Interstitial pneumonitis related to rituximab therapy for Waldenström's macroglobulinemia

Rituximab‐combined therapeutic regimens have been recommended for treatment of Waldenström's Macroglobulinemia (WM). We report one WM patient who developed interstitial pneumonitis after rituximab therapy.     

Interstitial laser therapy of liver tumors

Purpose: To evaluate MR-guided interstitial laser-induced thermotherapy (LITT) for the treatment of liver tumors.Materials and methods: To date, 1,632 patients with malignant liver metastases have been treated with LITT at our institute. A total of 10,310 laser applications were performed to treat 5,297 lesions.Results: MR-guided LITT achieves a reliable local tumor control and allows an improved survival in patients with primary and secondary liver tumors.Conclusion: MR-guided LITT is a safe method for the treatment of liver tumors and yields an acceptably low rate of major and minor complications due to its minimal invasive character.

Zusammenfassung

Interstitielle Lasertherapie von Lebertumoren Zielsetzung: Evaluation der MR-gestützten laserinduzierten Thermotherapie (LITT) zur Behandlung von Lebertumoren.Material und Methoden: Bis zum heutigen Tag wurden an unserem Institut 1632 Patienten mit malignen Lebermetastasen mit LITT behandelt. Insgesamt wurden 10,310 Applikationen zur Behandlung von 5297 Läsionen durchgeführt.Ergebnisse: Die MR-gestützte LITT erlaubt derzeit eine verläßliche lokale Tumorkontrolle, und eine verbesserte Überlebensrate bei Patienten mit primären und sekundären Lebertumoren kann erzielt werden.Schlussfolgerung: MR-gestützte LITT ist eine sichere Methode bei der Behandlung von Lebertumoren. Wegen ihres minimal-invasiven Charakters ist die Komplikationsrate niedrig.     

Acute unilateral pneumonitis in a patient with polymyositis: a unique presentation of polymyositis-associated pneumonitis

We describe a unique presentation of polymyositis-associated pneumonitis. A 45-year-old man with a history of polymyositis presented with an episode of fever, cough, dyspnea, rapidly progressive respiratory failure, and unilateral pulmonary infiltrates. Although bacterial pneumonia was initially suspected, all cultures, including bronchoalveolar cultures, remained negative, and the patient's condition worsened despite wide-spectrum antibiotics. Lung biopsy showed organizing pneumonia. The patient was treated with systemic corticosteroids and had complete resolution of respiratory failure and pulmonary infiltrates. We discuss polymyositis/dermatomyositis-associated pneumonitis.     

胺碘酮联合辛伐他汀与单用胺碘酮治疗心房颤动的Meta分析

目的评价胺碘酮联合辛伐他汀与单用胺碘酮治疗心房颤动（房颤）的疗效。方法计算机检索Co．chrane图书馆、EMBASE及万方医学数据库等1990-2011年收录的文献,对其中胺碘酮联合辛伐他汀（试验组）与单用胺碘酮（对照组）治疗房颤的随机对照试验进行Meta分析。结果共纳入12篇文献954例。经异质性检验发现各研究结果具有同质性（P=1．0,I^2=0％）,故选择固定效应模型合并进行两组疗效的Meta分析,求得OR=2．98,95％CI（2．21,4．02）,对总体效应进行假设检验得Z=7．18,P〈0．00001,提示试验组治疗房颤的效果较对照组好。漏斗图分析结果显示两组疗效Meta分析结果存在偏倚的可能性较小。Meta分析结果示两组治疗房颤不良反应发生率比较差异无统计学意义。结论胺碘酮联合辛伐他汀治疗房颤较单用胺碘酮效果好。     

Changes in guidelines for the therapy of non-nosocomial pneumonitis

In the USA therapeutic suggestions for a more appropriate treatment of community acquired pneumonias, are presently under revision. In this review we underline the difficulties encountered today, at the beginning of the year 2000, in the formulation of appropriate guidelines for this disease, taxed just about constantly by a mortality rate of nearly 8%. We emphasized the problem of bacterial resistance to multiple antibiotics and the frequency of polymicrobial pulmonary infections with an obvious worsening of the prognostic outlook. Directions about choice and use of some antibiotics have been provided, citing especially the fluoroquinolones and the more recent one, the moxifloxacine. A recommendation is given as well to pharmaceutical companies for them to provide better directives about the ideal modalities of administration of new antibiotics with the double aim of helping patients and also attempt to prevent onset of bacterial resistance.     

