Distinct Responses of Interleukin-6 and Other Laboratory Parameters to Treatment in a Patient with Polyarteritis Nodosa—A Case Report

The authors describe a patient in whom the serum levels of interleukin-6 (IL-6) and other laboratory parameters were monitored. The IL-6 and C-reac tive protein (CRP) levels, which were extremely high before treatment, declined rapidly with administration of prednisolone. Rheumatoid factor, IgG, and platelets count declined more gradually. Thus, determination of the serum IL-6 level might be useful in diagnosing and monitoring polyarteritis nodosa.

Influence of Etching Mode on Enamel Bond Durability of Universal Adhesive Systems

The purpose of this study was to determine the enamel bond durability of three universal adhesives in different etching modes through fatigue testing. The three universal adhesives used were Scotchbond Universal, Prime&Bond Elect universal dental adhesive, and All-Bond Universal light-cured dental adhesive. A single-step self-etch adhesive, Clearfil S³ Bond Plus was used as a control. The shear bond strength (SBS) and shear fatigue strength (SFS) to human enamel were evaluated in total-etch mode and self-etch mode. A stainless steel metal ring with an internal diameter of 2.4 mm was used to bond the resin composite to the flat-ground (4000-grit) tooth surfaces for determination of both SBS and SFS. For each enamel surface treatment, 15 specimens were prepared for SBS and 30 specimens for SFS. The staircase method for fatigue testing was then used to determine the SFS of the resin composite bonded to the enamel using 10-Hz frequencies for 50,000 cycles or until failure occurred. Scanning electron microscopy was used to observe representative debonded specimen surfaces and the resin-enamel interfaces. A two-way analysis of variance and the Tukey post hoc test were used for analysis of the SBS data, whereas a modified t-test with Bonferroni correction was used for the SFS data. All adhesives in total-etch mode showed significantly higher SBS and SFS values than those in self-etch mode. Although All-Bond Universal in self-etch mode showed a significantly lower SBS value than the other adhesives, there was no significant difference in SFS values among the adhesives in this mode. All adhesives showed higher SFS:SBS ratios in total-etch mode than in self-etch mode. With regard to the adhesive systems used in this study, universal adhesives showed higher enamel bond strengths in total-etch mode. Although the influence of different etching modes on the enamel-bonding performance of universal adhesives was found to be dependent on the adhesive material, total-etch mode effectively increased the enamel bond strength and durability, as measured by fatigue testing.

Endovascular Stenting for Pseudoaneurysms of the Cervical Carotid Artery

The authors report two cases of pseudoaneurysm of the cervical carotid artery treated with endovascular stenting. One patient presented with cerebral ischemia due to traumatic carotid dissection and underwent stent placement 3 weeks after injury when the wide-necked pseudoaneurysm was seen to enlarge at the dissecting portion.

The aneurysm thrombosed while the carotid artery remained patent without ischemic complications for 2 years. The other patient developed repeated massive bleeding from an exposed pseudoaneurysm at the right carotid-subclavian junction resulting from radiotherapy for thyroid cancer with subsequent skin infection.

Since skin grafting failed and two attempts at coil embolization resulted in compaction with recurrent enlargement of the aneurysm, endovascular stenting was performed with endosaccular coil packing between the stent struts. Hemostasis was achieved for 2 months. Both cases illustrate successes of the stent in highly difficult situations.

Mechanical Properties and Sliding-impact Wear Resistance of Self-adhesive Resin Cements

The present study determined the mechanical properties and impact-sliding wear characteristics of self-adhesive resin cements. Five self-adhesive resin cements were used: G-CEM LinkAce, BeautiCem SA, Maxcem Elite, Clearfil SA Automix, and RelyX Unicem 2. Clearfil Esthetic Cement was employed as a control material. Six specimens for each resin cement were used to determine flexural strength, elastic modulus, and resilience according to ISO specification #4049. Ten specimens for each resin cement were used to determine the wear characteristics using an impact-sliding wear testing apparatus. Wear was generated using a stainless-steel ball bearing mounted inside a collet assembly. The maximum facet depth and volume loss were determined using a noncontact profilometer in combination with confocal laser scanning microscopy. Data were evaluated using analysis of variance followed by the Tukey honestly significantly different test (α=0.05). The flexural strength of the resin cements ranged from 68.4 to 144.2 MPa; the elastic modulus ranged from 4.4 to 10.6 GPa; and the resilience ranged from 4.5 to 12.0 MJ/m3. The results for the maximum facet depth ranged from 25.2 to 235.9 μm, and volume loss ranged from 0.0107 to 0.5258 mm3. The flexural properties and wear resistance were found to vary depending upon the self-adhesive resin cement tested. The self-adhesive cements tended to have lower mechanical properties than the conventional resin cement. All self-adhesive resin cements, apart from G-CEM LinkAce, demonstrated significantly poorer wear resistance than did the conventional resin cement.

