Extended indications for anti‐tumor necrosis factor‐α therapy

Tumour necrosis factor‐α is a pleiotropic cytokine which has a broad range of actions in inflammation, infection and immunity. TNF‐α is supposed to play a crucial role in the pathogenesis of various autoimmune diseases. TNF‐α blocking agents have been demonstrated to be highly effective in the treatment of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and juvenile rheumatoid arthritis. TNF‐α inhibitors also have been tried with other rheumatic diseases and have emerged as promising treatments. We here review the current evidences of effectiveness of the anti‐TNF‐α therapy in various autoimmune diseases.     

Catheter revision for the treatment of intractable exit site infection/tunnel infection in peritoneal dialysis patients: A single centre experience

Aim: Catheter‐related infection is a major cause of catheter loss in peritoneal dialysis (PD). We evaluated the effect of catheter revision on the treatment of intractable exit site infection (ESI)/tunnel infection (TI) in PD patients who required catheter removal. Methods: We reviewed the medical records of 764 continuous ambulatory peritoneal dialysis (CAPD) patients from May 1995 to April 2011 at our hospital. One hundred and twenty six patients had more than one occurrence of ESI. Catheter revision was performed to treat intractable ESI/TI. Incidence of ESI, causative organisms and the outcomes of catheter revision were analyzed. Results: The total PD duration of all patients was 32 581 months. Three hundred and twelve ESI episodes occurred in 126 patients and the incidence of ESI was 1/104 patient‐months (0.12/patient‐year). The most common causative organism was methicillin‐sensitive Staphylococcus aureus (MSSA) (98 episodes), followed by Pseudomonas aeruginosa (63 episodes) and methicillin‐resistant S. aureus (MRSA) (28 episodes). Among these, catheter revision was required due to intractable ESI/TI in 36 patients. The most common causative organism was MSSA (14 episodes) followed by P. aeruginosa (10 episodes) and MRSA (six episodes) in catheter revision cases. The outcomes of catheter revision were as follows: ESI relapsed in 11 patients (30.6%) after catheter revision. Among them, five patients were treated with antibiotic treatment, two patients required secondary catheter revision, four patients required catheter removal due to ESI/TI accompanying peritonitis. The catheter survival rate after catheter revision was 89.7% in one year. There were no statistical differences in the rates of ESI relapse after catheter revision between ESI caused by P. aeruginosa (5/10, 50%) and ESI caused by S. aureus (6/21, 28.6%). Conclusion: Catheter revision may be an alternative treatment option to treat intractable ESI/TI before catheter removal is considered in PD patients.     

Patient-specific functional electrical stimulation strategy based on muscle synergy and walking posture analysis for gait rehabilitation of stroke patients

ObjectiveTo evaluate a novel multi-channel functional electrical stimulation (FES) rehabilitation method based on the evaluation of patient-specific walking dysfunction.MethodsThis study investigated a novel multi-channel FES-based rehabilitation method that analysed the patient’s muscle synergy and walking posture. A patient-specific FES profile was produced in the pre-evaluation stage by comparing the muscle synergy and walking posture of the patient with those of healthy control subjects. During the rehabilitation phase, this profile was used to determine an appropriate FES pulse width and amplitude for stimulating the patient’s muscles as they walked across a flat surface.ResultsTwo stroke patients with hemiplegic symptoms participated in a clinical evaluation of the proposed method involving a 4-week course of rehabilitation. An evaluation of the rehabilitation results based on a comparison of the pre- and post-rehabilitation muscle synergy and walking posture revealed that the rehabilitation enhanced the muscle synergy similarity between the patients and healthy control subjects and their quantitative walking performance, as measured by a 10-m walk test and walking speed, by up to 23.38% and 30.00%, respectively.ConclusionThese results indicated that the proposed rehabilitation method improved walking ability by improving muscle coordination and adequately supporting weakened muscles in stroke patients.     

