The CYP2A6*4 allele is determinant of S-1 pharmacokinetics in Japanese patients with non-small-cell lung cancer

S-1 is an oral fluorouracil anticancer drug that contains the 5-FU prodrug tegafur. Tegafur has been shown to be converted enzymatically to 5-FU to exert its antitumor effect, and this conversion is principally catalyzed by CYP2A6. Forty-six non-small-cell lung cancer patients were enrolled. The frequencies of the CYP2A6*4C, CYP2A6*7, and CYP2A6*9 alleles were 17.4, 19.6, and 15.2%, respectively. In the S-1 pharmacokinetic analysis, the area under the concentration-time curve from 0 to 10 h (AUC(0-10)) ratios of 5-FU/tegafur showed large interindividual variabilities, ranging from 5.14 to 112.6. The AUC(0-10) for tegafur was 1.5-fold higher in patients with the CYP2A6*4C allele than in patients without the CYP2A6*4C allele P < 0.05). Furthermore, patients with the CYP2A6*4C allele had a significantly lower maximum plasma concentration (102.6 +/- 32.9 ng/ml) for 5-FU than patients without the CYP2A6*4C allele (157.0 +/- 65.5 ng/ml, P < 0.05). Genotyping of CYP2A6 polymorphisms may provide vital information for effective cancer therapy using S-1.

Interstitial lung diseases associated with amyopathic dermatomyositis

The aim of the present study was to clarify the clinical characteristics and prognosis of patients with interstitial lung disease (ILD) associated with amyopathic dermatomyositis (ILD-ADM). The study consisted of 14 consecutive patients with ILD-ADM. Patients were classified into two categories, acute/subacute and chronic forms, according to the clinical presentation of ILD. The clinical features, responsiveness to therapy, and prognosis between the two forms were compared. Nine ILD-ADM patients were categorised as the acute/subacute form, and five as the chronic form. Arterial oxygen tension was significantly lower in the acute/subacute ILD than chronic ILD patients. On high-resolution computed tomography, ground-glass opacities were frequently found in the two forms, but consolidation was more common in acute/subacute ILD than chronic ILD. Bronchoalveolar lavage analysis showed higher numbers of total cells and lymphocytes in acute/subacute ILD than chronic ILD. Histologically, the most common finding was nonspecific interstitial pneumonia in the two forms, while diffuse alveolar damage was only found in acute/subacute ILD. Acute/subacute ILD was generally resistant to therapy, while chronic ILD responded well. Notably, the mortality of acute/subacute ILD was much higher than that of chronic ILD (67 versus 0%, respectively). In conclusion, interstitial lung disease associated with amyopathic dermatomyositis includes two different forms, the acute/subacute and chronic forms, with distinct prognoses.

Lateralization of Bilateral Transfer of Visuomotor Information in Right-Handers and Left-Handers

The author examined the lateralization of transfer of visuomotor information between the right and left hands during unimanual finger-tapping sequences with visual feedback. The finger-tapping task consisted of a target peak force of 2 N and a target intertap interval of 500 ms. Twenty right-handed and 10 left-handed participants performed the motor task, with 3 transfer trials following 3 practice trials. The author observed positive transfers from the left to the right hand for right-handers but the opposite direction of positive transfers for left-handers. However, left-handers showed a less variable peak force than right-handers did. The author discusses left-handers' interhemispheric information processing.

Th1/Th2 profile in peripheral blood in atopic cough and atopic asthma

BACKGROUND

Eosinophilic tracheobronchitis with cough hypersensitivity, abbreviated as atopic cough, is an important cause of chronic cough. The reason for the absence of airway hyper-responsiveness is unknown, differing from asthma, a Th2 cytokine-mediated disorder.

OBJECTIVE

To compare the type 1 helper T cell (Th1)/Th2 balance in the peripheral blood from subjects with atopic cough and atopic asthma, we assessed the intracellular cytokine production at the single-cell level.

METHODS

Thirty-six subjects (10 patients with atopic cough, 18 with atopic asthma, and eight control subjects) were included. Intracellular IL-4 and IFN-gamma were detected in CD4+ T cells by flow cytometry.

