Bronchus sign on thin-section computed tomography is a powerful predictive factor for successful transbronchial biopsy using endobronchial ultrasound with a guide sheath for small peripheral lung lesions: a retrospective observational study

Background

Recent advances in bronchoscopy, such as transbronchial biopsy (TBB) using endobronchial ultrasonography with a guide sheath (EBUS-GS), have improved the diagnostic yield of small-sized peripheral lung lesions. In some cases, however, it is difficult to obtain adequate biopsy samples for pathological diagnosis. Adequate prediction of the diagnostic accuracy of TBB with EBUS-GS is important before deciding whether bronchoscopy should be performed.

Methods

We retrospectively reviewed 149 consecutive patients who underwent TBB with EBUS-GS for small-sized peripheral lung lesions (≤30 mm in diameter) from April 2012 to March 2013. We conducted an exploratory analysis to identify clinical factors that can predict an accurate diagnosis by TBB with EBUS-GS. All patients underwent thin-section chest computed tomography (CT) scans (0.5-mm slices), and the CT bronchus sign was evaluated before bronchoscopy in a group discussion. The final diagnoses were pathologically or clinically confirmed in all studied patients (malignant lesions, 110 patients; benign lesions, 39 patients).

Results

The total diagnostic yield in this study was 72.5 % (95 % confidence interval: 64.8–79.0 %). Lesion size, lesion visibility on chest X-ray, and classification of the CT bronchus sign were factors significantly associated with the definitive biopsy result in the univariate analysis. In the multivariate analysis, only the CT bronchus sign remained as a significant predictive factor for successful bronchoscopic diagnosis. The CT bronchus sign was also significantly associated with the EBUS findings of the lesions.

Conclusion

Our results suggest that the CT bronchus sign is a powerful predictive factor for successful TBB with EBUS-GS.

[Efficacy and safety of cisplatin plus pemetrexed as a first-line treatment for Japanese patients with advanced non-squamous non-small-cell lung cancer -- a retrospective analysis]

BACKGROUND

Cisplatin plus pemetrexed is considered the standard of care for the first-line treatment of patients with advanced non-squamous non-small-cell lung cancer (NSCLC). However, little is known about the efficacy and safety of this regimen in Japanese patients in a daily clinical setting.

METHODS

We retrospectively analyzed 40 patients who received cisplatin (75 mg/m/(2)) and pemetrexed (500 mg/m(2)) as a first-line treatment for advanced non-squamous NSCLC.

RESULTS

Recorded Grade 3 or 4 hematological toxicities included neutropenia in 7 cases (17.5%), leukopenia in 5 cases (12.5%), anemia in 1 case (2.5%), thrombocytopenia in 1 case (2.5%), and febrile neutropenia in 1 case (2.5%). Grade 3 or 4 nonhematological toxicities included anorexia in 3 cases (7.5%), infection in 1 case (2.5%), rash in 1 case (2.5%), and increased transaminase expression in 1 case (2.5%). Therefore, the adverse events were mostly mild. There were no treatment related deaths. The overall response rate was 37.5%, median progression free survival was 5.6 months, and median overall survival (OS) was 18.8 months. In an epidermal growth factor receptor (EGFR) mutation status subgroup analysis, the median OS of patients with wild-type EGFR or unknown status (n=28)was 16.8 months.

CONCLUSION

Cisplatin plus pemetrexed was well tolerated as a first-line treatment and effective in Japanese patients with advanced non-squamous NSCLC.

Effect of long-term physical exercise of peripheral nerve: comparison of nerve conduction study and ultrasonography

AIM

The aim of this study was to assess the effects of long-term physical exercise on peripheral nerve using both nerve conduction study (NCS) and ultrasonography (US).

METHODS

The authors measured nerve conduction study and ultrasonography in 15 male (mean, 20±1.5 years) handball players and 13 male (mean, 21.3±1.9 years) control subjects. Cross-sectional area of the median nerve was evaluated using ultrasonography at the carpal tunnel and 6 cm proximal to the wrist, and the ulnar nerve at 6 cm proximal to the wrist crease, 2 cm proximal to the medial epicondyle, the epicondyle, and 2 cm distal to epicondyle.

RESULTS

US shows significantly increased cross-sectional area of both median and ulnar nerve in the players compared with that in the controls, and the latency times in both nerves were significantly delayed in the players compared with that in the controls. Cross-sectional area of the median nerve showed a significant correlation with latency (r=0.330, P<0.01).

CONCLUSION

This study suggests that the players have a tendency toward having both median and ulnar motor nerve damage in the wrist or elbow region although they are asymptomatic.

