectively, p less than 0.01). These results suggest that patients with childhood type are younger and have asthma of milder severity, and it is easier to determine specific antigens in childhood type than in adult type.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of chronic pulmonary emphysema with a past history of bilateral carotid body resection]

A 76-year-old man, whose carotid bodies had been resected for treatment of bronchial asthma 40 years previously was admitted for evaluation of abnormal arterial blood gases and exertional dyspnea. The case was diagnosed clinically as chronic pulmonary emphysema. His peripheral chemoreceptor function, estimated by hypoxic ventilatory and P0.1 response tests and withdrawal test was non-functioning. His PaCO2 value tended to rise over 50 Torr either after light exercise or during airway infection, though it was normal at rest. In addition his dyspnea had continued for 40 years in spite of carotid body resection. It was concluded that the effect of carotid body resection lasts more than 40 years and it does not have a good effect on COPD.

Read/write performance and reliability of a flying optical head using a monolithically integrated LD-PD

A flying head using the switching characteristics of an optically switched laser diode is shown to have an excellent read/write performance and head-disk interface. This head consists of an aluminum nitride slider and a 1.3-microm wavelength InGaAsP laser diode monolithically integrated with a photodetector (LD-PD). A ridged waveguide is fabricated on top of the LD facet to converge the light beam. The lensless flying head has a minimum power of 18 mW for writing information (at 1 MHz) at a medium velocity of 7 m/s. The disk has a SiN protective layer over a SbTeGe phase-change recording medium. The head signal remains good after more than 5 x 10(4) contact start/stop cycles and 4.4 x 10(8) passes in an experimental room environment.

Spectral and waveform characteristics of fine and coarse crackles

Two acoustically different types of lung crackles, fine and coarse, occur in different pathophysiological conditions. To differentiate these crackles from objective characteristics of frequency information, crackles were recorded from 16 patients with pulmonary fibrosis judged clinically to have "fine" crackles and from 10 with chronic bronchitis who had mainly "coarse" crackles. Time expanded waveforms (1/4 cycle duration, initial deflection width, two cycle duration, and 9/4 cycle duration; duration of the first 1/4, 2/4, 8/4, and 9/4 cycles of crackle waveforms) were examined and fast Fourier transform analysis (peak and maximum frequencies) was performed. All waveform measurements for fine crackles were significantly smaller than those for coarse crackles. Peak and maximum frequencies for fine crackles were significantly higher than those for coarse crackles. Although there was some overlap in these values for individual crackles between the two groups when average values of these measurements were calculated for each patient, there was no overlap between fine and coarse crackles and the two groups could be clearly separated. Log peak frequency and log maximum frequency correlated better with 9/4 cycle duration (r = 0.85, 0.84) and two cycle duration (r = 0.87, 0.86) than with 1/4 cycle duration (r = 0.66, 0.77) or initial deflection width (r = 0.67, 0.79). Early and late segments of crackles have different characteristics, probably related to the origin of the sound and the resonance of the lung respectively. These results suggest that spectral and waveform characteristics may help to improve the accuracy of pulmonary auscultation and increase knowledge of how crackles are generated.

[A prospective study of lung cancer in cases of idiopathic interstitial pneumonia (IIP)]

The incidence of lung cancer in 45 patients (37 males and 8 females), who were originally diagnosed as having idiopathic interstitial pneumonia (IIP), was studied prospectively by following them 4 to 10 years. As controls, sex-, age-, and smoking history matched patients with chronic obstructive lung disease (COLD) were also surveyed for the same follow up period. In addition, the differences in clinical findings between those with and without lung cancer were examined. Eight out of 45 patients with IIP (18%) developed lung cancer (adenocarcinoma; 4, small cell carcinoma; 3, squamous cell carcinoma; 2, including one double cancer). All lung cancer patients were male smokers. Looking only at males, 8 out of 37 patients with IIP (21.6%) developed lung cancer. This incidence was significantly higher than that of the male COLD group (2.2%, less than 0.01). In clinical findings, IIP patients with lung cancer had the characteristics of the chronic type of IIP (lack of volume loss on chest radiographic milder dyspnea, not on steroid treatment) when compared with those who did not develop lung cancer.

[Ureteral cancer resembling pulmonary edema induced by recombinant human tumor necrosis factor]

A 73-year-old woman with ureteral cancer and multiple systemic metastasis was admitted complaining of dyspnea on exertion after administration of recombinant human tumor necrosis factor (rH-TNF). On chest examination, coarse crackles were heard during inspiration throughout the lungs. Chest roentgenogram revealed a ground glass infiltration, an air bronchogram in the right lung field and an ill-defined right pulmonary artery. Her symptom and chest roentgenological finding improved and coarse crackles were not heard after discontinuation of rH-TNF. Neutrophils and lymphocytes of bronchoalveolar lavage fluid increased and transbronchial lung biopsy specimens showed slight thickening of alveolar septa with infiltration of inflammatory cells. The pulmonary edema was thought to be caused by rH-TNF which induces adherence of neutrophils to endothelium and stimulates them to increase lysosomal enzyme release and oxygen radical production. As a results, it is thought pulmonary permeability might be increased.

