Ipsilateral hemiparesis in ischemic stroke patients

OBJECTIVES

To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients.

MATERIALS AND METHODS

Patients with acute ischemic stroke were prospectively examined. Ipsilateral hemiparesis was defined as hemiparesis ipsilateral to recent stroke lesions. Patients with ipsilateral hemiparesis were examined with functional neuroimaging studies including transcranial magnetic stimulation (TMS) and functional MRI.

RESULTS

Of 8360 patients, ipsilateral hemiparesis was detected in 14 patients (0.17%, mean age 71±6 years, eight men). Lesions responsible for the recent strokes were located in the frontal cortex in three patients, corona radiata in seven, internal capsule in one, and pons in three. These lesions were located along the typical route of the corticospinal tract in all but one patient. Thirteen patients also had a past history of stroke contralateral to the recent lesions; 12 of these had motor deficits contralateral to past stroke lesions. During TMS, ipsilateral magnetic evoked potentials were evoked in two of seven patients and contralateral potentials were evoked in all seven. Functional MRI activated cerebral hemispheres ipsilaterally in eight of nine patients and contralaterally in all nine.

CONCLUSIONS

Most patients with ipsilateral hemiparesis had a past history of stroke contralateral to the recent one, resulting in motor deficits contralateral to the earlier lesions. Moreover, functional neuroimaging findings indicated an active crossed corticospinal tract in all of the examined patients. Both findings suggest the contribution of the uncrossed corticospinal tract contralateral to stroke lesions as a post-stroke compensatory motor system.

Quantitative Modeling and Simulation in PMDA: A Japanese Regulatory Perspective

In Japan in October 2016, the Pharmaceuticals and Medical Devices Agency (PMDA) began to receive electronic data in new drug applications (NDAs). These electronic data are useful to conduct regulatory assessment of sponsors’ submissions and contribute to the PMDA's research. In this article, we summarize the number of submissions of quantitative modeling and simulation (M&S) documents in NDAs in Japan, and we describe our current thinking and activities about quantitative M&S in PMDA.

Lymphatic Architecture of Suncus Murinus (House Musk Shrew) Palatum

The architecture of craniocervical lymphatic vessels in rodents has been examined previously. In the present study, we evaluated the distribution of collecting lymphatic vessels in the palate of Suncus, which is known to retain the prototype of placental mammals and is more similar to humans in terms of jaw bone morphology when compared with rodents. Three-dimensional reconstructed images of the Suncus palatum revealed that the collecting lymphatic vessels were connected to each other via smaller branches, and ran in an antero-posterior direction in the periosteum. The vessels entered the pair of posterior palatine foramina located near the fourth premolar or the first molar bilaterally, coursed through the posterior palatine canals, and reached the pterygopalatine fossa positioned posteriorly in the palate. The collecting lymphatic vessels changed directions from medial to superior to lateral while wrapping around arteries during their course, perhaps to enable the smooth transition from the palate to the deep cervical node. Inefficient lymphatic flow in humans is attributed to the superior location of the pterygopalatine fossa in the palate when compared with its location in the Suncus.

Relationship between Metabolic Syndrome and Number of Teeth in Japan

The 2004 Japanese National Health and Nutrition Survey collected data on several measures, including self-reported dental health. In addition, this was the first nationwide survey to focus on metabolic syndrome (MetS) in Japan. Therefore, the authors used this nationwide data set to assess the relationship between number of teeth present and MetS. Anonymized data were available with permission from the Ministry of Health, Labour and Welfare of Japan. Data from 3,195 men and women aged 35 to 99 y were examined, and logistic regression analyses were used to evaluate the association between number of teeth and MetS. Moreover, the authors performed an analysis of covariance to compare the mean number of teeth between those with and those without MetS, after adjusting for confounders. In comparison with those having ≥28 teeth, those with fewer remaining teeth demonstrated significantly higher odds of having MetS. Specifically, those having 1 to 9 teeth had higher odds of having MetS than those with more teeth and were more than twice as likely to be affected than those with ≥28 teeth. Furthermore, individuals with MetS in the age groups of 45 to 54, 55 to 64, and 65 to 74 y had significantly fewer teeth than those without MetS in the same age groups. These results suggest that the number of teeth present is associated with the prevalence of MetS in the Japanese population. Knowledge Transfer Statement: The results of this study can be used by clinicians when they examine patients with periodontal disease or extensive tooth loss to refer for a general medical examination.

