Tocilizumab,a humanized anti-interleukin-6 receptor antibody,ameliorated clinical symptoms and MRI findings of a patient with ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory osteoarticular disease. Although the etiology remains unknown, proinflammatory cytokines, such as tumor necrosis factor α and interleukin-6, have been implicated in the development of AS. Here, we report that a patient with AS, whose disease had been refractory to conventional treatment regimens and who needed to receive continuous corticosteroid, responded well to tocilizumab. While further clinical evaluation is required, tocilizumab may be an optional treatment for AS.     

Staphylococcal scalded skin syndrome after intra-articular injection of hyaluronic acid

One of the severe adverse effects of intra-articular injection in the knee is septic arthritis of the knee joint. Staphylococcus aureus is the most frequent pathogen of septic arthritis. Staphylococcal scalded skin syndrome (SSSS) refers to a spectrum of blistering skin diseases caused by S. aureus exfoliative toxins. Although SSSS is rarely observed in adults, the mortality rate is high in adult cases. We report a case of SSSS due to septic knee arthritis after intra-articular hyaluronic acid injections.     

Azilsartan treatment improves insulin sensitivity in obese spontaneously hypertensive Koletsky rats

Aim: Hypertension often coexists with insulin resistance. However, most metabolic effects of the antihypertensive agents have been investigated in nomotensive animals, in which different conclusions may arise. We investigated the metabolic effects of the new angiotensin II type 1 receptor blocker azilsartan using the obese Koletsky rats superimposed on the background of the spontaneously hypertensive rats. Methods: Male Koletsky rats were treated with azilsartan (2 mg/kg/day) over 3 weeks. Blood pressure was measured by tail‐cuff. Blood biochemical and hormonal parameters were determined by enzymatic or ELISA methods. Gene expression was assessed by RT‐PCR. Results: In Koletsky rats, azilsartan treatment lowered blood pressure, basal plasma insulin concentration and the homeostasis model assessment of insulin resistance index, and inhibited over‐increase of plasma glucose and insulin concentrations during oral glucose tolerance test. These effects were accompanied by decreases in both food intake and body weight (BW) increase. Although two treatments showed the same effect on BW gain, insulin sensitivity was higher after azilsartan treatment than pair‐feeding. Azilsartan neither affected plasma concentrations of triglyceride and free fatty acids, nor increased adipose mRNA levels of peroxisome proliferator‐activated receptor (PPAR)γ and its target genes such as adiponectin, aP2. In addition, azilsartan downregulated 11β‐hydroxysteroid dehydrogenase type 1 expression. Conclusions: These results show the insulin‐sensitizing effect of azilsartan in obese Koletsky rats. This effect is independent of decreases in food intake and BW increase or of the activation of adipose PPARγ. Our findings indicate the possible usefulness of azilsartan in the treatment of metabolic syndrome.     

Evaluation of blood purification and bortezomib plus dexamethasone therapy for the treatment of acute renal failure due to myeloma cast nephropathy

Aggressive removal of circulating free light chains (FLC) by blood purification accompanied by chemotherapy is a promising approach for the treatment of acute renal failure due to myeloma cast nephropathy. Plasma exchange has been performed to remove serum FLC; in order to examine an alternative strategy we performed hemodiafiltration using protein-leaking dialyzers for the treatment of dialysis-dependent acute renal failure due to myeloma cast nephropathy. In the first case with κ-light chain cast nephropathy, the pre-treatment serum creatinine was 9.65 mg/dL, and the serum κ-FLC was 27100 mg/L. Plasma exchange or hemodiafiltration was performed from Monday to Friday during the first several weeks. Chemotherapy was started with high-dose dexamethasone and then switched to bortezomib plus dexamethasone. The mean removal rates of κ-FLC were 45.8% (one plasma volume) and 66.9% (one-and-a-half plasma volumes) by plasma exchange. The removal rates of κ-FLC by hemodiafiltration (66.9%, FB210UHβ; 71.6%, PES210Dα; 75.2%, FXS220) were comparable to those by plasma exchange. In the second case with λ-light chain cast nephropathy, the pre-treatment serum creatinine was 4.14 mg/dL, and the serum λ-FLC was 4140 mg/L. The mean removal rates of λ-FLC were 60.2% (FXS140) and 64.2% (FB210UHβ) by hemodiafiltration. Both cases became dialysis-independent. The combination of an intense blood purification regimen and bortezomib plus dexamethasone therapy appears to be an efficient approach to renal recovery. Hemodiafiltration using protein-leaking dialyzers could become an alternative to plasma exchange as a method of removing FLC.     