The Effect of Phosphoric Acid Pre-etching Times on Bonding Performance and Surface Free Energy with Single-step Self-etch Adhesives

OBJECTIVE

The purpose of this study was to evaluate the effect of phosphoric acid pre-etching times on shear bond strength (SBS) and surface free energy (SFE) with single-step self-etch adhesives.

METHODS

The three single-step self-etch adhesives used were: 1) Scotchbond Universal Adhesive (3M ESPE), 2) Clearfil tri-S Bond (Kuraray Noritake Dental), and 3) G-Bond Plus (GC). Two no pre-etching groups, 1) untreated enamel and 2) enamel surfaces after ultrasonic cleaning with distilled water for 30 seconds to remove the smear layer, were prepared. There were four pre-etching groups: 1) enamel surfaces were pre-etched with phosphoric acid (Etchant, 3M ESPE) for 3 seconds, 2) enamel surfaces were pre-etched for 5 seconds, 3) enamel surfaces were pre-etched for 10 seconds, and 4) enamel surfaces were pre-etched for 15 seconds. Resin composite was bonded to the treated enamel surface to determine SBS. The SFEs of treated enamel surfaces were determined by measuring the contact angles of three test liquids. Scanning electron microscopy was used to examine the enamel surfaces and enamel-adhesive interface.

RESULTS

The specimens with phosphoric acid pre-etching showed significantly higher SBS and SFEs than the specimens without phosphoric acid pre-etching regardless of the adhesive system used. SBS and SFEs did not increase for phosphoric acid pre-etching times over 3 seconds. There were no significant differences in SBS and SFEs between the specimens with and without a smear layer.

CONCLUSION

The data suggest that phosphoric acid pre-etching of ground enamel improves the bonding performance of single-step self-etch adhesives, but these bonding properties do not increase for phosphoric acid pre-etching times over 3 seconds.

Measurement and comparison of individual external doses of high-school students living in Japan, France, Poland and Belarus-the 'D-shuttle' project

Twelve high schools in Japan (of which six are in Fukushima Prefecture), four in France, eight in Poland and two in Belarus cooperated in the measurement and comparison of individual external doses in 2014. In total 216 high-school students and teachers participated in the study. Each participant wore an electronic personal dosimeter 'D-shuttle' for two weeks, and kept a journal of his/her whereabouts and activities. The distributions of annual external doses estimated for each region overlap with each other, demonstrating that the personal external individual doses in locations where residence is currently allowed in Fukushima Prefecture and in Belarus are well within the range of estimated annual doses due to the terrestrial background radiation level of other regions/countries.

Determinants of chronic obstructive pulmonary disease severity in the late-elderly differ from those in younger patients

BACKGROUND

Although the age range of chronic obstructive pulmonary disease (COPD) patients is broad, few studies have focused on the effects of age on disease characteristics.

METHODS

Keio University and affiliated hospitals established an observational COPD cohort. Patients were assessed using high resolution computed tomography (CT) to quantify emphysema, health status using the COPD assessment test (CAT) and the St. George's Respiratory Questionnaire (SGRQ), spirometry, echocardiogram, dual X-ray absorption of bone, biomarkers and comorbid diagnoses. We examined the characteristics of COPD patients aged 75 and over compared with patients below 75.

RESULTS

A total of 443 patients comprising 252 patients aged <75 years and 191 patients aged ≥75 years, were enrolled. Emphysematous changes on CT and prevalence of possible pulmonary hypertension were greater in late-elderly patients. The slope of the relationship between CT emphysema densitometry score and forced expiratory volume in 1 s was significantly less steep in the late-elderly than the younger patients (p = 0.002). CAT and total SGRQ scores and the frequency of long-term oxygen therapy were significantly higher in the late-elderly with moderate airflow obstruction compared to those of the younger in the same grade, although the opposite was seen in late-elderly patients with very severe airflow obstruction. Hypertension, aortic aneurysm, prostatic hypertrophy, anemia, and cataract are more prevalent in late-elderly patients.

CONCLUSIONS

Elderly COPD patients show a varied age-related pattern of disease that warrants specific attention in clinical practice above and beyond assessment of airflow limitation. Trial registration Clinical trial registered with the University Hospital Medical Information Network (UMIN000003470, April 10, 2010).

