Incidence of interstitial lung disease in patients with breast cancer: a nationwide database study in Japan

Aim: This study estimated the incidence of moderate-to-severe drug-induced interstitial lung disease (ILD) among patients with breast cancer in Japan. Methods: We analyzed a large nationwide database of patients with breast cancer treated with anticancer therapies between 2009 and 2022. ILD was identified using diagnostic codes and treatment records. Results: Of the 81,601 patients, 1042 developed ILD requiring corticosteroids, corresponding to an incidence rate of 1.41 per 100 person-years. The incidence varied across years and treatment regimens. Most ILD incidents occurred within the initial 90-day period post-anticancer therapy initiation. Conclusion: Increase in ILD cases and potential risk variations among treatments underline the importance of continued monitoring, especially during treatment onset, and ILD management in patients with breast cancer undergoing therapy.

The first-in-human phase I study of a brain-penetrant mutant IDH1 inhibitor DS-1001 in patients with recurrent or progressive IDH1-mutant gliomas

BACKGROUND

Approximately 70% of lower-grade gliomas harbor isocitrate dehydrogenase 1 (IDH1) mutations, resulting in the accumulation of oncometabolite D-2-hydroxyglutarate (D-2-HG); this leads to epigenetic dysregulation, oncogenesis, and subsequent clonal expansion. DS-1001 is an oral brain-penetrant mutant IDH1 selective inhibitor. This first-in-human study investigated the safety, pharmacokinetics, pharmacodynamics, and efficacy of DS-1001.

METHODS

This was a multicenter, open-label, dose-escalation, phase I study of DS-1001 for recurrent/progressive IDH1-mutant (R132) glioma (N = 47) (NCT03030066). DS-1001 was administered orally at 125-1400 mg twice daily. Dose-escalation used a modified continual reassessment method.

RESULTS

The maximum tolerated dose was not reached. Eight patients were continuing treatment at the data cutoff. Most adverse events (AEs) were grade 1-2. Twenty patients (42.6%) experienced at least 1 grade 3 AE. No grade 4 or 5 AEs or serious drug-related AEs were reported. Common AEs (>20%) were skin hyperpigmentation, diarrhea, pruritus, alopecia, arthralgia, nausea, headache, rash, and dry skin. The objective response rates were 17.1% for enhancing tumors and 33.3% for non-enhancing tumors. Median progression-free survival was 10.4 months (95% confidence interval [CI], 6.1 to 17.7 months) and not reached (95% CI, 24.1 to not reached) for the enhancing and non-enhancing glioma cohorts, respectively. Seven on-treatment brain tumor samples showed a significantly lower amount of D-2-HG compared with pre-study archived samples.

CONCLUSIONS

DS-1001 was well tolerated with a favorable brain distribution. Recurrent/progressive IDH1-mutant glioma patients responded to treatment. A study of DS-1001 in patients with chemotherapy- and radiotherapy-naïve IDH1-mutated WHO grade 2 glioma is ongoing (NCT04458272).

ACT-14 A FIRST-IN-HUMAN STUDY OF MUTANT IDH1 INHIBITOR DS-1001B IN PATIENTS WITH RECURRENT GLIOMAS

BACKGROUND

WHO grade II/III gliomas frequently harbor isocitrate dehydrogenase 1 (IDH1) mutations, resulting in intratumoral accumulation of oncometabolite D-2-hydroxyglutarate (D-2-HG) and subsequent clonal expansion. DS-1001b is an oral selective inhibitor of mutant IDH1 R132X that was designed to penetrate the blood-brain barrier.

METHODS

In this first-in-human, multicenter, phase I study (NCT03030066), eligible patients (pts) with recurrent/progressive IDH1 mutant glioma received DS-1001b twice daily (bid), continuous. A modified continual reassessment method was used for dose escalation. RANO and RANO-LGG criteria were used to assess tumor response. Pts who planned to undergo salvage surgery after developing progressive disease (PD) and who provided informed consent received DS-1001b treatment until surgery. Tumor samples were also obtained from those pts to measure the free form of DS-1001b and D-2-HG levels.