CMAP decrement as a potential diagnostic marker for ALS

OBJECTIVE

We previously reported that decrement of compound muscle action potential (CMAP) by repetitive nerve stimulation (RNS) was greater in the median nerves than in the ulnar nerves of patients with amyotrophic lateral sclerosis (ALS). The aim of this study was to evaluate whether CMAP decrement by RNS is a feasible marker for the differentiation of ALS from other diseases.

MATERIALS & METHODS

We performed RNS in the median and ulnar nerves of 51 patients with ALS and 40 patients with other diseases.

RESULTS

The CMAP decrement was significantly greater in the median nerves of patients with ALS, compared to the disease control patients. In the median nerves of patients with ALS, CMAP decrement was significantly greater in the cervical region-onset group than in the other region-onset group.

CONCLUSIONS

The finding of CMAP decrement in the median nerves can be useful for differentiating ALS patients with cervical region onset from other controls with active neuropathic diseases.

Gate-Tunable Spin-Charge Conversion and the Role of Spin-Orbit Interaction in Graphene

The small spin-orbit interaction of carbon atoms in graphene promises a long spin diffusion length and the potential to create a spin field-effect transistor. However, for this reason, graphene was largely overlooked as a possible spin-charge conversion material. We report electric gate tuning of the spin-charge conversion voltage signal in single-layer graphene. Using spin pumping from an yttrium iron garnet ferrimagnetic insulator and ionic liquid top gate, we determined that the inverse spin Hall effect is the dominant spin-charge conversion mechanism in single-layer graphene. From the gate dependence of the electromotive force we showed the dominance of the intrinsic over Rashba spin-orbit interaction, a long-standing question in graphene research.

A phase I study of binimetinib (MEK162) in Japanese patients with advanced solid tumors

PURPOSE

Binimetinib is a potent, selective MEK1/2 inhibitor with demonstrated efficacy against BRAF- and RAS-mutant tumors. Retinal adverse events associated with MEK inhibitors have been reported in some cases. The aim of this study was to assess single-agent binimetinib, with detailed ophthalmologic monitoring, in Japanese patients with advanced solid tumors.

METHODS

This was an open-label phase I dose-escalation and dose-expansion study (NCT01469130). Adult patients with histologically confirmed, evaluable, advanced solid tumors were enrolled and treated with binimetinib 30 or 45 mg twice daily (BID). The primary objective was to determine the maximum tolerated dose (MTD) and/or recommended phase II dose (RP2D) of single-agent binimetinib in Japanese patients.

RESULTS

Twenty-one patients were enrolled; 3 and 8 patients had documented BRAF and KRAS mutations, respectively. Two of 6 patients (33 %) receiving binimetinib 45 mg BID in dose-escalation experienced recurrent grade 2 retinal adverse events (AEs) which were reversible, and this dose was declared the MTD and RP2D. All patients experienced ≥1 AE suspected to be treatment related; the most common (>50 %) were blood creatine phosphokinase increase (76 %), retinal detachment and aspartate aminotransferase increase (62 % each), and diarrhea (52 %). There were no complete or partial responses; 14 patients (67 %) had stable disease, which lasted >180 days in 5 patients. Expression of phospho-ERK decreased in the skin following binimetinib treatment at both dose levels, indicating target inhibition.

CONCLUSIONS

Binimetinib demonstrated efficacy and acceptable safety in Japanese patients with solid tumors, supporting the 45 mg BID dose of binimetinib as the RP2D.