Donor site selection and clinical outcomes of nipple-areola skin-sparing mastectomy with immediate autologous free flap reconstruction: A single-institution experience

BACKGROUND

The objective of this study was to examine the clinical outcomes of immediate breast reconstruction using perforator flaps from different donor sites, and to characterize the trends among these flaps.

METHODS

We retrospectively reviewed 136 consecutive patients who underwent immediate breast reconstruction using free flaps after skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM). The whole breast was pathologically analyzed in 5-mm sections. Breast reconstruction was performed using the deep inferior epigastric perforator (DIEP) flap, gluteal artery perforator (GAP) flap, and posterior medial thigh perforator (PMTP) flap. Patient characteristics were compared among donor sites.

RESULTS

NSM was converted to SSM because of intraoperative subareolar tumor positivity in 7 of 107 patients. Eleven patients had positive margins in permanent sections. All but one patient had a positive horizontal margin in the peripheral direction. The 5-year recurrence-free survival rate was 91.9%. The locoregional recurrence rate was 5.1% with a mean follow-up observation period of 75 months. DEIP, GAP, and PMTP flaps were used in 64 (47.1%), 38 (27.9%), and 34 (25.0%) patients, retrospectively. DIEP flaps were used in older patients and those with a higher body mass index. GAP flaps were used in younger patients. DIEP and GAP flaps were used for larger breasts, and PMTP flaps for smaller breasts.

CONCLUSION

NSM or SSM with immediate perforator flap breast reconstruction is an oncologically acceptable surgical option. We believe that age, desire to have children, body mass index, and excised breast volume are valuable factors for selecting the optimal donor site.

Simulated Wear of Self-Adhesive Resin Cements

One of the primary areas of concern with luting agents is marginal gap erosion and attrition. The purpose of this laboratory study was to evaluate bulk and marginal slit (gap) generalized wear of self-adhesive resin cements. Three self-adhesive resin cements were used in this study: G-CEM LinkAce (LA), Maxcem Elite (ME), and RelyX Unicem2 Automix (RU). A custom stainless-steel fixture with a cavity 4.5 mm in diameter and 4 mm deep was used for simulated generalized (bulk) wear. For simulated marginal gap wear, a two-piece stainless-steel custom fixture was designed with a slit (gap) 300 μm wide and 3 mm in length. For both wear models, 20 specimens each for each of the three adhesive cements were made for both light-cure and chemical-cure techniques. The cured cements were polished with a series of carbide papers to a 4000-grit surface and subjected to 100,000 cycles using the slit (gap) wear model and 400,000 cycles for generalized (bulk) wear in a Leinfelder-Suzuki (Alabama machine) wear simulator (maximum load of 78.5 N). Flat-ended stainless-steel antagonists were used in a water slurry of poly(methylmethacrylate) beads for simulation of generalized contact-free area wear with both wear models. Before and after the wear challenges, the specimens were profiled with a Proscan 2100 noncontact profilometer, and wear (volume loss [VL] and mean facet depth [FD]) was determined using AnSur 3D software. Two-way analysis of variance (ANOVA) and Tukey post hoc tests were used for data analysis for the two wear models. Scanning electron microscopy (SEM) was used to examine polished surfaces of the resin cements and the worn surfaces after the wear challenges. The two-way ANOVA of VL using the generalized (bulk) wear model showed a significant effect among the three resin cement materials for the factor of resin cement (p<0.001) and the interaction of the cement and cure method (p<0.001), but not for the cure method (p=0.465). The two-way ANOVA for FD also found a significant difference for the factor of resin cement (p<0.001) and the interaction of the resin cement and cure method (p<0.001), but not for the cure method (p=0.277). The simulated generalized (bulk) wear for the light-cure groups was as follows: VL (mm(3)): RU 0.631 (0.094), LA 0.692 (0.112), and ME 1.046 (0.141) and FD (μm): RU 43.6 (6.5), LA 47.0 (7.7), and ME 72.5 (9.9). The simulated generalized (bulk) wear for the chemical-cure groups was as follows: VL (mm(3)): LA 0.741 (0.105), RU 1.231 (0.234), and ME 1.305 (0.143) and FD (μm): LA 50.7 (7.2), RU 84.5 (16.1), and ME 91.7 (10.2). Simulated wear using the slit (gap) model for the light-cure groups was as follows: VL (mm(3)): RU 0.030 (0.006), LA 0.031 (0.006), and ME 0.041 (0.009) and FD (μm): RU 49.6 (5.7), LA 57.2 (8.4), and ME 70.9 (10.7). The wear values for the chemical-cure slit (gap) groups were as follows: VL (mm(3)): LA 0.031 (0.004), ME 0.038 (0.007), and RU 0.045 (0.009) and FD (μm): LA 53.9 (6.7), ME 63.5 (9.1), and RU 74.2 (12.9). Pearson correlation tests revealed a strong relationship between the two wear models for the light-cure groups and a good relationship for the chemical-cure groups. The observations using SEM showed differences in filler particle shape and size among the cements and the resultant effect of the wear challenges. The worn surfaces of each cement were essentially the same for both light-cure and chemical-cure methods. The bulk wear model and new slit (gap) model for evaluation of simulated generalized wear of luting agents demonstrated significant differences (p<0.05) in relative wear among three self-adhesive resin cements and between visible light- and chemical-cure techniques.