RESULTS

Between Jan 2017 and May 2019, DS-1001b (125–1400 mg bid) had administered for 47 pts, and 15 pts were continuing treatment. Maximum tolerated dose (MTD) was not reached. Most AEs were Gr 1–2. Gr 3 AEs were observed in 40% of pts. No Gr 4 or 5 AEs or serious drug-related AEs were reported. One dose limiting toxicity was Gr 3 white blood cell count decreased (1000 mg bid). Of 35 evaluable pts with contrast enhancing gliomas, one, five and 11 achieved complete response, partial response and stable disease (SD), respectively. Of evaluable 12 pts with contrast non-enhancing gliomas, four achieved minor response and eight achieved SD. Peak plasma concentration (Cmax) and area under the curve (AUC) increased dose-dependently.

CONCLUSIONS

DS-1001b was well tolerated up to 1400 mg bid with favorable brain distribution, and MTD was not reached. Recurrent/progressive IDH1 mutant glioma pts responded to treatment. Investigation is ongoing to determine the recommended Phase II dose. The latest data will be updated. Funding source: This study was funded by Daiichi Sankyo Co., Ltd.

Phase I study of a brain penetrant mutant IDH1 inhibitor DS-1001b in patients with recurrent or progressive IDH1 mutant gliomas

2004

Background: WHO grade II/III gliomas frequently harbor isocitrate dehydrogenase 1 ( IDH1) mutations, resulting in intratumoral accumulation of oncometabolite 2-hydroxyglutarate (2-HG) and subsequent clonal expansion. DS-1001b is an oral selective inhibitor of mutant IDH1 R132X that was designed to penetrate the blood-brain barrier. Methods: In this first-in-human, multicenter, phase I study (NCT03030066), eligible patients (pts) with recurrent/progressive IDH1 mutant glioma received DS-1001b twice daily (bid), continuous. A modified continual reassessment method was used for dose escalation. RANO and RANO-LGG criteria were used to assess tumor response. Pts who planned to undergo salvage surgery after developing progressive disease (PD) and who provided informed consent received DS-1001b treatment until surgery. Tumor samples were also obtained from those pts to measure the free form of DS-1001b and 2-HG levels. Results: Between Jan 2017 and Oct 2018, DS-1001b (125-1400 mg bid) had administered for 45 pts (median age 44 yrs, prior radiation therapy 100%, prior chemotherapy 82%), and 17 pts were continuing treatment. Maximum tolerated dose (MTD) was not reached. Most AEs were Gr 1-2. Gr 3 AEs were observed in 42.2% of pts. No Gr 4 or 5 AEs or serious drug-related AEs were reported. One dose limiting toxicity was Gr 3 white blood cell count decreased (1000 mg bid). Common AEs ( > 20%) were skin hyperpigmentation, diarrhea, pruritus, nausea, rash, and headache. Of 29 evaluable pts with contrast enhancing gliomas, one, three and 10 achieved complete response, partial response and stable disease (SD), respectively. Of evaluable nine pts with contrast non-enhancing gliomas, two achieved minor response and seven achieved SD. Peak plasma concentration (Cmax) and area under the curve (AUC) increased dose-dependently. The brain/plasma ratio of free form of DS-1001b ranged 0.19‒0.77 in 3 pts. Conclusions: DS-1001b was well tolerated up to 1400 mg bid with favorable brain distribution, and MTD was not reached. Recurrent/progressive IDH1 mutant glioma pts responded to treatment. Investigation is ongoing to determine the recommended Phase II dose. Clinical trial information: NCT03030066.

Keratinizing Squamous Epithelium Associated with Syringocystadenoma Papilliferum Differentiates towards Infrainfundibulum: Case Report with Immunohistochemical Study of Cytokeratins

We describe a case of Syringocystadenoma papilliferum (SCAP) with keratinizing squamous epithelium in a 26-year-old female presenting with a dark brown to black nodule on her forehead. After surgical excision, the specimen was examined immunohistochemically using antibodies against cytokeratin (CK) 1, 8, 10, 14, 17, 18 and 19. Within the keratinizing squamous epithelium, CK1, 10, 14 and 17 were present, whereas the other CKs were absent. Based on CK expression, keratinizing squamous epithelium in SCAP seems to differentiate towards the infrainfundibulum.