Altered risk‐aversion and risk‐taking behaviour in patients with Alzheimer's disease

Aim: Normal individuals are risk averse for decisions framed as gains but risk taking for decisions framed as losses. This framing effect is supposed to be attenuated in Alzheimer's disease (AD) patients. We investigated the effects of highlighting rewards versus highlighting punishments on the risky decision‐making of AD patients. Method: Fourteen mild to moderate AD patients (Mini‐Mental Status Examination score, 11–23; Clinical Dementia Rating, 1–2) and 16 healthy volunteers were recruited for the study. Subjects completed a computerized task on risky decision‐making in which mathematically equivalent dilemmas were presented in terms of opportunities to gain monetary rewards (‘positive frame’) or avoid suffering losses (‘negative frame’). Results: As expected, AD patients chose more risky options under the positive frame than the negative frame, contrary to the control group (Z =?2.671, P= 0.007). The normal difference in the distribution of risky choices between positively and negatively framed dilemmas was significantly reduced in the AD group after we adjusted for years of education, mean age and depression (F= 5.321, P= 0.030). Deliberation time did not differ significantly between the two groups. Conclusion: These results suggest that AD patients making high‐risk choices is associated with attenuated sensitivity to the emotional frames that highlight rewards or punishments, possibly reflecting altered evaluations of prospective gains and losses.     

Predictors for progression in immunoglobulin A nephropathy with significant proteinuria

Aim: Proteinuria is a primary factor requiring treatment in immunoglobulin (Ig)A nephropathy. The purpose of this study was to assess the relevance of treatment response and relapse of proteinuria with renal function decline. Methods: One hundred and twenty‐five biopsy‐proven primary IgA nephropathy patients who had more than 1.0 g/day proteinuria at the first assessment were studied. All patients underwent anti‐proteinuric treatment, and the association of the rate of renal function decline with treatment responsiveness, clinical and laboratory data was investigated. Results: The treatment response of the patients was: 30.4% complete response (<0.3 g/day proteinuria), 32.8% partial response (0.3–1.0 g/day), 23.2% minimal response (decrement but not reduced to <1 g/day) and 13.6% no response (no decrement of proteinuria). The slope of renal function decline (?1.06 vs?1.24 mL/min per 1.73 m²/year, P = 0.580) was comparable between complete and partial response groups, but they were slower than those of minimal or non‐response groups (P < 0.001). In multivariate analysis including other parameters, mean arterial pressure (MAP; β = –0.240, P = 0.004) during follow up, minimal (β = –0.393, P < 0.001) and non‐response (β = –0.403, P < 0.001) were significant predictors. In further investigation of complete and partial response groups, MAP (β = –0.332, P = 0.001) and relapse of proteinuria (β = –0.329, P = 0.001) were independently associated with slope of renal decline. Conclusion: Achievement of less than 1.0 g/day proteinuria and MAP were important for limiting the loss of renal function, and relapse of proteinuria should be closely monitored in proteinuric IgA nephropathy.     

Risedronate Inhibition of Matrix Metalloproteinase-2 Expression in Osteosarcoma Cell Line

Background and objective Osteosarcoma is a high-malignant bone tumor and is the most frequent malignant bone tumor in children and adolescents. Significant proportions of the patient     

Enhancer of zeste homolog 2 expression is associated with tumor cell proliferation and metastasis in gastric cancer