RESULTS

A significantly lower ratio of IFN-gamma-/IL-4-producing CD4+ T cells after phorbol 12-myristate acetate/ionomycin stimulation was found in patients with atopic cough and atopic asthma compared with normal subjects. In comparison between atopic patients, the ratio of IFN-gamma-/IL-4-producing cells was significantly higher in atopic cough than in atopic asthma. However, the proportion of IL-4-producing CD4+ T cells was significantly higher in patients with atopic asthma than in normal control subjects and no significant difference was detected between patients with atopic cough and normal subjects. No significant difference in the proportion of IFN-gamma-producing cells was found between the subjects. Overall, the total IgE levels were positively correlated to the IL-4-producing cells and inversely correlated to the ratio of IFN-gamma-/IL-4-producing cells.

CONCLUSION

These results show the lower degree of Th2 cytokine predominance in atopic cough compared with atopic asthma and suggest the relation between the Th1/Th2 balance and atopic status.

Independence of timing and force control during finger-tapping sequences by pianists

To examine the relation between timing and forcc control during finger-tapping sequences by both the 10 pianists and the 13 nonpianists, participants tapped a force plate connected to strain gauges. A series of finger-tapping tasks consisted of 16 combinations of pace and peak force. Analysis showed that pianists had smaller correlation between intertap interval and peak force than nonpianists. Thus, force control was more independent of timing for pianists than for nonpianists.

Comparison of the relation between timing and force control during finger-tapping sequences by pianists and non pianists

To examine the relation between timing and force control during finger taping sequences by both pianists and nonpianists, participants tapped a force plate connected to strain gauges. A series of finger tapping tasks consisted of 16 combinations of pace (intertap interval: 180, 200, 400, or 800 ms) and peak force (50, 100, 200, or 400 g). Analysis showed that, although movement timing was independent of force control under low or medium pace conditions, there were strong interactions between the 2 parameters under high pace conditions. The results indicate that participants adapted the movement by switching from separately controlling these parameters in the slow and moderate movement to coupling them in the fast movement. While variations in the intertap interval affected force production by nonpianists, they had little effect for pianists. The ratios of time-to-peak force to press duration increased linearly in pianists but varied irregularly in nonpianists, as the required force decreased. Thus, pianists regulate peak force by timing control of peak force to press duration, suggesting that training affects the relationship between the 2 parameters.

Correlation between 25-hydroxyvitamin D3 1 alpha-hydroxylase gene expression in alveolar macrophages and the activity of sarcoidosis

PURPOSE

To demonstrate expression of the 25-hydroxyvitamin D3 1 alpha-hydroxylase (1 alpha-hydroxylase) gene in human alveolar macrophages and measure the correlations among the 1 alpha-hydroxylase mRNA level, the activity of sarcoidosis, and calcium metabolism.

SUBJECTS AND METHODS

We examined 7 patients with sarcoidosis and 6 control patients with other pulmonary disorders who underwent bronchoalveolar lavage. Levels of 1 alpha-hydroxylase mRNA were measured by semiquantitative polymerase chain reaction amplification. We measured serum levels of calcium, ionized calcium, parathyroid hormone, calcitriol (1,25-dihydroxyvitamin D3), and 25-hydroxyvitamin D3 to evaluate calcium metabolism. To estimate the activity of sarcoidosis, we measured the cell count, the CD4/CD8 ratio in bronchoalveolar lavage cells, and the serum angiotensin-converting enzyme (ACE) activity.

RESULTS

Expression of 1 alpha-hydroxylase was demonstrated in purified human alveolar macrophages. The 1 alpha-hydroxylase mRNA levels in bronchoalveolar lavage cells were fivefold higher in sarcoidosis patients than in control patients (10.8 +/- 3.6 vs. 2.2 +/- 1.4, P <0.003). Among all patients studied, there were significant correlations between the 1 alpha-hydroxylase mRNA level in bronchoalveolar lavage samples and the percentage of alveolar lymphocytes (r = 0.83, P <0.005), the CD4/CD8 ratio (r = 0.77, P <0.02), serum ACE level (r = 0.58, P <0.05), serum ionized calcium level (r = 0.58, P <0.05), and the calcitriol/25-hydroxyvitamin D3 ratio (r = 0.57, P <0.05). In the sarcoidosis patients, a significant correlation was also observed between 1 alpha-hydroxylase mRNA and the percentage of alveolar lymphocytes (r = 0.82, P <0.05).