Effects of Melatonin and Rilmazafone on Nocturia in the Elderly

We compared the effects of melatonin, an antioxidant and sleep inducer in humans, and rilmazafone hydrochloride, a hypnotic, in elderly patients with nocturia. Patients received either melatonin (2 mg/day; n = 20) or rilmazafone (2 mg/day; n = 22) for 4 weeks. There were no significant differences in the mean age, the quality of life (QoL) score and the serum melatonin levels between the two groups at baseline. After 4 weeks' treatment, the number of nocturnal urinations was significantly decreased and the QoL score was significantly improved in both groups. There was no significant difference between the patient-reported effectiveness ratings between the two groups. The serum melatonin level was significantly increased in the melatonin-treated group, but it remained unchanged in the rilmazafone-treated group. Melatonin and rilmazafone were equally effective for nocturia in the elderly. We recommend that the problems of sleep disturbance should be considered when choosing a therapy for nocturia.

Trichilemmoma: an immunohistochemical study of cytokeratins

BACKGROUND

The histogenesis of trichilemmoma remains unclear.

OBJECTIVES

To clarify the histogenesis of trichilemmoma by evaluating its cytokeratin (CK) expression.

METHODS

In three cases of trichilemmoma, CK expression was studied immunohistochemically using seven antikeratin antibodies against CK1, 10, 14-17 and 19, respectively.

RESULTS

CK1 and CK10 were present in keratinizing ductal epithelium. CK14 was present in the whole layer. CK15 was present in suprabasal layers in two cases. CK16 was present in the suprabasal layer, but was absent in keratinizing ductal epithelium. CK17 was present in suprabasal layers and the sebaceous duct-like structure. CK19 was totally absent.

CONCLUSIONS

These results showed that trichilemmoma may differentiate mainly towards two directions: infundibular keratinization and proliferation of the outer root sheath with undifferentiated and pluripotent characteristics.

Cytokeratin expression in pilonidal sinus

BACKGROUND

Pilonidal sinus (PS) is considered to belong in the category of follicular occlusion diseases (acne triad).

OBJECTIVES

The aim of our study was to elucidate the pathogenesis of PS by evaluating its cytokeratin (CK) expression.

METHODS

CK expression in nine cases of PS was studied immunohistochemically using six antikeratin antibodies.

RESULTS

Infundibular-like epithelium contained CK1, 10 and 14 similar to normal infundibulum, but it did not contain CK17. In non-infundibular-like epithelium, CK14, 16 and 17 were detected similar to that in normal outer root sheath. CK expression in PS was similar to that in hidradenitis suppurativa, suggesting that sinus epithelium may be fragile, hyperproliferative and undifferentiated.

CONCLUSIONS

PS can be classified in the same entity as follicular occlusion diseases based on CK expression.

Immunohistochemical study of cytokeratins in hidradenitis suppurativa (acne inversa)

In 14 cases of hidradenitis suppurativa, cytokeratin (CK) expression was studied immunohistochemically, using six antikeratin antibodies against CK1, CK10, CK14, CK16, CK17 and CK19, respectively. The draining sinus tract epithelium of hidradenitis suppurativa lesions was divided into three components: infundibular-like keratinized epithelium (type A), non-infundibular keratinized epithelium (type B), and non-keratinized epithelium (type C). In type A samples, CK17 (which is found in normal infundibulum) was not detected, suggesting fragility of this epithelial type. Keratin expression in types B and C epithelia was similar to that observed in the outer root sheath in normal hair follicles. Our results suggest that the draining sinus epithelium may possess characteristics of fragility, undifferentiation and hyperproliferation, as shown with CK expression.

