Interatrial septum pacing decreases atrial dyssynchrony on strain rate imaging compared with right atrial appendage pacing

Background: Interatrial septum pacing (IAS‐P) decreases atrial conduction delay compared with right atrial appendage pacing (RAA‐P). We evaluate the atrial contraction with strain rate of tissue Doppler imaging (TDI) during sinus activation or with IAS‐P or RAA‐P. Methods: Fifty‐two patients with permanent pacemaker for sinus node disease were enrolled in the study. Twenty‐three subjects were with IAS‐P and 29 with RAA‐P. The time from end‐diastole to peak end‐diastolic strain rate was measured and corrected with RR interval on electrocardiogram. It was defined as the time from end‐diastole to peak end‐diastolic strain rate (TSRc), and the balance between maximum and minimum TSRc at three sites (ΔTSRc) was compared during sinus activation and with pacing rhythm in each group. Results: There were no significant differences observed in general characteristics and standard echocardiographic parameters except the duration of pacing P wave between the two groups. The duration was significantly shorter in the IAS‐P group compared with the RAA‐P group (95 ± 34 vs 138 ± 41; P = 0.001). TSRc was significantly different between sinus activation and pacing rhythm (36.3 ± 35.7 vs 61.6 ± 36.3; P = 0.003) in the RAA‐P group, whereas no significant differences were observed in the IAS‐P group (25.4 ± 12.1 vs 27.7 ± 14.7; NS). During the follow‐up (mean 2.4 ± 0.7 years), the incidence of paroxysmal atrial fibrillation (AF) conversion to permanent AF was not significantly different between the two groups. Conclusions: IAS‐P decreased the contraction delay on atrial TDI compared to RAA‐P; however, it did not contribute to the reduction of AF incidence in the present study. (PACE 2011; 34:370–376)     

Efficacy and safety of one intravitreal injection of bevacizumab in diabetic macular oedema

Purpose: To assess the efficacy, duration of effect and safety of one intravitreal injection of bevacizumab in diabetic macular oedema (DMO). Methods: Bevacizumab (1 mg/0.04 ml) was injected intravitreally into eyes with DMO (29 with and nine without previous treatments). Best corrected visual acuity (BCVA), intraocular pressure and central retinal thickness (CRT) were measured; slit‐lamp examination, macular biomicroscopy, optical coherence tomography and fluorescein angiography were performed before and at 2–4, 8 and 12 weeks post‐injection. Best corrected VA and CRT were analysed in both groups. Results: In the non‐pretreated group, mean BCVA improved from 0.76 ± 0.33 (baseline) to 0.57 ± 0.30 and 0.54 ± 0.27 at 2–4 weeks and 8 weeks post‐injection, respectively (p = 0.02, p = 0.014, paired t‐test). Mean CRT decreased from 632.4 ± 196.0 μm (baseline) to 392.3 ± 113.6 μm and 370.4 ± 141.7 μm at the same time‐points, respectively (p = 0.01, p = 0.01). There was no difference in BCVA or CRT at 12 weeks. In the pretreated group, mean BCVA improved from 0.62 ± 0.30 (baseline) to 0.53 ± 0.33 at 2–4 weeks post‐injection (p = 0.01), and mean CRT decreased from 583.9 ± 180.7 μm (baseline) to 404.1 ± 197.9 μm at 2–4 weeks post‐injection (p < 0.001). Mean BCVA was unchanged at 8 weeks and 12 weeks post‐injection, although mean CRT remained lower at 8 weeks (p = 0.004). No ocular or systemic side‐effects developed during follow‐up. Conclusions: One intravitreal injection of bevacizumab for DMO seems to be effective and safe in both eyes that have been treated previously and eyes that have not. The therapeutic effect is temporary and repeat treatment may be needed.     

Asymptomatic endobronchial tuberculosis represented as a solitary airway stenosis without tree‐in‐bud appearance on computed tomography

Bronchoscopy is a crucial tool for diagnosing endobronchial tuberculosis in patients with airway stenosis. Early diagnosis and treatment may reduce airway sequelae and prevent the spread of infection.     

Marked thrombocytopenia in a neonate is associated with anti‐HPA‐5b,anti‐HLA‐A31, and anti‐HLA‐B55 antibodies

Maternal antibodies against human platelet antigen (HPA) and/or human leukocyte antigen (HLA) cause fetal and neonatal alloimmune thrombocytopenia (FNAIT) in 0.09‐0.15% of live births. Severe cases account for 5‐31% and the frequency of multiple kinds of alloantibodies is 6.9‐9% of FNAIT. We present a case of severe FNAIT associated with anti‐HPA‐5b, anti‐HLA‐A31, and anti‐HLA‐B55 antibodies, successfully treated with immunoglobulin and platelet transfusion. The anti‐HLA‐B55 antibody was detected in the newborn's serum, but disappeared on the 20th day, which was followed by an increase of the platelet count. These findings suggested the potential involvement of an anti‐HLA antibody in the pathogenesis of FNAIT.     

A mathematical estimation of true cancer incidence using data from population-based cancer registries

BACKGROUND: Accurate cancer incidence data are needed to plan, monitor and evaluate national cancer control programs. In Japan, however, such information is not available owing to incomplete cancer registries. In order to attain incidence estimation adjusted to account for this incomplete information, we have developed a new method. METHODS: We developed a nonlinear regression model between observed incidence/mortality ratios and proportions of death certificate notification to observed incidence in various cancer registries. This model enables us to obtain the 'true incidence/mortality ratio', which, in the regression curve, is at zero point for the proportion of death certificate notifications. This is an ideal registration state without any missing cases. By multiplying it by the number of cancer mortalities from the National Vital Statistics, corrected cancer incidence can be estimated. RESULTS: Applying this method for the estimation of the Japanese cancer incidence in 1997, we obtained the 'true incidence/mortality ratios' of 2.074 for men and 2.587 for women. Cancer incidences in Japan for 1997 were thus estimated to be 346,000 for men and 280,000 for women. CONCLUSIONS: A new method is proposed to estimate the national cancer incidence after adjusting for completeness of cancer registries. This method enables us to more accurately estimate the cancer incidence in a country where several cancer registries exist with various degrees of completeness of registration.     