Lateral Asymmetry and Spatial Difference of Iron Deposition in the Substantia Nigra of Patients with Parkinson Disease Measured with Quantitative Susceptibility Mapping

BACKGROUND AND PURPOSE

Quantitative susceptibility mapping is useful for assessing iron deposition in the substantia nigra of patients with Parkinson disease. We aimed to determine whether quantitative susceptibility mapping is useful for assessing the lateral asymmetry and spatial difference in iron deposits in the substantia nigra of patients with Parkinson disease.

MATERIALS AND METHODS

Our study population comprised 24 patients with Parkinson disease and 24 age- and sex-matched healthy controls. They underwent 3T MR imaging by using a 3D multiecho gradient-echo sequence. On reconstructed quantitative susceptibility mapping, we measured the susceptibility values in the anterior, middle, and posterior parts of the substantia nigra, the whole substantia nigra, and other deep gray matter structures in both hemibrains. To identify the more and less affected hemibrains in patients with Parkinson disease, we assessed the severity of movement symptoms for each hemibrain by using the Unified Parkinson's Disease Rating Scale.

RESULTS

In the posterior substantia nigra of patients with Parkinson disease, the mean susceptibility value was significantly higher in the more than the less affected hemibrain substantia nigra (P < .05). This value was significantly higher in both the more and less affected hemibrains of patients with Parkinson disease than in controls (P < .05). Asymmetry of the mean susceptibility values was significantly greater for patients than controls (P < .05). Receiver operating characteristic analysis showed that quantitative susceptibility mapping of the posterior substantia nigra in the more affected hemibrain provided the highest power for discriminating patients with Parkinson disease from the controls.

CONCLUSIONS

Quantitative susceptibility mapping is useful for assessing the lateral asymmetry and spatial difference of iron deposition in the substantia nigra of patients with Parkinson disease.

Measurement of small fibre pain threshold values for the early detection of diabetic polyneuropathy

AIM

To investigate whether Aδ and C fibre pain threshold values, measured using intra-epidermal electrical stimulation (IES), in people with and without Type 2 diabetes are useful in evaluating diabetic polyneuropathy (DPN) severity.

METHODS

Aδ and C fibre pain threshold values were measured in Japanese people with (n = 120) and without (n = 76) Type 2 diabetes by IES. Nerve conduction studies and other tests were performed to evaluate diabetic complications.

RESULTS

Aδ and C fibre pain threshold values were high in people with diabetes compared with control subjects (Aδ fibre: 0.050 vs. 0.030 mA, P < 0.01; C fibre: 0.180 vs. 0.070 mA, P < 0.01). Participants with diabetes and neuropathy had significantly higher Aδ and C fibre pain threshold values than participants without neuropathy (Aδ fibres 0.063 vs. 0.039 mA, P < 0.01; C fibres 0.202 vs. 0.098 mA, P < 0.05). C fibre pain threshold values were significantly higher in participants with diabetes and diabetic microvascular complications than in participants without complications. Threshold values increased with complication progression. When DPN was diagnosed according to the Diabetic Neuropathy Study Group in Japan criteria, the cut-off for the C fibre pain threshold values was 0.125 mA (area under the curve 0.758, sensitivity 81.5%, specificity 61.5%). The IES test took less time (P < 0.01) and was less invasive (P < 0.01) than the nerve conduction studies.

CONCLUSIONS

Intra-epidermal electrical stimulation is a non-invasive and easy measurement of small fibre pain threshold values. It may be clinically useful for C fibre measurement to diagnose early DPN as defined by the Diabetic Neuropathy Study Group in Japan criteria.

Distinct X chromosomal rearrangements in four haemophilia B patients with entire F9 deletion

INTRODUCTION

Haemophilia B is an X-linked bleeding disorder caused by a coagulation factor IX gene (F9) abnormality. Numerous F9 defects have been identified to date; however, only a few with an entire F9 deletion have been reported in detail.

AIM

To elucidate the cause of severe haemophilia B, we investigated the precise X chromosome abnormalities in four Japanese patients who did not show all amplifications in F9-specific PCR.