CONCLUSION

There is a correlation between 1 alpha-hydroxylase gene expression in alveolar macrophages with the activity of sarcoidosis and its associated disturbances in calcium metabolism.

Effects of sensory feedback on variations on intertap interval and force in finger-tapping sequences

This study was designed to examine effects of somatosensory feedback on variations of intertap interval and muscle force in finger-tapping sequences over 10 minutes. Although intertap intervals were decreased on the massed task as the time passed, the intervals were constant in the distributed task. In finger-tapping for a long time, impulses perhaps circulate within the loop circuits between the cerebral motor cortex and the peripheral nerve and subsequently increase further the excitability of the circuits. This increase in the excitability within the circuits may shorten the interval and increase variation of the interval. On the other hand, although peak force increased up to the 5-min. mark on the massed task, the force decreased after the 6-min. mark. This increase of force also may be produced by increasing activation of the corticoperipheral loop circuits. Although the decrease of force was perhaps produced by the fatigue of finger muscles for tapping during a few minutes, fatigue appeared more clearly in muscle force than in timing control. However, the force and the variation were constant in the distributed task.

[A recurrent case of idiopathic interstitial pneumonia histologically diagnosed as nonspecific interstitial pneumonia group 1]

A 59-year-old man was admitted to our hospital because of dyspnea. Chest radiography showed infiltration and consolidation in both lung fields. He was clinically diagnosed as having idiopathic interstitial pneumonia (IIP), and histological examination of a thoracoscopic lung biopsy specimen showed nonspecific interstitial pneumonia (NSIP) group 1. Corticosteroid therapy had previously been effective, but about 1 year later the disease recurred. The patient's clinical condition was very similar to the first episode, and is improving in response to the same treatment again. Although it is generally accepted that patients with IIP diagnosed histologically as NSIP have a good prognosis, it should be remembered that recurrence is possible, even in patients with group 1.

Retention of relative force in the scaling of a serial force pattern with an attenuated-force tap

The present study was designed to examine the retention of relative force in the scaling of a serial force pattern in a finger-tapping sequence using an attenuated tap. On practice trials, 12 undergraduate students tapped a force plate connected to strain gauges that gave them feedback about the force. On test trials, participants recalled the force pattern (200 gm-200 gm-200 gm-100 gm) and the intertap interval (400 msec.) practiced during the practice period without the feedback (recalled task). Then, they adaptively produced a halved (halved task) or doubled force profile (doubled task) at the fixed intertap interval. Analyses showed that mean peak forces at the first three tap positions of the tapping sequence undershot the expected forces across all tasks. Hence, the ratios of the forces in Serial Positions 1:4, 2:4, and 3:4 were considerably lower than 2.0. This is a contextual effect suggesting that the last attenuated tap affected the first three taps of the tapping sequence. Thus, because the relative force of movements appears to be a weaker invariant feature than sequencing and relative timing for generalized motor program theory of Schmidt and Lee, this finding does not support the relative force for a generalized motor program.

TH1/TH2 and TC1/TC2 profiles in peripheral blood and bronchoalveolar lavage fluid cells in pulmonary sarcoidosis

BACKGROUND

Sarcoidosis is thought to be a type-1 cytokine-mediated disorder. However, few data are available on the profiles of cytokine expression by TH cells at the single-cell level, as assessed by intracellular cytokine flow cytometry. Additionally, it remains to be determined whether the balance of TC1 and TC2 cells can be altered in sarcoidosis.

OBJECTIVE

The aim of this study was to evaluate the TH1/TH2 and TC1/TC2 balances in sarcoidosis.