Micturition in thoracic spinal cord injured cats with autografting of the adrenal medulla to the sacral spinal cord

PURPOSE

The role of noradrenergic projection from the pontine micturition center to the sacral spinal cord during micturition was examined in thoracic spinal cord injured cats after autografting the adrenal medulla to the sacral spinal cord.

MATERIALS AND METHODS

In 13 female cats the lower thoracic cord was transected and the right adrenal gland was removed under halothane anesthesia. The resected adrenal medulla was divided into several small pieces, which were subsequently autografted to the sacral spinal cord in 7 cats. Another 6 cats underwent sham operation and served as controls. Continuous cystometry and electromyography of the external urethral sphincter were performed every 2 weeks postoperatively without anesthesia. At week 8 the sacral spinal cord was removed and immunohistochemical testing was done to assess tyrosine hydroxylase immunoreactivity.

RESULTS

At week 6 the relative mean duration of detrusor-external sphincter coordination plus or minus standard error during bladder contraction was 62.4% +/- 4.9% in adrenal grafted cats, which was significantly (p = 0.0485) longer than in controls (34.2% +/- 12.6%). However, maximum bladder contraction pressure, bladder contraction duration and post-void residual urine volume were not significantly different in the 2 groups. Tyrosine hydroxylase immunoreactive cells were observed in and on the sacral spinal cord in adrenal grafted animals but not in controls.

CONCLUSIONS

Autografting the adrenal medulla to the sacral spinal cord prolonged detrusor-external sphincter coordination during bladder contraction in thoracic spinal cord injured cats, although other urodynamic parameters did not change. Therefore, noradrenergic projections to the sacral spinal cord may relax the external urethral sphincter during bladder contraction.

Glyoxylate determination in rat urine by capillary electrophoresis

Oxalate is important in the study of renal stone formation and is derived from the endogenous metabolism of glyoxylate. The aim of this study was to determine urinary glyoxylate levels by capillary electrophoresis (CE). Urine specimens were obtained from 25 male Wistar rats (16 rats intravenously injected with 10 mg or 20 mg glyoxylate and nine controls) by bladder puncture 1 h after administration of glyoxylate or saline. Urinary glyoxylate was measured by CE using an electrolyte composed of 5 mmol/L pyridinedicarboxylic acid and 0.5 mmol/L cetyltrimethylammonium bromide (pH 5.6 and 11.0). The mean +/- SD urinary glyoxylate concentration was 43.1 +/- 14.7 micromol/L in control rats, 722.8 +/- 165.5 micromol/L in rats given 10 mg of glyoxylate and 1290.0 +/- 470.8 micromol/L in rats given 20 mg of glyoxylate. The mean +/- SD recovery after spiking 675.7 micromol/L of glyoxylate into 16 urine specimens was 98.82 +/- 12.81%. When the reproducibility of urinary glyoxylate determination was assessed, the intra-assay coefficient of variation (CV) ranged from 1.38 to 2.59% and the inter-assay CV ranged from 2.94 to 6.69%. Capillary electrophoresis enables sensitive and reproducible determination of urinary glyoxylate levels in rats. This method appears to be suitable for laboratory use and has the advantage of determining glyoxylate and several other urinary anions simultaneously.

Prolonged inhibition of cholesterol synthesis by atorvastatin inhibits apo B-100 and triglyceride secretion from HepG2 cells