Functional changes in a patient with aspiration pneumonitis

The functional changes in a 47 year-old woman who presented with aspiration pneumonitis complicating a coma from excess of barbiturates are discussed. Physiological studies carried out on the twentieth day after aspiration demonstrated severe hypoxaemia ascribed to inequality of the ventilation/perfusion ratio, low dynamic compliance and evidence of hyperinflation. All these values except dynamic lung volumes had reverted to within normal range by the time of her discharge from hospital.     

Surfactant adjunctive therapy forPneumocystis carinii pneumonitis in an infant with acute lymphoblastic leukaemia

We report successful treatment of adult respiratory distress syndrome (ARDS) with artificial surfactant (40mg/kg, Colfosceril Palmitate, Exosurf, Wellcome) in an infant with severePneumocystis carinii pneumonitis.     

Chiropractic manipulative therapy and low-level laser therapy in the management of cervical facet dysfunction: a randomized controlled study

Purpose

The aim of this study was to determine the short-term effect of chiropractic joint manipulation therapy (CMT) and low-level laser therapy (LLLT) on pain and range of motion in the management of cervical facet dysfunction.

Methods

Sixty ambulatory women between the ages of 18 and 40 years with cervical facet joint pain of more than 30-day duration and normal neurologic examination were randomized to receive 1 of 3 treatment options: (1) CMT of the cervical spine, (2) LLLT applied to the cervical facet joints, or (3) a combination of CMT and LLLT. Each participant received 6 treatments in 3 weeks. The main outcome measures were as follows: the Numerical Pain Rating Scale, Neck Disability Index, Cervical Range of Motion Instrument, and Baseline Digital Inclinometer. Measurements were taken during weeks 1 (baseline), 2, 3, and 4.

Results

No differences existed between the 3 groups at baseline. A significant difference was seen between groups 1 (CMT) and 2 (LLLT) for cervical flexion, between groups 1 (CMT) and 3 (CMT + LLLT) for cervical flexion and rotation, and between groups 2 (LLLT) and 3 (CMT + LLLT) for pain disability in everyday life, lateral flexion, and rotation.

Conclusion

All 3 groups showed improvement in the primary and secondary outcomes. A combination of CMT and LLLT was more effective than either of the 2 on their own. Both therapies are indicated as potentially beneficial treatments for cervical facet dysfunction. Further studies are needed to explore optimal treatment procedures for CMT and LLLT and the possible mechanism of interaction between therapies.     

Dronedarone,an Amiodarone Analog with Improved Anti-Leishmania mexicana Efficacy

Dronedarone and amiodarone are cationic lipophilic benzofurans used to treat cardiac arrhythmias. They also have activity against the parasitic protozoan Trypanosoma cruzi, the causative agent of Chagas'' disease. They function by disrupting intracellular Ca²⁺ homeostasis of the parasite and by inhibiting membrane sterol (ergosterol) biosynthesis. Amiodarone also has activity against Leishmania mexicana, suggesting that dronedarone might likewise be active against this organism. This might be of therapeutic interest, since dronedarone is thought to have fewer side effects in humans than does amiodarone. We show here that dronedarone effectively inhibits the growth of L. mexicana promastigotes in culture and, more importantly, has excellent activity against amastigotes inside infected macrophages (the clinically relevant form) without affecting the host cell, with the 50% inhibitory concentrations against amastigotes being 3 orders of magnitude lower than those obtained previously with T. cruzi amastigotes (0.65 nM versus 0.75 μM). As with amiodarone, dronedarone affects intracellular Ca²⁺ homeostasis in the parasite, inducing an elevation of intracellular Ca²⁺ levels. This is achieved by rapidly collapsing the mitochondrial membrane potential and inducing an alkalinization of acidocalcisomes at a rate that is faster than that observed with amiodarone. We also show that dronedarone inhibits parasite oxidosqualene cyclase, a key enzyme in ergosterol biosynthesis known to be vital for survival. Overall, our results suggest the possibility of repurposing dronedarone as a treatment for cutaneous, and perhaps other, leishmaniases.     