METHODS

Using triple-color flow cytometry and phorbol 12-myristate acetate/ionomycin stimulation, we measured the production of the intracellular cytokines IFN-gamma and IL-4 in CD4+ and CD8+ T cells separately, which were obtained from peripheral blood and bronchoalveolar lavage fluid (BALF) of 20 patients with sarcoidosis, and compared their cytokine expressions with those of 10 normal subjects.

RESULTS

Under unstimulated conditions, there were no significant differences in the proportion of cytokine-producing CD4+ or CD8+ T cells in peripheral blood or BALF between patients with sarcoidosis and normal control subjects. On stimulation with phorbol 12-myristate acetate/ionomycin for 4 hours, in BALF of the patients, but not in peripheral blood, we found a significant increase in the percentage of IFN-gamma-producing CD4+ T cells and a decrease in the percentage of IL-4-producing CD4+ T cells, resulting in a 3.5-fold higher ratio of IFN-gamma/IL-4-producing CD4+ T cells compared with that found in normal subjects. In contrast, no difference was found in the proportions of cytokine-producing CD8+ T cells or the ratio of IFN-gamma/IL-4-producing CD8+ T cells in either the peripheral blood or BALF between the patients and normal subjects.

CONCLUSIONS

These findings suggest that the prominent shift toward a type-1 phenotype may occur in CD4+ T-cell populations but not in CD8+ T-cell populations in the affected organs of sarcoidosis.

Retention and adaptive control of force pattern on a finger-tapping sequence with an attenuated force tap

The present study was designed to examine the retention and adaptive control of a force pattern in the scaling of speed profiles in a finger-tapping sequence with an attenuated tap. On practice trials, 11 college students tapped on a force plate connected to strain gauges with feedback. On test trials, participants recalled the force pattern (200 gm-200 gm-200 gm-100 gm) and the intertap interval 1400 msec.) acquired during practice without feedback (recalled task). Then, participants adaptively tapped the acquired force pattern at the half (speeded task) and double (slowed task) the intertap interval acquired during the practice. Analyses showed that mean peak forces increased across tasks as the tapping speed was slowed down. Mean peak forces at the first three tap positions in sequence were smaller than the required forces in both the recall and speeded tasks. So, although the slowed task had the lowest ratio of forces in serial positions 1:4, 2:4, and 3:4, the ratios were less than 2 across tasks. These indicated that changing to a slow pace creates a more difficult adaptive task than changing to a fast pace, and further that a serial force pattern with an attenuated force creates a more difficult motor task for fine control than that with an accentuated force.

Retention of relative force in the scaling of a serial force pattern

The present study was designed to examine the retention of relative force in the scaling of a serial force pattern in finger-tapping sequences. On practice trials, 11 male college students tapped a force plate connected to strain gauges which provided feedback. On test trials, subjects recalled both the force pattern (100 g-100 g-100 g-300 g) and intertap interval (400 msec.) acquired during practice without feedback (recalled task) and then produced a halved (halved task) or doubled-force (doubled task) at the fixed intertap interval. Analysis showed that, although there was no difference for absolute forces between the recalled task and the halved task, the forces at the doubled task were three times as great as those at the recalled task. For relative forces, on the other hand, although there was no difference among the three tasks, the force ratios were closer to 1:1:1:2 than 1:1:1:3. This indicated that the scaling of force pattern was a more difficult adaptive task than that of the intertap interval in the previous study (Inui, Ishida, & Yamanishi, 1999).

Increased numbers of dendritic cells in the bronchiolar tissues of diffuse panbronchiolitis