Phase I study of nintedanib in combination with pemetrexed as second-line treatment of Japanese patients with advanced non-small cell lung cancer

PURPOSE

This open-label, phase I, dose-escalation part of a phase I/II study evaluated the safety, pharmacokinetics, and preliminary efficacy of nintedanib, a triple angiokinase inhibitor, combined with pemetrexed in Japanese patients with advanced non-small cell lung cancer (NSCLC) after first-line chemotherapy.

METHODS

A fixed dose of pemetrexed (500 mg/m(2) iv) was administered on Day 1 of each 21-day cycle followed by oral nintedanib twice daily (bid) on days 2-21, starting at 100 mg bid and escalating to 200 mg bid in 50-mg intervals, using a standard 3 + 3 design. After ≥4 cycles of combination therapy, patients could continue nintedanib monotherapy until disease progression or undue adverse events (AEs). Primary endpoints were maximum tolerated dose (MTD), defined as the highest dose at which the incidence of dose-limiting toxicities (DLTs) was <33.3 % during the first treatment course, and AEs (CTCAE v3.0). DLTs were primarily defined as grade ≥3 non-hematologic or grade 4 hematologic AEs.

RESULTS

Eighteen patients were included in the analysis. DLTs were experienced by 2/9 patients receiving 200 mg bid, 1/6 receiving 150 mg bid, and 0/3 receiving the lowest dose. The MTD of nintedanib plus pemetrexed was 200 mg bid. The most common drug-related AEs were elevated liver enzymes and gastrointestinal AEs. Two patients achieved partial response, and 10 had stable disease.

CONCLUSIONS

Nintedanib plus pemetrexed had a manageable safety profile and showed promising signs of efficacy in previously treated Japanese patients with advanced NSCLC. As in Caucasian patients, the MTD of nintedanib was 200 mg bid. Clinical trial information NCT00979576.

[Pulmonary Mucoepidermoid Carcinoma--A Case Report]

Mucoepidermoid carcinoma (MEC) of the lungs is a rare type of lung cancer, mainly arising from the submucosal salivary type mucous glands of the large bronchi. MEC is classified into low- and high-grade subtypes based on its cytological and histological features, and this classification correlates well with prognosis. We report the case of a 36-year-old man diagnosed after an initial episode of obstructive pneumonia. CT and bronchoscopy revealed an endobronchial mass in the right S3 bronchus and distal atelectasis. Although biopsy is important for deciding the treatment plan, both pre- and intraoperative biopsy resulted in false negativity in this patient. The tumor was completely resected via right upper lobectomy, and the final pathological diagnosis was low-grade MEC. No evidence of disease was found 2 years after the operation without any adjuvant therapy. At (11; 19) translocation with the associated CRTC1-MAML2 fusion oncogene is often recognized in cases of both salivary and pulmonary MEC. It is speculated that MEC is sensitive to EGFR-TKI therapy, which disrupts CRTC1-MAML2-induced proliferation signals via upregulation of the EGFR ligand amphiregulin.

The reasons for triple therapy in stable COPD patients in Japanese clinical practice

Background

Triple combination therapy involving long-acting muscarinic antagonists long-acting β₂ agonists, and inhaled corticosteroids has recently become an option for maintenance treatment of COPD. Some add-on clinical trials have reported the benefits of these combinations. However, the process to step up to triple therapy varies for individual cases.

Methods

Keio University and affiliated hospitals conducted an observational COPD cohort study, recruiting patients diagnosed as having COPD by pulmonary physicians and those referred for investigation of possible COPD. Their prescription history and clinical course were retrospectively analyzed based on the physicians’ medical records and patient questionnaires. This study was registered with UMIN (UMIN000003470, April 10, 2010).

