The effects of isosorbide dinitrate on exercise-induced ST-segment elevation at the infarcted area in old myocardial infarction

To clarify the clinical significance and therapeutic implication of exercise-induced ST elevation at the infarcted area in old myocardial infarction (OMI), 30 patients with exercise-induced ST elevation underwent treadmill exercise testing. The patients with transient perfusion defects at the infarcted area on thallium-201 stress myocardial scintigraphy (group I: n = 12) revealed a decreased rate of ST elevation expressed as delta ST/delta HR X 10(2) after 10 mg of isosorbide dinitrate (ISDN), compared to the results of treadmill exercise testing under no medication (3.1 +/- 2.5 vs. 4.7 +/- 2.6, p less than 0.001). Exercise capacity and anginal threshold were improved after ISDN in group I. In contrast, the patients without transient perfusion defects (group II: n = 18) revealed an increased rate of ST elevation after ISDN (2.4 +/- 1.1 vs. 2.0 +/- 0.8, p less than 0.05). It is concluded from the above results that if exercise-induced ST elevation at the infarcted area reflects transient myocardial ischemia, ISDN can decrease it by its anti-anginal effect. Additionally, treadmill exercise testing with ISDN is a useful means of clarifying the underlying pathophysiology and management in OMI cases with this effect on exercise-induced ST elevation at the infarcted area.     

Eosinophilic leucocytes and arylsulfatase activity in bronchoalveolar lavage fluid of patients with bronchial asthma

The arylsulfatase activity and histamine concentration of bronchoalveolar lavage fluid (BALF) were examined in patients with bronchial asthma in relation to the eosinophil count and asthma type (atopic and non-atopic). The BALF arylsulfatase activity and histamine concentration were significantly higher in atopic asthmatics than in non-atopic asthmatics. In atopic asthmatics, the activity of arylsulfatase was significantly increased in patients with a higher eosinophil count (10% or more). However, the BALF histamine concentration did not correlate with the eosinophil count. In non-atopic asthmatics, there was no significant correlation between arylsulfatase activity and the eosinophil count. The results show that arylsulfatase participates in IgE-mediated allergic reactions.     

MR evaluation of wallerian degeneration of the pyramidal tract

This study is based on 135 magnetic resonance (MR) exams of 110 patients with wallerian degeneration of the pyramidal tract shown on MR images acquired on a mid field imaging scanner. The MR findings of wallerian degeneration were abnormal signal band along the course of the pyramidal tract and ipsilateral brain stem shrinkage. In all 110 cases an abnormal signal band was seen on T2-weighted spin-echo images, that is, a hypointense band in four exams between 30 days and 116 days after onset of symptoms, and hyperintense bands in 122 exams. The hyperintense signal on T2-weighted images was shown in most cases after 200 days from the onset. In one case a signal of the pyramidal tract showed a hyperintense band at 7 days, hypointense at 30 days, and hyperintense again at 123 days after onset. Sequential MR exams of another case showed gradual narrowing of the hyperintense signal band and progression of the ipsilateral brainstem shrinkage. The narrowing of the pyramidal tract and the ipsilateral brain stem shrinkage tended to be shown after 6 months from onset.(ABSTRACT TRUNCATED AT 250 WORDS)     

Asthma classification by score calculated from clinical findings and examinations. Comparison between clinical diagnosis and score diagnosis]

Asthma classification by clinical symptoms and signs (clinical diagnosis) was compared with the classification by score calculated from clinical findings and examinations (score diagnosis) in 25 patients with bronchial asthma. 1. Ten subjects classified as Ia (simple bronchoconstriction type) by clinical diagnosis were divided into 6 cases with expectoration of less than 49 ml a day and 4 cases with expectoration of between 50 and 99 ml. The level of serum IgE and number of eosinophils in BALF were significantly higher in the latter cases than in the former cases. The cases whose expectoration was from 50 to 99 ml a day were classified as Ib (bronchoconstriction with hypersecretion type) by score diagnosis. 2. The six subjects who were classified as type Ib by clinical diagnosis were also evaluated as type Ib by score diagnosis. 3. Nine of the 10 subjects classified as type II by clinical diagnosis were evaluated as type II by score diagnosis. One case, whose score was under 12 points, was evaluated as questionable type II by score diagnosis.     