Isatuximab monotherapy in relapsed/refractory multiple myeloma: A Japanese,multicenter, phase 1/2, safety and efficacy study

Isatuximab, an anti‐CD38 monoclonal antibody, targets cells that strongly express CD38 including malignant plasma cells. This open‐label, single‐arm, multicenter, phase 1/2 trial investigated the tolerability/safety and efficacy of isatuximab monotherapy in Japanese patients with heavily pretreated, relapsed/refractory multiple myeloma (RRMM). In Phase 1, patients were sequentially assigned to receive isatuximab once weekly (QW) in cycle 1 (4 weeks) and every 2 weeks (Q2W) in subsequent cycles. Cohort 1 (n = 3) received 10 mg/kg QW/Q2W; cohort 2 (n = 5) received 20 mg/kg QW/Q2W. No dose‐limiting toxicities occurred; the recommended dose for the single‐arm phase 2 study (n = 28) was 20 mg/kg QW/Q2W. The overall safety profile was consistent with the current knowledge of isatuximab. The most common adverse events were infusion reactions (42.9%; 12/28); all were grade 1/2 and generally occurred during the first infusion. The overall response rate with 20 mg/kg QW/Q2W isatuximab was 36.4% (12/33); patients with high‐risk cytogenetic abnormalities had comparable results. In phase 2, the median progression‐free survival was 4.7 (95% confidence interval, 3.75 to not reached) months. Median overall survival was not reached. Isatuximab monotherapy was well tolerated and effective in patients with heavily pretreated RRMM including high‐risk cytogenetic patients. This trial is registered at ClinicalTrials.gov as {"type":"clinical-trial","attrs":{"text":"NCT02812706","term_id":"NCT02812706"}}NCT02812706.     

Gene expression signature for recurrence in stage III colorectal cancers

BACKGROUND:

Colorectal cancer patients with lymph node metastases (stage III) show poorer prognosis than those without. Predicting development of recurrence may guide the need for intensive follow‐up and/or adjuvant chemotherapy in such patients. The authors' objective was to identify a set of discriminating genes that could predict recurrence in stage III colorectal cancer.

METHODS:

Thirty‐six stage III colorectal cancer patients were studied. Tumor samples were obtained from surgically resected specimens. Thirteen patients developed recurrence, whereas 23 patients did not. Gene expression profiles were determined using human HG‐U133 Plus 2.0 Gene Chip (Affymetrix, Santa Clara, Calif).

RESULTS:

The authors identified 45 discriminating genes between patients with and without recurrence. By using this gene set, they established a new model to predict recurrence with an accuracy of 90.9%. The discriminating genes included calcineurin‐binding protein 1 (CABIN1), whose expression differed remarkably between patients with and without recurrence (P = .0073). The authors further examined the DNA copy number of CABIN1 and were able to show a significant relation with recurrence (P < .012). Patients having CABIN1 gene loss demonstrated a higher risk of recurrence (odds ratio, 18.8). DNA copy number of CABIN1 alone could predict recurrence with an accuracy of 80.0%.

CONCLUSIONS:

The results of the current study demonstrated that gene expression profiling is useful in predicting recurrence in stage III colorectal cancer. The authors identified CABIN1 among discriminating genes that may play a key role in the development of recurrence. These results may help to establish an individualized therapy for stage III colorectal cancer. Cancer 2009. © 2009 American Cancer Society.     

脊柱化脓性骨髓炎的诊断及现代外科治疗

[目的]探究脊柱化脓性骨髓炎的特点及外科治疗方法。[方法]39例脊柱化脓性骨髓炎患者均行一期前路病灶清除加椎间植骨术。分析其临床表现、实验室、病原学及影像学特点和疗效。[结果]随访2~17年,平均8.5年。所有患者腰背疼痛均有缓解,其中17例疼痛完全消失,其余22例有时轻微疼痛。下肢神经功能除1例感觉障碍加重,均有不同程度改善,临床症状和体征改善率20%~100%,平均75.6%。所有患者均获得骨性融合,融合时间2~6个月,平均4个月。血沉从术前平均73mm/h恢复到术后平均29mm/h,而C反应蛋白全部恢复正常。无与手术直接相关的死亡及其他并发症。病原学结果:19例(48.7%)患者细菌培养阳性:金黄色葡萄球菌阳性10例,表皮葡萄球菌2例,大肠杆菌2例,绿脓杆菌2例,肺炎链球菌1例,肺炎克雷白杆菌1例,弗氏柠檬酸杆菌1例。[结论]患者本身的基础疾患是导致脊柱化脓性骨髓炎发病的重要因素之一,不仅金黄色葡萄球菌可以致病,某些条件致病菌或非致病菌如大肠杆菌及表皮葡萄球菌等也可以导致脊柱化脓性骨髓炎的发病;C反应蛋白比ESR及白细胞计数更为敏感,可用于脊柱化脓性骨髓炎的诊断及判定疗效的重要参考指标;MRI对脊柱化脓性骨髓炎的诊断更为敏感、特异及准确;一期前路病灶清除植骨术是治疗脊柱化脓性骨髓炎安全有效的手术方法。