Dendritic cells (DCs) are potent antigen-presenting cells (APCs); they are considered to be the most important APC in the lung. Recently, the number of DCs in the large airways was demonstrated to increase in patients with atopic asthma, leading to the concept that DCs play an important role in airway inflammation. However, little is known about the distribution of lung DCs in the small airways under other pathological conditions. The aim of the present study was to examine the distribution of DCs in the bronchiolar tissues in patients with diffuse panbronchiolitis (DPB), which is a chronic inflammatory disorder of the airways histologically characterized by peribronchiolitis. We investigated the distribution of DCs in the bronchiolar tissues of the lungs in 11 patients with DPB and 7 control subjects with normal lungs using immunohistochemical methods. Marked increases in the number of CD1a(+), CD1c(+), and CD83(+) DCs were found in both the bronchiolar epithelium and submucosal tissues of patients with DPB, compared with control subjects with normal lungs. The most striking increase occurred in the number of DCs expressing CD83, a marker of mature DCs, in the submucosal tissues of patients with DPB. The increases of these positive cells in patients with DPB were more marked in the submucosal tissues than in the epithelium. The bronchiolar epithelial cells in patients with DPB strongly expressed GM-CSF protein, which is an important cytokine for the differentiation and function of DCs, suggesting that the increased local production of GM-CSF may be responsible for the accumulation and differentiation of DCs in the bronchiolar tissues of patients with DPB. These results suggest that increased DCs in the bronchiolar tissues, together with their phenotypical maturation, may play an important role in the mucosal immune response in patients with DPB through their potent antigen-presenting function.

Critical behavior of a random diode network

We study the percolation properties of a random diode network (RDN) which contains two kinds of directed bonds on a square lattice. This network is a special case of the random insulation-resistor-diode network. Both Monte Carlo simulations and series expansion for the percolation probability show that an estimated critical exponent, beta=0.1794+/-0.008, is different from known values for a conventional insulation-resistor-diode network. RDN belongs to neither the isotropic percolation universality class nor to the directed percolation universality, which we attribute to a difference of symmetry breakdown around the critical point.

Retention and adaptive control of force patterns in finger-tapping sequences

The present study was designed to examine whether a serial force pattern in the finger-tapping sequences was retained and adaptively controlled. On practice trials, 15 male college students tapped a force plate connected to strain gauges which provided feedback. On test trials, subjects recalled the force pattern and the intertap interval acquired during practice without feedback (recalled task). Next, subjects adaptively tapped the acquired force pattern at the half (speeded task) and twice the intertap interval acquired during practice (slowed task). Analysis showed that the force patterns were quite precisely retained across tasks, and the relative force pattern was retained. Although there was no difference for force between the slowed and the recalled task, the force in the speeded task differed from that in the recalled task. This indicated that changing to a fast pace creates a more difficult adaptive task than changing to a slow pace.

[A case of pulmonary alveolar proteinosis presenting with peripheral infiltrates]

We report a case of pulmonary alveolar proteinosis (PAP). A 39-year-old asymptomatic woman was admitted to our hospital because of abnormal shadows on chest X-ray films. Chest X-ray films revealed peripheral infiltrates in both lungs. Computed tomographic examination showed patchy peripheral ground-glass attenuation, concentrated subpleurally. Bronchoalveolar lavage fluid was clear. Because transbronchial lung biopsy findings were inconclusive, a VATS-biopsy was performed. The specimens demonstrated accumulation of proteinaceous materials within alveolar spaces. The patient was given a diagnosis of PAP. Although the distribution of radiographic shadows varies in patients with PAP, perihilar or centralized shadows usually predominate. In our patient, subpleural areas of the lung were affected almost exclusively.

[Pulmonary cryptococcosis exhibiting diffuse multiple nodular shadows]

We report a case of pulmonary cryptococcosis showing diffuse multiple nodular shadows in all lung fields. A 39-year-old woman with no immunological abnormalities was admitted with complaints of cough and sputum. She had experienced measles 4 weeks prior to admission. Chest x-ray films revealed diffuse nodular opacities throughout the lung fields, a finding suggestive of metastatic lung cancer. Detailed examinations, including transbronchial lung biopsy, were not conclusive. A diagnosis of pulmonary cryptococcosis was made on the basis of findings from video-assisted thoracoscopic biopsy. Primary pulmonary cryptococcosis usually appears as a solitary nodule or limited infiltration. Immunologically compromised hosts commonly demonstrate various abnormal shadows, such as the multiple nodular shadows observed in our patient. It has been reported that measles infection can cause temporary immune suppression. Secondary immunodeficiency resulting from the preceding infection with measles could explain the unusual chest x-ray findings in this case.