Atorvastatin is a new HMG-CoA reductase inhibitor that strongly lowers plasma cholesterol and triglyceride (TG) levels in humans and animals. Since previous data indicated that atorvastatin has prolonged inhibition of hepatic cholesterol synthesis, we tested whether this longer duration of inhibitory effect on cholesterol synthesis decreased hepatic lipoprotein secretion in vitro. We used the HepG2 hepatoma cell line to: (1) determine the time required until levels of secreted apo B-100 and TG declined significantly, (2) examine the relation to the mass of cellular cholesteryl ester (CE) and (3) test microsomal triglyceride transfer protein (MTP) activity which leads to decreased apo B-100 production. Although atorvastatin significantly inhibited cholesterol synthesis in HepG2 cells regardless of treatment duration (1, 14 or 24 h), it did not inhibit TG synthesis. Apo B-100 and TG secretion were unchanged after 1-h atorvastatin treatment, but declined significantly after 24-h treatment. Atorvastatin treatment also reduced cellular CE mass, exhibiting both time- and dose-dependency. Mevalonolactone, a product of HMG-CoA reductase, attenuated the inhibitory effects of atorvastatin. Atorvastatin strongly reduced mRNA levels of MTP, whereas it did not inhibit MTP activity as measured by TG transfer assay between liposomes. Simvastatin also induced treatment- and time-dependent reductions in apo B-100, whereas the MTP inhibitor BMS-201038 exhibited no time dependency, instead inhibiting this variable even on 1-h treatment. These results indicate that reduced apo B-100 secretion caused by atorvastatin is a secondary result owing to decreased lipid availability, and that atorvastatin's efficacy depends on the duration of cholesterol synthesis inhibition in the liver.

Three new scalarane sesterterpenoids from the Okinawan sponge Hyrtios erectus

Three new scalarane sesterterpenoids-hyrtiolide (1), 16-hydroxyscalarolide (2), and 12-deacetyl-Delta(17)-hyrtial (3), were isolated from Okinawan sponge Hyrtios erectus, along with scalarolide (4) and 12-deacetylhyrtial (5). The structures of new compounds 1-3 were determined by spectroscopic analysis and chemical conversions. Compounds 3 and 5 showed antiproliferative activity toward KB cells.

Teratogenic effects of bis-diamine on early embryonic rat heart: an in vitro study

BACKGROUND

Bis-diamine induces cardiac defects, including conotruncal anomalies in rat embryos when the agent is administered to the mother. To evaluate the teratogenic effects and mechanism of bis-diamine, we performed morphological and immunohistochemical analyses of early rat embryos cultured in medium containing bis-diamine.

METHODS

The embryos were removed from mother rats on gestational day 10.5 and cultured in medium containing 1 mg of bis-diamine for 6 hr. The embryos were then cultured in medium only for another 6, 12, 18, and 42 hr, corresponding to embryonic day (ED) 11.0, 11.25, 11.5, and 12.5, respectively. Some embryos from the same mothers were used as controls and were cultured in medium only for the corresponding periods to the embryos exposed to bis-diamine. Some mother rats were given a single oral dose of 200 mg of bis-diamine on gestational day 10.5. Embryos from these pregnant rats were removed 6 hr after the oral administration of bis-diamine, and were also cultured in medium only for 6, 12, 18, and 42 hr.

RESULTS

No cardiac abnormalities were detected in the controls at any stage of development. Thirty-three of 51 (65%) embryos exposed to bis-diamine and 15 of 20 (75%) embryos removed from bis-diamine-administered mothers showed abnormal cardiac development, including dilated ventricle, elongation of outflow tract, and pericardial defect on ED 11.5. Four of six (67%) embryos exposed to bis-diamine, and five of seven (71%) removed from bis-diamine-administered mothers also presented almost the same cardiac abnormalities on ED 12.5. No cardiac abnormalities were detected in bis-diamine-treated embryos before ED 11.5. In addition, the expression of neural cell adhesion molecule (N-CAM) was examined using immunohistochemical methods. Fewer N-CAM immunoreactive cells were detected in the third and fourth aortic arches in the bis-diamine-treated embryos than in controls on ED 11.5. However, more N-CAM immunoreactive cells were detected in the bis-diamine-treated embryos than in controls on ED 12.5.

CONCLUSIONS

These results suggest that bis-diamine induces cardiac anomalies by delaying the migration of neural crest cells into the heart and by disturbing the proliferation of pericardial precursor during early cardiac development.