METHODS

We analysed the patient's genomic DNA using Multiplex ligation-dependent probe amplification (MLPA). To assess the extent of any deletions, we further performed mapping PCRs, inverse PCRs or long-range PCRs and direct sequencing analyses of the X chromosome.

RESULTS

We detected entire F9 deletions in four haemophilia B patients and identified the precise deleted regions of the X chromosome including F9. Patient 1 had a 149-kb deletion with breakpoints 90-kb upstream and 30-kb downstream from F9. Patients 2 and 3 showed 273-kb and 1.19-Mb deletions respectively. Patient 4 had two deleted regions: a 1663-bp deletion 1.34-Mb upstream from F9 and a 7.2-Mb deletion including F9. These distinct breakpoints found in four different patients suggest that the mechanism of X chromosome deletion may be different between individuals. Non-allelic homologous recombination (NAHR), microhomology-mediated break-induced replication (MMBIR) or fork stalling and template switching (FoSTeS) may occur in respective X chromosomes of the four haemophilia B patients analysed.

CONCLUSIONS

We identified diverse X chromosomal rearrangements in four haemophilia B patients, which might be caused by distinct mechanisms of genomic rearrangement.

Diagnostic Significance of Cortical Superficial Siderosis for Alzheimer Disease in Patients with Cognitive Impairment

BACKGROUND AND PURPOSE

Because the diagnostic significance of cortical superficial siderosis for Alzheimer disease and the association between cortical superficial siderosis and the topographic distribution of cerebral microbleeds have been unclear, we investigated the association between cortical superficial siderosis and clinicoradiologic characteristics of patients with cognitive impairment.

MATERIALS AND METHODS

We studied 347 patients (217 women, 130 men; mean age, 74 ± 9 years) who visited our memory clinic and underwent MR imaging (3T SWI). We analyzed the association between cortical superficial siderosis and the topographic distribution of cerebral microbleeds plus clinical characteristics including types of dementia. We used multivariate logistic regression analysis to determine the diagnostic significance of cortical superficial siderosis for Alzheimer disease.

RESULTS

Twelve patients (3.5%) manifested cortical superficial siderosis. They were older (P = .026) and had strictly lobar cerebral microbleeds significantly more often than did patients without cortical superficial siderosis (50.0% versus 19.4%, P = .02); the occurrence of strictly deep and mixed cerebral microbleeds, however, did not differ in the 2 groups. Alzheimer disease was diagnosed in 162 (46.7%) patients. Of these, 8 patients (4.9%) had cortical superficial siderosis. In the multivariate logistic regression analysis for the diagnosis of Alzheimer disease, lacunar infarcts were negatively and independently associated with Alzheimer disease (P = .007).

CONCLUSIONS

Although cortical superficial siderosis was associated with a strictly lobar cerebral microbleed location, it was not independently associated with Alzheimer disease in a memory clinic setting. Additional studies are required to investigate the temporal changes of these cerebral amyloid angiopathy-related MR imaging findings.

Morphologic Features of Carotid Plaque Rupture Assessed by Optical Coherence Tomography

BACKGROUND AND PURPOSE

Rupture of the plaque fibrous cap and subsequent thrombosis are the major causes of stroke. This study evaluated morphologic features of plaque rupture in the carotid artery by using optical coherence tomography in vivo.

MATERIALS AND METHODS

Thirty-six carotid plaques with high-grade stenosis were prospectively imaged by optical coherence tomography. "Plaque rupture" was defined as a plaque containing a cavity that had overlying residual fibrous caps. The fibrous cap thickness was measured at its thinnest part for both ruptured and nonruptured plaques. The distance between the minimum fibrous cap thickness site and the bifurcation point was also measured. Optical coherence tomography identified 24 ruptured and 12 nonruptured plaques.