脂蛋白(a)循环免疫复合物诱导巨噬细胞胆固醇酯蓄积

目的探讨氧化、天然脂蛋白（a）[Lp（a）]循环免疫复合物（IC）致动脉粥样硬化作用。方法采用人源的氧化、天然Lp（a）与异源的抗载脂蛋白B（apoB）结合制备IC，观察不同浓度的Lp（a）-IC对小鼠腹腔巨噬细胞胆固醇酯的蓄积和泡沫细胞形成作用。结果氧化、天然Lp（a）-IC均引起巨噬细胞内胆固醇酯大量堆积，其效果强于Ox-Lp（a）（P〈0．001），且随着剂量的增加而升高，并转化为泡沫细胞；而天然Lp（a）、抗apoB处理的巨噬细胞内未见胆固醇酯的堆积。结论Lp（a）-IC导致巨噬细胞转化为泡沫细胞，参与动脉粥样硬化形成。     

Flow cytometric detection of cell-associated interleukin-8 in alveolar macrophages in vivo from patients with hypersensitivity pneumonitis and sarcoidosis

In comparison with neutrophil-mediated lung diseases, such as acute respiratory distress syndrome, the involvement of IL-8 in lymphocyte-mediated lung diseases has not been fully investigated. Several reports have shown a slight increase in bronchoalveolar lavage fluid (BALF) IL-8 in patients with hypersensitivity pneumonitis (HP) and sarcoidosis (SAR), but the source of the IL-8 has not been clarified. In the present study, the in vivo production of IL-8 by alveolar macrophages (AMs) is examined in these patients by analyzing the cell-associated IL-8, using the flow cytometric method adopted previously. The IL-8 levels in the epithelial lining fluid (ELF) were also assessed. Initially, slight, but significant, increased levels of ELF IL-8 in HP and SAR were confirmed. Using flow cytometric analysis, a significant increase was found in the cell-associated IL-8 of the freshly isolated AMs in HP, but not in SAR, indicating in vivo production of IL-8 by AMs in HP. The cell-associated IL-8 of the AMs cultured with or without lipopolysaccharide was also analyzed. However, in contrast to previous findings in patients with idiopathic pulmonary fibrosis, no differences were found between SAR and HP patients and control subjects. Based on these findings, it is speculated that ELF IL-8 levels are slightly increased in HP and SAR, and they may contribute to the accumulation of neutrophils and possibly lymphocytes. However, the source of IL-8 may be different and AMs are the candidate source of IL-8 in HP, but not in SAR. The flow cytometric method may be useful in assessing cytokines production by AMs.     

~(125)Ⅰ粒子组织间放射治疗恶性肿瘤病人的心理护理研究

目的探讨与总结125I粒子组织间放射治疗恶性肿瘤病人的心理护理。方法对200例接受125I粒子内放射治疗的恶性肿瘤患者,随机分为护理组(150例)和对照组(50例)。护理组:采用住院评估、护理前后焦虑自评量表(SAS)、自评抑郁量表(SDS)及问卷评定病人的情绪状态,作出护理诊断;对照组:进行125Ⅰ粒子植入治疗知识介绍,按疾病护理常规进行护理。应用125Ⅰ相关知识介绍、健康教育、心理护理、针对性护理干预进行护理,以患者心理状态的改变、治疗依从性作为观察指标评价护理效果。结果经上述护理后,护理组焦虑患者降低82%,抑郁患者降低84%,治疗依从性提高68%。患者对治疗的需求、情绪状态的变化和治疗依从性具有显著性差异。患者能正确对待疾病及125I粒子植入治疗肿瘤的作用及副作用并积极配合手术及护理。对照组患者按常规护理后治疗依从性提高20%,无显著差异。结论针对不同心理状态的病人采取不同的护理干预可改善患者不良心境及消除谈“核”色变的情绪,能积极配合完成组织间放射治疗过程。     