The bacteriology of acne vulgaris and antimicrobial susceptibility of Propionibacterium acnes and Staphylococcus epidermidis isolated from acne lesions

We examined the species of bacteria aerobically and anaerobically isolated from 30 acne lesions and determined antimicrobial susceptibilities of Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis (S. epidermidis) using nine antimicrobial agents. Among the bacteria isolated, S. epidermidis was most dominant. Both P. acnes and S. epidermidis were isolated from half of the acne lesions. The MIC of seven antimicrobials (ampicillin, erythromycin, roxithromycin, clindamycin, tetracycline, minocycline, nadifloxacin) against P. acnes was under 3.13 micrograms/ml. There were very few resistant strains of P. acnes, but many of S. epidermidis. More than 30% of the S. epidermidis isolates were resistant to erythromycin, roxithromycin, and clindamycin. After long-term systemic antibiotic therapy, the resistant strains of S. epidermidis increased, but P. acnes resistance was still limited. When we use antimicrobial agents for the treatment of acne, it should be noticed that not only P. acnes but also S. epidermidis in the acne lesions may acquire resistance to antimicrobials.

[The effects of propofol anesthesia with or without the use of nitrous oxide on the intraoperative involuntary movement, the postoperative awareness and vomiting]

The authors investigated the effect of anesthesia with nitrous oxide and propofol on intraoperative involuntary movement, muscle relaxant usage, postoperative nausea and vomiting, the total amount of propofol used, and recovery time from anesthesia. Eighty-eight patients for gynecological surgery were randomly divided into group PE: propofol/epidural (n = 44), and group PEG: propofol/epidural/nitrous oxide (n = 44). The frequency of postoperative nausea and vomiting were assessed at 24-h postoperatively by blinded observers. There were significant decreases of the mean amounts of propofol and muscle relaxant used between group PEG and group PE. The authors found no correlation between the use of nitrous oxide and intraoperative involuntary movement, subsequent development of postoperative quality of awareness, recovery time, nausea and vomiting. We recommend PEG method for gynecological surgery rather than PE from an economical viewpoint because it is associated with the reduction of mean propofol and muscle relaxant used.

Antimicrobial susceptibility of Propionibacterium acnes isolated from acne vulgaris

Systemic and topical antimicrobial treatment for acne vulgaris remains the mainstay method of therapy in Japan. Strains of Propionibacterium acnes (P. acnes) resistant to erythromycin (EM), clindamycin (CLDM), tetracycline (TC), doxycycline (DOXY) and minocycline (MINO) have been reported. The aim of the present study was to examine the antimicrobial susceptibility to 10 currently used antimicrobial agents of 50 strains of P. acnes isolated from acne lesions and identified using a Rap ID ANA II panel. Minimum inhibitory concentrations (MIC) were determined by the agar dilution method according to the criteria of the Japan Society of Chemotherapy. EM, ampicillin (ABPC), and CLDM were the most potent drugs, followed by MINO, nadifloxacin (NDFX), cephalexin (CEX), DOXY, ofloxacin (OFLX), and TC. In terms of the MIC80, EM and ABPC were the most potent, followed by CLDM, NDFX, MINO, CEX, DOXY, OFLX, TC and gentamycin (GM). Although most of the strains used were susceptible to the antimicrobial agents tested, strains of P. acnes resistant (MIC 12.5 mug/ml) to EM (4%), CLDM (4%), DOXY (2%) and TC (2%) were observed. In this study, no strains of P. acnes resistant to MINO were seen, suggesting that oral MINO is the most useful treatment for acne vulgaris with minimal risk of bacterial resistance.

Hypocholesterolemic effects of the LDL receptor gene transcriptional upregulator CP-230821

CP-230821 is a novel, potent LDL receptor gene transcriptional upregulator which decreases total plasma cholesterol level. Interestingly, this plasma LDL decrease does not alter hepatic lipid contents. A series of experiments was undertaken to study the molecular biology of this phenomenon. Twelve hours after CP-230821 treatment, the transcriptional activity and mRNA level of the LDL receptor gene in HepG2 cells were increased by 264% and 426%, respectively. Although treatment with the HMG-CoA reductase inhibitor compactin also increased LDL receptor gene transcription and mRNA, CP-230821 did not increase the level of HMG-CoA reductase gene transcription or mRNA. These results indicate that LDL receptor gene activity may play an important role in the decrease of plasma LDL level. These results further suggest that the LDL receptor gene and the HMG-CoA reductase gene are not strictly coordinately controlled.