RESULTS

Multiple ruptures were observed in 9 (38%) patients: Six patients had 2 ruptures in the same plaque, 2 patients had 3 ruptures in the same plaque, and 1 patient had 5 ruptures in the same plaque. Most (84%) of the fibrous cap disruptions were identified at the plaque shoulder and near the bifurcation point (within a 4.2-mm distance). The median thinnest cap thickness was 80 μm (interquartile range, 70-100 μm), and 95% of ruptured plaques had fibrous caps of <130 μm. Receiver operating characteristic analysis revealed that a fibrous cap thickness of <130 μm was the critical threshold value for plaque rupture in the carotid artery.

CONCLUSIONS

Plaque rupture was common in high-grade stenosis and was located at the shoulder of the carotid plaque close to the bifurcation. A cap thickness of <130 μm was the threshold for plaque rupture in the carotid artery.

Experimental Demonstration of Room-Temperature Spin Transport in n-Type Germanium Epilayers

We report an experimental demonstration of room-temperature spin transport in n-type Ge epilayers grown on a Si(001) substrate. By utilizing spin pumping under ferromagnetic resonance, which inherently endows a spin battery function for semiconductors connected with a ferromagnet, a pure spin current is generated in the n-Ge at room temperature. The pure spin current is detected by using the inverse spin-Hall effect of either a Pt or Pd electrode on n-Ge. From a theoretical model that includes a geometrical contribution, the spin diffusion length in n-Ge at room temperature is estimated to be 660 nm. Moreover, the spin relaxation time decreases with increasing temperature, in agreement with a recently proposed theory of donor-driven spin relaxation in multivalley semiconductors.

An internally and externally validated nomogram for predicting the risk of irinotecan-induced severe neutropenia in advanced colorectal cancer patients

Background:

In Asians, the risk of irinotecan-induced severe toxicities is related in part to UGT1A1*6 (UGT, UDP glucuronosyltransferase) and UGT1A1*28, variant alleles that reduce the elimination of SN-38, the active metabolite of irinotecan. We prospectively studied the relation between the UGT1A1 genotype and the safety of irinotecan-based regimens in Japanese patients with advanced colorectal cancer, and then constructed a nomogram for predicting the risk of severe neutropenia in the first treatment cycle.

Methods:

Safety data were obtained from 1312 patients monitored during the first 3 cycles of irinotecan-based regimen in a prospective observational study. In development of the nomogram, multivariable logistic regression analysis was used to test the associations of candidate factors to severe neutropenia in the first cycle. The final nomogram based on the results of multivariable analysis was constructed and validated internally using a bootstrapping technique and externally in an independent data set (n=350).

Results:

The UGT1A1 genotype was confirmed to be associated with increased risks of irinotecan-induced grade 3 or 4 neutropenia and diarrhoea. The final nomogram included type of regimen, administered dose of irinotecan, gender, age, UGT1A1 genotype, Eastern Cooperative Oncology Group performance status, pre-treatment absolute neutrophil count, and total bilirubin level. The model was validated both internally (bootstrap-adjusted concordance index, 0.69) and externally (concordance index, 0.70).

Conclusions:

Our nomogram can be used before treatment to accurately predict the probability of irinotecan-induced severe neutropenia in the first cycle of therapy. Additional studies should evaluate the effect of nomogram-guided dosing on efficacy in patients receiving irinotecan.

Development of Clinical Database System Specialized for Heavy Particle Therapy

We have developed a data archiving system for study of charged particle therapy. We required a data-relation mechanism between electronic medical record system (EMR) and database system, because it needs to ensure the information consistency. This paper presents the investigation results of these techniques. The standards in the medical informatics field that we focus on are Integrating the Healthcare Enterprise (IHE) and 2) Health Level-7 (HL7) to archive the data. As a main cooperation function, we adapt 2 integration profiles of IHE as follows, 1) Patient Administration Management (PAM) Profile of IHE-ITI domain for patient demographic information reconciliation, 2) Enterprise Schedule Integration(ESI) profile of IHE-Radiation Oncology domain for order management between EMR and treatment management system(TMS). We also use HL7 Ver2.5 messages for exchanging the follow-up data and result of laboratory test. In the future, by implementation of this system cooperation, we will be able to ensure interoperability in the event of the EMR update.