Influence of long-term cigarette smoking on immunoglobulin E-mediated allergy, pulmonary function, and high-resolution computed tomography lung densitometry in elderly patients with asthma

Background Smoking is the most important cause of chronic obstructive pulmonary disease (COPD). However, the influence of cigarette smoking on the pathogenesis of asthma in the elderly remains controversial. This study attempted to clarify the influence of cigarette smoking on elderly asthmatics. Methods Forty‐eight asthmatics over 70 years old (25 ex‐smokers and 23 never‐smokers) and 20 patients with COPD over 70 years old (all ex‐smokers) were studied to determine the influence of cigarette smoking on IgE‐mediated allergy (total IgE, IgE antibodies against inhalant allergens, bronchial hyper‐responsiveness (BHR), generation of leukotriene (LT) B₄ and C₄), pulmonary function, and the relative area of lung showing attenuation values less than ?950 Hounsfield units (RA₉₅₀) on high‐resolution computed tomography scans. Results The incidence of positive IgE antibodies against inhalant allergens, BHR, and the generation of leukotriene B₄ (LTB₄) by leucocytes were significantly increased in patients with a history of smoking compared with those without. Residual volume (%RV) was significantly increased, and diffusing capacity for carbon monoxide was significantly decreased in ex‐smokers with asthma and COPD compared with never‐smokers with asthma. Inspiratory RA₉₅₀ and ratio of expiratory RA₉₅₀ to inspiratory RA₉₅₀ were significantly larger in asthmatics with a smoking history than in those without, and in COPD patients than in asthmatics. Conclusion Cigarette smoking enhances the production of IgE antibodies, BHR, and generation of LTB₄ by leucocytes in elderly asthmatics. Increased hyper‐inflation or emphysematous changes of the lungs expressed by increased RA₉₅₀, closely related to %RV, was more frequently observed in ex‐smokers compared with never‐smokers.     

The first case of adult-onset PFAPA syndrome in Japan

A 26-year-old woman presented with fever and pharyngitis. She previously experienced four periodic febrile episodes at 30- to 40-day intervals. We suspected periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, and prescribed predisolone, thereby her fever rapidly subsided. Her febrile episodes improved after daily cimetidine treatment. Genetic testing results of genomic DNA for periodic fever syndromes were negative, although she was heterozygous for p.Glu148Gln variation in MEFV, supporting the diagnosis of PFAPA syndrome.     

FGFR gene alterations in lung squamous cell carcinoma are potential targets for the multikinase inhibitor nintedanib

Fibroblast growth factor receptor (FGFR) gene alterations are relatively frequent in lung squamous cell carcinoma (LSCC) and are a potential targets for therapy with FGFR inhibitors. However, little is known regarding the clinicopathologic features associated with FGFR alterations. The angiokinase inhibitor nintedanib has shown promising activity in clinical trials for non‐small cell lung cancer. We have now applied next‐generation sequencing (NGS) to characterize FGFR alterations in LSCC patients as well as examined the antitumor activity of nintedanib in LSCC cell lines positive for FGFR1 copy number gain (CNG). The effects of nintedanib on the proliferation of and FGFR signaling in LSCC cell lines were examined in vitro, and its effects on tumor formation were examined in vivo. A total of 75 clinical LSCC specimens were screened for FGFR alterations by NGS. Nintedanib inhibited the proliferation of FGFR1 CNG‐positive LSCC cell lines in association with attenuation of the FGFR1–ERK signaling pathway in vitro and in vivo. FGFR1 CNG (10.7%), FGFR1 mutation (2.7%), FGFR2 mutation (2.7%), FGFR4 mutation (5.3%), and FGFR3 fusion (1.3%) were detected in LSCC specimens by NGS. Clinicopathologic features did not differ between LSCC patients positive or negative for FGFR alterations. However, among the 36 patients with disease recurrence after surgery, prognosis was significantly worse for those harboring FGFR alterations. Screening for FGFR alterations by NGS warrants further study as a means to identify patients with LSCC recurrence after surgery who might benefit from nintedanib therapy.