Hepatocellular carcinoma associated with noncirrhotic autoimmune hepatitis

A rare case of hepatocellular carcinoma (HCC) in a 78-year-old woman with a 10-year history of autoimmune hepatitis (AIH) without liver cirrhosis and no history of alcohol abuse, drug injection, or blood transfusion is presented. At the time HCC was diagnosed, based on imaging studies showing a 5-cm-diameter S6 liver tumor, she had normal liver function, positive anti-nuclear antibodies, negative hepatitis B and C markers, and elevated alfa-fetoprotein (AFP; 169 ng/ml) and protein-induced by vitamin K absence or antagonist II (PIVKA-II; 721 mAU/ml) levels. Following subsegmental S6 resection, no evidence of fibrosis or cirrhosis was observed.     

A model of bipedal walking adaptable to an unpredictably dynamic environment

Modern science has been developed through concept of subject-object separation. That is, nature has been cordoned off from human beings and objectified. We have attempted to discover ideal world laws wherein we can consider nature as homogeneous. The real world, however, is by far more complicated than what natural sciences have so far been able to decipher. There are many problems that cannot be effectively addressed with the existing scientific technology. Because the real world is so unpredictable and dynamic, it is impossible to objectify it in advance and apply traditional methodology. This real world problem arises especially in information processing systems, that is, the recognition and the motion control systems coping with the real world. The current information systems can only handle explicit and complete information. Life is an intrinsic part of nature. To be both pliant and sturdy in a complex environment requires autonomy capable of creating the information needed to control the self. It forms the premise for the cognizance and control of life systems that exist in reality. To "live," a life system must independently forge a harmonious relationship with an unlimited environment. It requires that the life system be capable of creating the information necessary for self-control. It is this autonomy that clearly distinguishes the world of life systems from the physical world. Here, we will show an example of adaptive bipedal walking under an indefinite environment.     

Anesthetic management for pneumonectomy in a patient with cardiac amyloidosis

Cardiac amyloidosis may cause restrictive cardiomyopathy associated with heart failure, conduction disorder and ischemic heart disease. Therefore, patients with amyloidosis require careful hemodynamic monitoring in perioperative period. A 63-year-old man with cardiac amyloidosis was scheduled for pneumonectomy. His transthoracic echocardiography assessment showed a hypertrophic interventricular septum and slight decreased ejection fraction of 55%, but left ventricular (LV) diastolic function was decreased. Pulse Doppler for mitral valve inflow showed that the early peak velocity/atrial peak velocity (E/A) ratio was 0.9, the deceleration time (DT) was 163 msec and the early diastolic mitral annular tissue velocity (E') was 4 cm x sec(-1). These data suggested a pseudonormalization state. We performed careful monitoring using arterial pressure-based cardiac output (APCO), central venous oxygen saturation (ScvO2) and transesophageal echocardiography. There were no severe complications such as circulatory collapse and arrhythmia in the perioperative period.     

false-positive results of human chorionic gonadotropin β measurement after high orchiectomy for stage i seminoma: report of a case

A 21-year-old male presented at our hospital with a complaint of left scrotal swelling. The serum human chorionic gonadotropin-β (hCG-β) level was 1.3 ng/ml. A left high orchitectomy was performed, and a histological study demonstrated seminoma. Computerized tomography showed no evidence of metastasis. Adjuvant radiation therapy with 25 Gy was performed for stage I seminoma. Although complete clinical remission was achieved,the hCG-β level remained slightly positive (0.3-0.5 ng/ml). The urine hCG-β-core fragment was determined to be within normal limits. This confirmed that the result of serum hCG-β measurement was false-positive in our case. The patient received no additional treatment, and is free from recurrence 3 years and 1 month after surgery. In the testicular germ cell tumors,the measurement of urine hCG-β-core fragment is useful for differential diagnosis in cases of low level-positive serum hCG-β without clinical evidence of disease.