Development and practice of ISMS at a Radiotherapy Hospital by using IHE Integration profiles

Our hospital is specialized for radiation therapy and has many information devices. Various job categories are working. When we implemented an EMR, we aimed to enforce ISMS by using IHE profiles. To solve the already existed system-related problems, we selected and use some profiles (EUA, PSA, ATNA and PAM). After implementation, we audited and then some findings were pointed out. These findings are being settled by the PDCA cycle. We also found that appropriate IHE profiles were effective in the building of ISMS.

Non-Gilbert-damping Mechanism in a Ferromagnetic Heusler Compound Probed by Nonlinear Spin Dynamics

The nonlinear decay of propagating spin waves in the low-Gilbert-damping Heusler film Co_{2}Mn_{0.6}Fe_{0.4}Si is reported. Here, two initial magnons with frequency f_{0} scatter into two secondary magnons with frequencies f_{1} and f_{2}. The most remarkable observation is that f_{1} stays fixed if f_{0} is changed. This indicates, that the f_{1} magnon mode has the lowest instability threshold, which, however, cannot be understood if only Gilbert damping is present. We show that the observed behavior is caused by interaction of the magnon modes f_{1} and f_{2} with the thermal magnon bath. This evidences a significant contribution of the intrinsic magnon-magnon scattering mechanisms to the magnetic damping in high-quality Heusler compounds.

Successful immunotherapy of autoimmune cholangitis by adoptive transfer of forkhead box protein 3(+) regulatory T cells

Treatment of primary biliary cirrhosis (PBC) has lagged behind that of other autoimmune diseases. In this study we have addressed the potential utility of immunotherapy using regulatory T cells (Treg ) to treat murine autoimmune cholangitis. In particular, we have taken advantage of our ability to produce portal inflammation and bile duct cell loss by transfer of CD8(+) T cells from the dominant negative form of transforming growth factor beta receptor type II (dnTGF-βRII) mice to recombination-activating gene (Rag)1(-/-) recipients. We then used this robust established adoptive transfer system and co-transferred CD8(+) T cells from dnTGF-βRII mice with either C57BL/6 or dnTGF-βRII forkhead box protein 3 (FoxP3(+) ) T cells. Recipient mice were monitored for histology, including portal inflammation and intralobular biliary cell damage, and also included a study of the phenotypical changes in recipient lymphoid populations and local and systemic cytokine production. Importantly, we report herein that adoptive transfer of Treg from C57BL/6 but not dnTGF-βRII mice significantly reduced the pathology of autoimmune cholangitis, including decreased portal inflammation and bile duct damage as well as down-regulation of the secondary inflammatory response. Further, to define the mechanism of action that explains the differential ability of C57BL/6 Treg versus dnTGF-βRII Treg on the ability to down-regulate autoimmune cholangitis, we noted significant differential expression of glycoprotein A repetitions predominant (GARP), CD73, CD101 and CD103 and a functionally significant increase in interleukin (IL)-10 in Treg from C57BL/6 compared to dnTGF-βRII mice. Our data reflect the therapeutic potential of wild-type CD4(+) FoxP3(+) Treg in reducing the excessive T cell responses of autoimmune cholangitis, which has significance for the potential immunotherapy of PBC.

Tumor induction in mice after local irradiation with single doses of either carbon-ion beams or gamma rays

PURPOSE

To determine the dose-dependent relative biological effectiveness (RBE) for tumor prevalence in mice receiving single localized doses to their right leg of either carbon ions (15, 45 or 75 keV/μm) or 137Cs gamma rays.

METHODS AND MATERIALS

A total of 1647 female C3H mice were irradiated to their hind legs with a localized dose of either reference gamma rays or 15, 45 or 75 keV/μm carbon-ion beams. Irradiated mice were evaluated for tumors twice a month during their three-year life span, and the dimensions of any tumors found were measured with a caliper. The tumor induction frequency was calculated by Kaplan-Meier analysis.