Improvement in enzyme activity and stability by addition of low molecular weight polyethylene glycol to sodium bis(2-ethyl-L-hexyl)sulfosuccinate/isooctane reverse micellar system

The activity and stability of Chromobacterium viscosum lipase (glycerolester hydrolase, EC 3.1.1.3)-catalyzed olive oil hydrolysis in sodium bis (2-ethyl-l-hexyl)sulfosuccinate (AOT)/isooctane reverse micelles is increased appreciably when low molecular weight polyethylene glycol (PEG 400) is added to the reverse micelles. To understand the effect of PEG 400 on the phase behavior of the reverse micellar system, the phase diagram of AOT/ PEG 400/water/isooctane system was studied. The influences of relevant parameters on the catalytic activity in AOT/PEG 400 reverse micelles were investigated and compared with the results in the simple AOT reverse micelles. In the presence of PEG 400, the linear decreasing trend of the lipase activity with AOT concentration, which is observed in the simple AOT reverse micelles, disappeared. Enzyme entrapped in AOT/PEG reverse micelles was very stable, retaining >75% of its initial activity after 60 d, whereas the half-life in simple AOT reverse micelles was 38 d. The kinetics parameter maximum velocity (Vmax) exhibiting the temperature dependence and the activation energy obtained by Arrhenius plot was suppressed significantly by the addition of PEG 400.

Antithrombogenicity of polyacrylonitrile-polyethyleneoxide hollow fiber membrane developed for designing an antithrombogenic continuous ultrafiltration system

To develop a continuous arteriovenous hemofiltration (CAVH) system, which does not need systemic anticoagulation, for patients of acute renal failure having bleeding tendencies, a totally antithrombogenic continuous ultrafiltration system (ACUS) was designed, which consists of an antithrombogenic polyacrylonitrile-polyethyleneoxide (PAN-PEO) hollow fiber membrane and ionically heparin-bound catheter, tubing, and module header. Antithrombogenicity of PAN-PEO membrane, which occupies more than 90% of total inner surface area of ACUS, was considered to be due to highly concentrated PEO near the inner surface of the membrane and the finely dispersed (less than 500 A) microstructure of the inner surface. ACUS was applied to 24 patients without systemic anticoagulation, and one filter worked for an average of 32 h without deteriorating their bleeding tendencies. Any significant changes in major parameters of biocompatibility during those treatments were not observed. More than 200 ml/h of ultrafiltrate was obtained even under very low mean blood pressure, less than 70 mm Hg. Based upon these results, ACUS was concluded to be suitable for mild and sustained treatment to control fluid and electrolyte balance in patients of acute renal failure with bleeding complications.

Distribution of grifolan NMF-5N (I/B), a chemically modified antitumor beta-glucan in mice

The distribution of a 3H-labeled chemically modified antitumor beta-glucan, grifolan NMF-5N (I/B), in various tissues after an injection into mice was examined in order to obtain information on distribution of the parent antitumor beta-glucan, grifolan NMF-5N. Grifolan NMF-5N was treated with sodium metaperiodate and sodium borotritide to obtain tritium-labeled grifolan NMF-5N [3H-grifolan (I/B)]. When 3H-grifolan (I/B) was administered into normal mice by intraperitoneal (i.p.) or intravenous (i.v.) injection, radioactivity was detected in various mouse tissues. Next, 3H-grifolan (I/B) was injected into tumor-bearing mice 7 d after the tumor inoculation, which is the most effective administration timing for the antitumor effect of grifolan NMF-5N. The results indicated a strong radioactivity in spleens and tumor masses. These results suggested a close relationship between the antitumor activity and the distribution of grifolan NMF-5N in mice.

Host-mediated antitumor effect of grifolan NMF-5N, a polysaccharide obtained from Grifola frondosa

The antitumor mechanism of grifolan NMF-5N, a beta-1,3-glucan obtained from mycelia of Grifola frondosa, was examined. Grifolan NMF-5N did not show direct cytocidal effect on cultured tumor cells. However, intraperitoneal injection of grifolan NMF-5N increased the number of peritoneal exudate cells and peritoneal adherent cells which showed cytostatic activity towards syngeneic tumor cells. In an in vivo assay, the administration of carrageenan, an inhibitor of macrophage function, reduced the antitumor activity of grifolan NMF-5N. The delayed-type hypersensitivity reaction was augmented in the grifolan NMF-5N-administered mice. The administration of NMF-5N augmented the induction of cytotoxic T cells but the antitumor activity of grifolan NMF-5N was reduced in athymic nu/nu mice. In addition, the treatment with anti-Thy 1,2 antibody and complement C' of spleen cells taken from mice which showed regression of tumor due to grifolan NMF-5N, reduced the neutralizing effect in Winn assay. These results suggested that grifolan NMF-5N shows antitumor activity via host-mediated mechanisms and both macrophages and T cells play important roles in the mechanisms.