Pyodermia chronica glutealis complicated by acromegalic gigantism

We report a case of pyodermia chronica glutealis complicated by acromegalic gigantism associated with hyperprolactinemia. The serum prolactin, growth hormone, adrenocorticotropic hormone, and 11-deoxycortisol levels were elevated, but the estradiol and dehydroepiandrosterone-sulphate levels were within normal limits. However, the testosterone level was very low. Histopathologically, we found sinus tracts and scarring in a specimen from the buttocks. We could not immunohistochemically detect clear androgen, growth hormone, or prolactin receptors at any site. The patient was a man with a height of 197 cm and weight of 140 kg, he had clinical features of active acromegaly such as excessive sweating and increased thickness of soft tissue. He was also diagnosed with diabetes mellitus. Under such conditions, bacteria could easily grow and lesions might have been aggravated by the heavy pressure from his weight, a possible causes of his pyodermia chronica glutealis.

Fixed drug eruption caused by tosufloxacin tosilate

A 39-year-old woman presented with a purple-red macula, 2 cm in diameter, on the back of her right hand. She had had similar maculae at this location several times before and residual pigmentation had persisted for 6 months. Histopathological examination showed slight acanthosis of the epidermis and perivascular round-cell infiltration and melanophages in the dermis. Oral provocation tests with five drugs that the patient had received as common-cold treatments on different occasions were positive only in the case of tosufloxacin; after an hour the skin lesion reappeared. To our knowledge this is the first published report of a fixed drug eruption caused by tosufloxacin, although such eruptions have previously been reported for several other fluoroquinolones.

Sensitivity of antibacterials of Staphylococcus aureus isolated from impetigo patients

We measured the sensitivity to antibacterials of Staphylococcus aureus isolated from impetigo lesions during one year (from July 1994 to July 1995). The largest number of strains was resistant to gentamicin, followed by erythromycin. Few methicillin-resistant S. aureus strains were isolated and few strains were resistant to more than one drug. We conclude that nadifloxacin and tosufloxacin are likely to be most effective against S. aureus, but fusidic acid is more suitable for the treatment of children.

Staphylococcus aureus in the anterior nares and subungual spaces of the hands in atopic dermatitis

We examined the prevalence of Staphylococcus aureus in the anterior nares and the subungual spaces of the hands of patients with atopic dermatitis to determine whether the presence of S. aureus at these sites may contribute to the aggravation of the dermatitic skin lesions. The prevalence of S. aureus in the anterior nares of patients with atopic dermatitis was over five times higher than that in the anterior nares of patients with other skin diseases or in healthy adult controls, and the prevalence of S. aureus in the subungual spaces was 10 times higher in patients with atopic dermatitis than in those with other skin diseases or in controls. Both the anterior nares and the subungual spaces of the hands are important reservoirs of S. aureus in atopic dermatitis. The phage type of S. aureus strains isolated from the anterior nares is similar to that of the strains isolated from the subungual spaces.

Sensitivity to antibacterials of Staphylococcus aureus isolated from different types of skin infections

We examined the antibacterial susceptibility of Staphylococcus aureus isolated from several types of skin infections, which were classified into four groups: (i) impetigo, (ii) folliculitis, (iii) atopic dermatitis and eczema and (iv) ulcers and decubitus. The 50% minimal inhibitory concentration (MIC50) of the antibacterial agents was 3.13 micrograms/ml or lower, except that of gentamicin with isolates from the impetigo groups (25 micrograms/ml). The MIC90 of gentamicin was 50 micrograms/ml or more for isolates from all four groups. The isolates from the ulcers and decubitus group showed multiple resistance against antibacterial agents. The frequency of methicillin-resistant S. aureus was low, but was highest, at 25%, in the isolates from the ulcers and decubitus group. Few isolates from the atopic dermatitis and eczema group were resistant, and there was little difference in antibacterial resistance between isolates from atopic dermatitis and eczema.