RESULTS

The incidence of tumors from 50 Gy of 45 keV/μm carbon ions was marginally higher than those from 50 Gy of gamma rays. However, 60 Gy of 15 keV/μm carbon ions induced significantly fewer tumors than did gamma rays. RBE values of 0.87 + 0.12, 1.29 + 0.08 or 2.06 + 0.39 for lifetime tumorigenesis were calculated for 15, 45 or 75 keV/μm carbon-ion beams, respectively. Fibrosarcoma predominated, with no Linear Energy Transfer (LET)-dependent differences in the tumor histology. Experiments measuring the late effect of leg skin shrinkage suggested that the carcinogenic damage of 15 keV/μm carbon ions would be less than that of gamma rays.

CONCLUSIONS

We conclude that patients receiving radiation doses to their normal tissues would face less risk of secondary tumor induction by carbon ions of intermediate LET values compared to equivalent doses of photons.

A comparative study of thin-section CT findings between seasonal influenza virus pneumonia and Streptococcus pneumoniae pneumonia

OBJECTIVE

To compare the pulmonary thin-section CT findings in patients with seasonal influenza virus pneumonia with Streptococcus pneumoniae pneumonia.

METHODS

The study group included 30 patients (20 males and 10 females; age range, 20-91 years; mean age, 55.9 years) with seasonal influenza virus pneumonia and 71 patients (47 males and 24 females; age range, 27-92 years; mean age, 67.5 years) with S. pneumoniae pneumonia.

RESULTS

The proportion of community-acquired infection was significantly higher in patients with influenza virus pneumonia than with S. pneumoniae pneumonia (p = 0.001). CT findings of ground-glass attenuation (GGA) (p = 0.012) and crazy-paving appearance (p = 0.03) were significantly more frequent in patients with influenza virus pneumonia than with S. pneumoniae pneumonia. Conversely, consolidation (p < 0.001), mucoid impaction (p < 0.001), centrilobular nodules (p = 0.04) and pleural effusion (p = 0.003) were significantly more frequent in patients with S. pneumoniae pneumonia than in those with influenza virus pneumonia.

CONCLUSION

Pulmonary thin-section CT findings, such as consolidation and mucoid impaction may be useful in distinguishing between seasonal influenza virus pneumonia and S. pneumoniae pneumonia.

ADVANCES IN KNOWLEDGE

(1) Distinguishing seasonal influenza virus pneumonia with S. pneumoniae pneumonia is important. (2) The CT findings of GGA and crazy-paving appearance were more frequently found in patients with influenza virus pneumonia than in patients with S. pneumoniae pneumonia, whereas consolidation, mucoid impaction, centrilobular nodules and pleural effusion were more frequently found in patients with S. pneumoniae pneumonia.

Abrupt transition from ferromagnetic to antiferromagnetic of interfacial exchange in perpendicularly magnetized L1(0)-MnGa/FeCo tuned by Fermi level position

An abrupt transition of the interfacial exchange coupling from ferromagnetic to antiferromagnetic was observed in the interface of perpendicularly magnetized L10-MnGa/Fe1-xCox epitaxial bilayers when x was around 25%. By considering the special band structure of the MnGa alloy, we present a model explaining this transition by the spin-polarization reversal of Fe1-xCox alloys due to the rise of the Fermi level as the Co content increases. The effect of interfacial exchange coupling on the coercive force (Hc) and the spin-dependent tunneling effect in perpendicular magnetic tunnel junctions (pMTJs) based on the coupled composite were also studied. Changes from the normal spin valve to inverted magnetoresistance loops corresponding to the coupling transition were observed in pMTJs with MnGa/Fe1-xCox as an electrode.