Ion beam sputtered (SiO(2))(x)(Si(3)N(4))(1-x) antireflection coatings on laser facets produced using O(2)-N(2) discharges

The chemical composition of a (SiO(2))(x)(Si(3)N(4))(1-x) film produced by ion beam sputtering was precisely controlled by the ratio of O(2) and N(2) flow rates under a discharge current kept constant to within an accuracy of +/-0.05 A. The reproducibility of the refractive index was improved to +/-0.01. This film was applied to form antireflection coatings with extremely low reflectivity on facets of 830-nm AlGaAs double heterostructure lasers. The minimum reflectivity was 6.8 x 10(-5), and a reflectivity of 1 x 10(-4) was achieved reproducibly. Experimental studies show that antireflection coatings are effective for suppressing the interferometric light output variation of composite cavity lasers.

Pharmacological differentiation of epithelium-derived relaxing factor from nitric oxide

We examined the possibility that nitric oxide is one of the epithelium-derived relaxing factors in guinea pig airways. First we studied whether nitric oxide could relax isolated tracheal strips, and then we examined the effects of known inhibitors of endothelium-dependent relaxation (EDR) in the vascular system [hemoglobin, methylene blue, and NG-monomethyl-L-arginine (L-NMMA)] on epithelium-dependent relaxation (EpDR) induced by hyperosmotic stimuli in perfused whole tracheal preparations. Mannitol (160 mM in Krebs-Henseleit solution) applied to the epithelial surface was used as an osmotic stimulus to induce EpDR after carbachol-induced contraction (2 microM, serosal side). Nitric oxide produced concentration-dependent and complete relaxation of epithelium-denuded tracheal strips. Preincubation of the whole trachea with hemoglobin significantly inhibited osmotic-induced EpDR (P less than 0.05), but preincubation with methylene blue and L-NMMA did not. Hemoglobin introduced into the epithelial side after EpDR induced by hyperosmotic stimuli reversed relaxation, but methylene blue and L-NMMA did not. These results suggest that, although EpDR and vascular EDR have some pharmacological similarities and nitric oxide can relax airway smooth muscle, nitric oxide is not responsible for osmotic-induced EpDR.

[Surgical treatment of inflammatory abdominal aortic aneurysm]

A 53-year-old man was hospitalized with chronic abdominal pain. A CT scan was performed and demonstrated an aortic aneurysm surrounded by a soft tissue mantle. In the laparotomy, extensive fibrotic adhesions between the aneurysm and the duodenum were discovered. This made mobilization of the duodenum and the left renal vein difficult. The aortic wall was white, thickened, and surrounded with dense fibrous tissue. The aneurysm was replaced by a Dacron graft. Histology of the fibrous tissue showed the features of chronic inflammation. He had no abdominal pain after the operation, and he was discharged in good health. In the preoperative diagnosis of inflammatory aneurysms, the CT scan is useful. We are of the opinion that the preferred treatment for inflammatory aneurysm is aneurysmectomy (or aneurysmorrhaphy) plus grafting.

Supersmall flying optical head for phase change recording media

A supersmall optically switched laser (OSL) head is proposed. A laser diode attached to an air bearing slider forms a complex cavity together with a recording medium, and its light output is detected by a photodetector placed at the other end of the laser facet. Data signals and track error signals read from the sampled servo marks are successfully detected. The signal amplitude variation caused by the flying height change is much reduced, and the SNR is increased to 36 dB (40 kHz to 20 MHz for a phase change medium) by decreasing the reflectivity of the laser facet facing the medium to <5%.

Five-year follow-up of Micropolyspora faeni antibody in smoking and nonsmoking farmers

To examine factors that influence changes in Micropolyspora faeni (MF) antibody titer in farmer's lung disease (FLD), we followed for 5 yr the prevalence of serum MF antibody and the epidemiologic factors (years on farm, hours in barn, and hay-handling time) among 92 dairy farmers in Hokkaido, Japan. The prevalence of MF antibody among nonsmokers was significantly higher than that among smokers: 27.1% versus 7.7% in 1979, 31.3% versus 2.9% in 1984. There was no remarkable change in overall prevalences of MF antibody between 1979 and 1984 (18.5 and 19.6%, respectively). However, out of 17 seropositive farmers, six (35%) became seronegative, and out of 75 seronegative farmers, seven (9.3%) became seropositive after 5 yr. The nonsmoking farmers who remained seronegative throughout the follow-up period were older and had worked longer on farms than the farmers with seroconversion. These results suggest that in addition to smoking habits, age and exposure time to MF influence the immune response to MF in dairy farmers. Out of 11 farmers who remained seropositive throughout the 5-yr period, two (18.2%) developed FLD. Therefore, continuously positive MF antibody is one of the risk factors in the development of FLD.