Interstitial nephritis in a patient with Legionnaires' disease

Renal involvement in legionnaires' disease is a well-known, yet incompletely understood, complication. Manifestations of renal involvement include proteinuria, hematuria, pyuria, cylindruria, and azotemia. Previous cases of legionnaires' disease with renal involvement have shown pathophysiologic changes consistent with acute tubulointerstitial nephritis or acute tubular necrosis. A toxic metabolite produced by Legionella pneumophila has been theorized to produce a vasoconstrictive effect on the renal microvasculature, leading to ischemia and renal dysfunction. The case reported here is unique in that the patient presented with interstitial nephritis in the absence of pulmonary signs or symptoms.     

125I粒子组织间放射治疗恶性肿瘤病人的心理护理研究

目的探讨与总结^125I粒子组织间放射治疗恶性肿瘤病人的心理护理。方法对200例接受^125I粒子内放射治疗的恶性肿瘤患者，随机分为护理组（150例）和对照组（50例）。护理组：采用住院评估、护理前后焦虑自评量表（SAS）、自评抑郁量表（SDS）及问卷评定病人的情绪状态，作出护理诊断；对照组：进行^125I粒子植入治疗知识介绍，按疾病护理常规进行护理。应用^125I相关知识介绍、健康教育、心理护理、针对性护理干预进行护理，以患者心理状态的改变、治疗依从性作为观察指标评价护理效果。结果经上述护理后，护理组焦虑患者降低82％，抑郁患者降低84％，治疗依从性提高68％。患者对治疗的需求、情绪状态的变化和治疗依从性具有显著性差异。患者能正确对待疾病及^125I粒子植入治疗肿瘤的作用及副作用并积极配合手术及护理。对照组患者按常规护理后治疗依从性提高20％，无显著差异。结论针对不同心理状态的病人采取不同的护理干预可改善患者不良心境及消除谈“核”色变的情绪，能积极配合完成组织间放射治疗过程。     

Interstitial lung disease associated with vindesine and radiation therapy for carcinoma of the lung

Diffuse interstitial lung disease and pulmonary fibrosis occurred after the use of vindesine and radiation therapy in a patient with squamous cell carcinoma of the lung. Clinical improvement occurred after the drug was discontinued and corticosteroid therapy was initiated. Review of the literature reveals no previously reported cases of pulmonary toxicity due to vindesine when used alone or in combination with other therapeutic modalities.     

腰椎小关节不对称与椎间盘及小关节退变的关系

背景：腰椎小关节不对称与椎间盘退变程度之间的关系一直存在争议,并且国内在下腰痛患者中对小关节不对称与小关节退变程度之间关系的研究较少.目的：调查分析腰椎小关节不对称在腰椎间盘退变与小关节退变过程中的作用.方法：测量312例下腰痛患者共936个脊柱功能单位的小关节角度差值,差值〈7°定义为小关节对称,差值≥7°定义为小关节不对称.对936个脊柱节段的椎间盘退变程度及小关节退变程度进行分级.结果与结论：①小关节是否对称在年龄及性别上差异无显著性（P 〉 0.05）.②小关节不对称与椎间盘退变程度之间无显著关联（P 〉 0.05）.③在L4～L5节段小关节不对称组比小关节对称组的小关节退变程度更重（P 〈 0.01）.提示小关节不对称与椎间盘退变无明显影响,但在腰椎活动度最大的L4～L5节段,小关节不对称可能会引起小关节的退变.     