Antitumor effect of polysaccharide grifolan NMF-5N on syngeneic tumor in mice

Antitumor activity of grifolan NMF-5N, a beta-1,3-glucan obtained from mycelia of Grifola frondosa, was examined. Grifolan NMF-5N showed antitumor activities in allogeneic and syngeneic murine tumor systems. In the allogeneic tumor system, a potent antitumor activity over 95% was observed against the solid form of sarcoma 180 when grifolan NMF-5N was injected intraperitoneally (i.p.) at 25-200 micrograms/mouse daily for 10 successive days. In the syngeneic tumor systems, significant antitumor activities were observed against Meth A fibrosarcoma and MM 46 carcinoma by injection at 100 micrograms/mouse daily for 5 successive days, especially i.p. injection at day 7-11, when the tumor cells were inoculated subcutaneously (s.c.) on day 0. Moreover, when grifolan NMF-5N was injected i.p. every other week, significant antitumor activity was also observed. In addition, a single treatment with grifolan NMF-5N at 500 micrograms/mouse showed antitumor activities. Grifolan NMF-5N exhibited antitumor activities against these two syngeneic tumors by intraveneous (i.v.) injection. However, a marked inhibitory activity was observed by intratumorous (i.t.) injection against Meth A fibrosarcoma but not against MM46 carcinoma. These results suggest that antitumor activities of grifolan NMF-5N in murine syngeneic tumor systems depend on not only dosage but also injection routes and timing.

Recent Developments with Tire Cords and Cord-to-Rubber Bonding

The first pneumatic tire was made in 1888 by J. B. Dunlop with Irish flax as reinforcing material. This fiber was one of the strongest at that time. It was gradually replaced by cotton since Irish flax was expensive. Cotton tire fabrics in the early stages, about 1910, were plain fabrics. As requirements imposed by the severity of tire operating conditions increased, these fabrics were gradually replaced by the present tire cord fabrics, which type of fabric was first devised by J. F. Palmer in 1892. Prior to World War II, cotton was the sole textile used to any large extent in pneumatic tires. However, this cotton tire cord fabric also failed to meet requirements imposed by further increasing severity of tire operations so that tire engineers began to pay attention to man-made fibers. The first rayon tire cord, tenacity about two grams per denier, was produced in 1923. Du Pont started to manufacture high tenacity rayon, Cordura, in 1933, and Courtaulds also started to manufacture high tenacity rayon, Tenasco, in 1936, but by 1940, high tenacity rayons had only a small portion of the total tire cord market. In the late 1940's, use of high tenacity rayon tire cords increased rapidly in the United States and Europe. In Japan, rayon truck tires were first manufactured in 1951. Initially rayon cords were used only for truck tires. The rayon cord tire had improved carcass performance and its life was increased 30 to 60%. This improvement of tire quality was utilized more for truck tires than for passenger car tires. Increased power of automobile vehicles, however, gave birth to troubles in rayon cord (truck) tires. New, tougher materials were required for tire cords especially for heavy duty tires. In 1947, nylon cords (nylon 66) were examined as reinforcing materials for truck tires in the United States, and it was confirmed that nylon truck tires have excellent properties especially under severe operating conditions. In the late 1950's, rayon cords were gradually replaced by nylon cords, especially in the United States. Japanese tire manufactures made extensive efforts to use nylon 6 for tire cords. Nylon 6 was available from domestic suppliers, (nylon 66 was more costly) and nylon 6 tires, when post cure inflation was used, showed no difference from nylon 66 tires in practice. Mass production of nylon tires in Japan started in 1958. In the first five years, 60% of all tire cords had been replaced by nylon cords. In 1967, per cent nylon cord use was up to 90% in Japan. On the other hand, in Europe, rayon cord still has a greater portion of the tire cord market. Goodyear started to produce polyester tires as passenger car tires in 1962. In recent years, production of polyester tires is gradually increasing and their future seems to be promising. Mass production of polyester tires in Japan started in 1967. In both countries, polyester tire producers seemed to desire to penetrate into original equipment tires for passenger cars where rayon cords have been used for many years. Steel cords, which made their appearance in France in 1936, have been used extensively in Europe in radial tires. Glass fiber cords, one of the most promising types for the belt ply of radial tires or belted bias tires, recently appeared in tires in the United States.