Sensitivity to antibacterials of Staphylococcus aureus isolated from skin infections: a comparison of two hospitals

We compared the sensitivities to antibacterials of Staphylococcus aureus strains isolated from skin infections in two hospitals of different sizes. There were differences between the two hospitals in the proportions of the strains isolated that were resistant to certain drugs, and these differences may be related to the patterns of drug use at each hospital. The differences in the patterns of drug use at each hospital may be due to the types of infections encountered and/or the ages of the patients, both of which differed greatly. The proportions of resistant strains may also be related to differences in the proportions of in-patients.

Sensitivity of Propionibacterium acnes isolated from acne patients: comparative study of antimicrobial agents

The antimicrobial susceptibility of Propionibacterium acnes isolated before and after treatment of acne patients was measured. The four female and three male acne patients were treated with an oral acne medication, roxithromycin or minocycline, and/or a topical acne medication, nadifloxacin cream or clindamycin hydrochloride lotion for 1-8 weeks. The isolated strains were tested for their susceptibility to the antimicrobial action of: nadifloxacin, ofloxacin, erythromycin, clindamycin hydrochloride, tetracycline hydrochloride, minocycline, doxycycline, ampicillin, cephalexin and gentamycin. No resistant strains of P. acnes were observed.

Activity of nadifloxacin against methicillin-resistant Staphylococcus aureus isolated from skin infections: comparative study with seven other fluoroquinolones

The in vitro susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) to nadifloxacin and seven other fluoroquinolones (norfloxacin, ofloxacin, enoxacin, ciprofloxacin, lomefloxacin, tosufloxacin and sparfloxacin) was evaluated. The MRSA isolates were isolated from 114 skin infections between 1991 and 1994. Nadifloxacin exhibited the lowest minimum inhibitory concentration and there were no MRSA isolates resistant to nadifloxacin, while there were some resistant to all of the other seven fluoroquinolones. The minimum concentrations of these drugs needed to cause 50% inhibition of the isolates increased dramatically from 1991 to 1992, but has hardly changed since 1992.

Clinical evaluation of roxithromycin in patients with acne

On the basis of reports that erythromycin is effective in the treatment of acne, we investigated whether roxithromycin (ROM), a new derivative of erythromycin, might also be effective in treating acne. Roxithromycin was administered to 30 patients with acne for 8 weeks. General improvement was assessed 8 weeks after the initiation of the therapy with a six-graded scale as follows; 1: good improvement, 2: moderate improvement, 3: slight improvement, 4: no change, 5: worsening, and 6: no assessment. The percentage of good or moderate improvement was 73.3%, and that of good improvement alone was 20.0%. Our results suggest that ROM is effective in the treatment of acne.

A regulatory mechanism for the balanced synthesis of membrane phospholipid species in Escherichia coli

The mechanism that assures the balanced synthesis of zwitterionic (phosphatidylethanolamine) and acidic phospholipids (phosphatidylglycerol and cardiolipin) in Escherichia coli has been examined by genetically manipulating the two enzymes at the biosynthetic branch point, i.e., phosphatidylglycerophosphate synthase, encoded by pgsA, and phosphatidylserine synthase, encoded by pssA. A mutant in which the most part of the pssA gene was replaced with a drug resistance gene lacked phosphatidylserine synthase and phosphatidylethanolamine and required divalent metal ions for growth, as did a previously reported insertion-inactivated pssA mutant. When this mutant harbored a plasmid containing a Bacillus subtilis gene that encodes membrane-bound phosphatidylserine synthase, the phosphatidylethanolamine content was dependent on its activity, in contrast to that with the soluble E. coli counterpart. A defective mutation, pgsA3, caused reductions not only in acidic-phospholipid synthesis but also in phosphatidylethanolamine synthesis, despite the normal level of phosphatidylserine synthase activity. These results, together with previous observations, indicate that phosphatidylserine synthesis requires the membrane-associated form of phosphatidylserine synthase, which is related to the membrane-levels of acidic phospholipids, thus yielding balanced compositions of zwitterionic and acidic phospholipids.