腰椎小关节不对称与椎间盘及小关节退变的关系

背景:腰椎小关节不对称与椎间盘退变程度之间的关系一直存在争议,并且国内在下腰痛患者中对小关节不对称与小关节退变程度之间关系的研究较少。目的:调查分析腰椎小关节不对称在腰椎间盘退变与小关节退变过程中的作用。方法:测量312例下腰痛患者共936个脊柱功能单位的小关节角度差值,差值<7°定义为小关节对称,差值≥7°定义为小关节不对称。对936个脊柱节段的椎间盘退变程度及小关节退变程度进行分级。结果与结论:①小关节是否对称在年龄及性别上差异无显著性(P>0.05)。②小关节不对称与椎间盘退变程度之间无显著关联(P>0.05)。③在L4～L5节段小关节不对称组比小关节对称组的小关节退变程度更重(P<0.01)。提示小关节不对称与椎间盘退变无明显影响,但在腰椎活动度最大的L4～L5节段,小关节不对称可能会引起小关节的退变。     

Kruppel样因子6基因对巨噬细胞中胆固醇蓄积的影响

背景：研究表明,Kruppel样因子6与巨噬细胞极化密切相关。但是,关于Kruppel样因子6在巨噬泡沫细胞形成中的作用尚不清楚。目的：观察Kruppel样因子6过表达对氧化低密度脂蛋白刺激下的小鼠巨噬细胞（RAW264.7）胆固醇蓄积及对ATP结合盒转运蛋白A1表达的影响。方法：取Raw264.7巨噬细胞株分别转染慢病毒空载体和重组载体p CDH-KLF6,作为对照组和Kruppel样因子6组,另取稳定感染慢病毒空载体的Raw264.7巨噬细胞株和稳定感染重组载体p CDH-KLF6的Raw264.7巨噬细胞株均加入50 mg/L氧化低密度脂蛋白共孵育48 h后,得到氧化低密度脂蛋白组和Kruppel样因子6＋氧化低密度脂蛋白组。结果与结论：与对照组相比,氧化低密度脂蛋白组巨噬细胞内总胆固醇和胆固醇酯表达水平显著增加（P〈0.05）。与氧化低密度脂蛋白组巨噬细胞相比,Kruppel样因子6＋氧化低密度脂蛋白组细胞内总胆固醇和胆固醇酯表达水平明显下降,胆固醇酯/总胆固醇明显降低（P〈0.05）。而未加入氧化低密度脂蛋白处理的2组细胞内脂质表达水平少,且对照组与Kruppel样因子6组相比,细胞内脂质表达水平差异无显著性意义。提示Kruppel样因子6可能通过促进ATP结合盒转运蛋白A1的表达,抑制氧化低密度脂蛋白诱导的RAW264.7巨噬细胞胆固醇蓄积。     

Cellular accumulation and activity of quinolones in ciprofloxacin-resistant J774 macrophages

Ciprofloxacin is the substrate for a multidrug resistance-related protein (MRP)-like multidrug transporter in J774 mouse macrophages, which also modestly affects levofloxacin but only marginally affects garenoxacin and moxifloxacin (J.-M. Michot et al., Antimicrob. Agents Chemother. 49:2429-2437, 2005). Two clones of ciprofloxacin-resistant cells were obtained by a stepwise increase in drug concentration (from 34 to 51 to 68 mg/liter) in the culture fluid. Compared to wild-type cells, ciprofloxacin-resistant cells showed (i) a markedly reduced ciprofloxacin accumulation (12% of control) and (ii) a two- to threefold lower sensitivity to the enhancing effect exerted by MRP-inhibitors (probenecid and MK571) on ciprofloxacin accumulation or by ciprofloxacin itself. ATP-depletion brought ciprofloxacin accumulation to similarly high levels in both wild-type and ciprofloxacin-resistant cells. Garenoxacin and moxifloxacin accumulation remained unaffected, and levofloxacin showed an intermediate behavior. DNA and protein synthesis were not impaired in ciprofloxacin-resistant cells for ciprofloxacin concentrations up to 100 mg/liter (approximately 85 and 55% inhibition, respectively, in wild-type cells). In Listeria monocytogenes-infected ciprofloxacin-resistant cells, 12-fold higher extracellular concentrations of ciprofloxacin were needed to show a bacteriostatic effect in comparison with wild-type cells. The data suggest that the resistance mechanism is mediated by an overexpression and/or increased activity of the MRP-like ciprofloxacin transporter expressed at a basal level in wild-type J774 macrophages, which modulates both the intracellular pharmacokinetics and activity of ciprofloxacin.