Choi JH, Song YS, Yoon JS, Song KW, Lee YY. Enhancer of zeste homolog 2 expression is associated with tumor cell proliferation and metastasis in gastric cancer. APMIS 2010; 118: 196–202. The enhancer of zeste homolog 2 (EZH2), a member of the polycomb group of proteins, plays an important role in cell proliferation and cell cycle regulation. EZH2 is overexpressed in aggressive forms of prostate, breast, bladder, and endometrial cancers. However, the role of EZH2 expression in gastric cancer has not been fully determined. This study was conducted to investigate the correlation between EZH2 and cell cycle‐related molecules, and the clinical value of EZH2 expression in gastric cancer. We analyzed EZH2 expression using Western blotting in AGS, MKN‐28, SNU‐16, SNU‐484, SNU‐601, and SNU‐638 gastric cancer cell lines. After transfection of EZH2 siRNA into MKN‐28 cells, the change in cell cycle‐related molecules was assessed by Western blot analysis. Expression of EZH2, Ki‐67, and p53 was determined by immunohistochemical staining of tissue microarrays from specimens of 137 cases of resected gastric cancer. We found high expressions of EZH2 in all of the tested gastric cancer cell lines. RNA interference of EZH2 induced upregulation of p53 and HDAC1 and downregulation of cyclin D1 and cyclin E. High EZH2 expression was observed in 60.6% of gastric cancers and in 6.7% of non‐neoplastic gastric tissues (p < 0.01); 40.1% were positive for p53 in gastric cancers. High EZH2 expression was correlated with Ki‐67 and p53 expressions and was significantly associated with distant metastases and non‐signet ring cells. Our results suggest that high EZH2 expression is associated with tumor cell proliferation and metastasis in gastric cancer.     

原发性月经痛与下腹部温度差异的研究

目的研究痛经与腹部温度之间的关系。方法我们通遏筛查选择了95例痛经患者，分别通过DITI测量4个点位的腹部温度（CV17，CV12，CV4，CV3），然後检查CV17与CV4、CV17与CV3、CV12与CV4及CV12与CV3之间的温度差异（△T）。然後，与痛经的严重程度进行比对。痛经的严重程度按照多维标准（Bibe roglu＆Berhrman（VRS；B＆B）设计的经改编的口头分级）和由Andersch Milsom（MVRS）设计的多维口头分级标准进行评估。按照疼痛的严重程度，我们将疼痛进行标准化分类（轻微、中度、严重）．在统计学方面，我们使用了Pearson统计学方法、Spearman的rho统计学方法和视窗SPSS11.0统计方法。结果在MVRS病例中，MVRS的指数和三组的严重程度都与温度差异无关。在VRS和B＆B病例中，B＆B、VRS指数均与温度差异（CV12与CV4和CV12与CV3）有关，三组严重程度也与温度差异（CV12和CV3）有关，统计学显示有明显差异（p〈0.05）。所以我们认为，温度差异（CV12和CV3）与VRS和B＆B的痛经严重程度密切相关。结论痛经病人显示，VRS和B＆B的严重程度与温度差异（CV12和CV3）是有联系的。所以，我们可以将D17I作为痛经的测量仪器，并且必须进一步研究测量点，从而能够通过DITI对痛经做出准确评价。     

Changes of psychiatric parameters and their relationships by oral isotretinoin in acne patients

Oral isotretinoin is a highly effective agent for the treatment of moderate to severe acne, but ever since oral isotretinoin was introduced as a modality for acne, the relationship between oral isotretinoin therapy and psychiatric problems, especially depression, has been controversial. The purposes of this study were to know the acute effects of oral isotretinoin therapy on psychiatric symptoms and to investigate the relationships among them, which have not been reported in the published work. This cohort study included 38 acne patients who started oral isotretinoin therapy. Individual patients were examined before administering oral isotretinoin and 2 and 8 weeks after commencement. Acne severity was graded using the Leeds revised acne grading system. Acute psychiatric effects of oral isotretinoin were assessed using a questionnaire authorized by two psychiatrists. This questionnaire included assessments of acne-related quality of life (Assessment of the Psychological and Social Effects of Acne [APSEA]), depression (Beck's depression inventory [BDI]), anxiety (Beck's anxiety inventory [BAI]) and psychopathology (Symptomchecklist-90-revised [SCL-90-R]). Acne grading and APSEA showed similar change patterns. Both improved after 8 weeks of oral isotretinoin treatment. On the other hand, the severity of depression decreased after 2 weeks of treatment. A significant correlation was found between BDI and APSEA, but no correlation was found between BDI and acne grade. These results indicate that oral isotretinoin therapy alleviates depressive symptoms. Improvements in depression are directly related to acne-related life quality improvements rather than to improvement in acne grade.