Acute aortic dissection in a patient receiving multiple tyrosine kinase inhibitors for 5 years

A 48-year-old male presented with para-aortic lymph node metastases after surgical resection of a clear cell renal cell carcinoma. After first-line treatment with interferon alpha-2b, he was started on pazopanib and lapatinib. Blood pressure was well controlled with temocapril and amlodipine. Treatment had to be stopped 4 years and 8 months after initiation due to overt proteinuria. Then, sunitinib was started as third-line treatment. During the second cycle of sunitinib, he died due to a Stanford type A aortic dissection. Acute aortic dissection could be an adverse event associated with the long-term use of antiangiogenic tyrosine kinase inhibitors.

Abstract P4-16-11: Phase I trial of afatinib plus vinorelbine in Japanese patients with advanced solid tumors including breast cancer

Background: Afatinib, a potent irreversible ErbB Family Blocker, inhibits signaling from HER1, HER2 and HER4 dimers, and transphosphorylation of HER3. A Phase I trial was conducted to assess if afatinib 40 mg/day in combination with vinorelbine (VNR) 25 mg/m2 i.v. weekly could be safely administered to Japanese patients (pts).

Patients and methods: The safety, tolerability and pharmacokinetics (PK) of daily oral afatinib plus weekly i.v. VNR in a 28-day cycle in Japanese pts was assessed using a 3+3 design. The primary endpoint was to determine the maximum tolerated dose (MTD), based on dose-limiting toxicities (DLTs) in Cycle 1 (see Table; dose Levels 1 and 2). When the MTD was exceeded, dose Levels 2a and 3 allowed modifications of VNR dosing as used in clinical practice. Eligible pts were ≥20 years old with histologically confirmed refractory advanced/metastatic solid tumours, and an ECOG performance status (PS) 0-1. Adverse events (AEs) were documented as per NCI CTCAE v3.0. Response was assessed using RECIST 1.1, and PK parameters for both drugs were analyzed by intra-individual comparison, based on frequent blood sampling.

Results: Seventeen pts were recruited. Median age was 60 (range 40-68) years, all pts had received previous chemotherapy, and 7/9 pts with BC had received HER2-targeted therapy. No DLTs were observed at dose Level 1. When 3/5 pts developed DLTs in Cycle 1 at an afatinib dose of 40 mg in Level 2 (see Table), an intermediate cohort 2a was introduced at 20 mg/m2 VNR i.v. weekly. Tolerability at Level 2a was confirmed. With afatinib dose modification permitted, and VNR dose skipping allowed for ANC &lt;1500/mm3, dose re-escalation to VNR 25mg/m2 i.v. weekly at Level 3 was performed to establish a recommended phase II dose. At Level 3, 7/24 planned doses of VNR were skipped due to Grade 2 and 3 neutropenia, not qualifying as DLTs. One DLT occurred in a pt with Grade 2 epigastralgia in Course 1, who required afatinib dose reduction. Overall, the most frequent drug-related AEs were leukopenia, neutropenia (100% each), diarrhea (94%), anemia (70%), stomatitis (64%) and rash (41%). Nine BC pts were treated in cohorts 2a and 3, and all experienced diarrhea, leukopenia and neutropenia. No PK drug-drug interactions between afatinib and VNR were observed. Safety and PK profiles did not appear to differ between Japanese pts and Caucasian pts in a previous Phase I study. Two pts with BC and prior trastuzumab treatment had partial responses. Tumor shrinkage was observed in four of six evaluable BC pts, but not in other tumor types.

Conclusions: Afatinib 40 mg/day plus vinorelbine 25 mg/m2/week was tolerable and showed early signs of clinical activity in Japanese pts. AEs were as expected and were managed by dose modifications of both compounds. Final data will be presented at this congress.

Dose LevelsAfatinibVinorelbineN treatedDLTs (n)120 mg/day25 mg/m2/week3None240 mg/day25 mg/m2/week5Grade 4 neutropenia for 7 days (1); Grade 3 febrile neutropenia (1); Grade 3 pharyngeal infection with Grade 4 lipase and amylase elevations (1)2a40 mg/day20 mg/m2/week3 (all BC)None340 mg/day25 mg/m2/week6 (all BC)Grade 2 epigastralgia (1)

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-16-11.