Results

A total of 95 of the 445 COPD patients (21%) were treated with inhaled corticosteroids/long-acting β₂ agonists/long-acting muscarinic antagonists as maintenance therapy, including 12 in COPD Grade I, 31 in Grade II, 38 in Grade III, and 14 in Grade IV, based on the Global Initiative for Chronic Obstructive Lung Disease spirometric grading. For more than half of the patients on triple therapy, the treatment had been intensified due to unsatisfactory improvement of symptoms, and 32% were treated with triple therapy due to comorbid asthma. In contrast, there were COPD patients whose therapy was maintained after starting with triple therapy because of their serious conditions or concurrent exacerbation at diagnosis (8%).

Conclusion

Triple therapy was often prescribed in the real-life management of COPD, even in patients whose airflow limitation was not severe. To better control symptoms was the major reason for choosing triple therapy, regardless of the severity of COPD, in Japan.

Effect of Phosphoric Acid Pre-etching on Fatigue Limits of Self-etching Adhesives

The purpose of this study was to use shear bond strength (SBS) and shear fatigue limit (SFL) testing to determine the effect of phosphoric acid pre-etching of enamel and dentin prior to application of self-etch adhesives for bonding resin composite to these substrates. Three self-etch adhesives—1) G- ænial Bond (GC Corporation, Tokyo, Japan); 2) OptiBond XTR (Kerr Corp, Orange, CA, USA); and 3) Scotchbond Universal (3M ESPE Dental Products, St Paul, MN, USA)—were used to bond Z100 Restorative resin composite to enamel and dentin surfaces. A stainless-steel metal ring with an inner diameter of 2.4 mm was used to bond the resin composite to flat-ground (4000 grit) tooth surfaces for determination of both SBS and SFL. Fifteen specimens each were used to determine initial SBS to human enamel/dentin, with and without pre-etching with a 35% phosphoric acid (Ultra-Etch, Ultradent Products Inc, South Jordan, UT, USA) for 15 seconds prior to the application of the adhesives. A staircase method of fatigue testing (25 specimens for each test) was then used to determine the SFL of resin composite bonded to enamel/dentin using a frequency of 10 Hz for 50,000 cycles or until failure occurred. A two-way analysis of variance and Tukey post hoc test were used for analysis of SBS data, and a modified t-test with Bonferroni correction was used for the SFL data. Scanning electron microscopy was used to examine the area of the bonded restorative/tooth interface. For all three adhesive systems, phosphoric acid pre-etching of enamel demonstrated significantly higher (p&lt;0.05) SBS and SFL with pre-etching than it did without pre-etching. The SBS and SFL of dentin bonds decreased with phosphoric acid pre-etching. The SBS and SFL of bonds using phosphoric acid prior to application of self-etching adhesives clearly demonstrated different tendencies between enamel and dentin. The effect of using phosphoric acid, prior to the application of the self-etching adhesives, on SBS and SFL was dependent on the adhesive material and tooth substrate and should be carefully considered in clinical situations.

Localized and Generalized Simulated Wear of Resin Composites

A laboratory study was conducted to examine the wear of resin composite materials using both a localized and generalized wear simulation model. Twenty specimens each of seven resin composites (Esthet•X HD [HD], Filtek Supreme Ultra [SU], Herculite Ultra [HU], SonicFill [SF], Tetric EvoCeram Bulk Fill [TB], Venus Diamond [VD], and Z100 Restorative [Z]) were subjected to a wear challenge of 400,000 cycles for both localized and generalized wear in a Leinfelder-Suzuki wear simulator (Alabama machine). The materials were placed in custom cylinder-shaped stainless steel fixtures. A stainless steel ball bearing (r=2.387 mm) was used as the antagonist for localized wear, and a stainless steel, cylindrical antagonist with a flat tip was used for generalized wear. A water slurry of polymethylmethacrylate (PMMA) beads was used as the abrasive media. A noncontact profilometer (Proscan 2100) with Proscan software was used to digitize the surface contours of the pretest and posttest specimens. AnSur 3D software was used for wear assessment. For localized testing, maximum facet depth (μm) and volume loss (mm3) were used to compare the materials. The mean depth of the facet surface (μm) and volume loss (mm3) were used for comparison of the generalized wear specimens. A one-way analysis of variance (ANOVA) and Tukey post hoc test were used for data analysis of volume loss for both localized and generalized wear, maximum facet depth for localized wear, and mean depth of the facet for generalized wear. The results for localized wear simulation were as follows [mean (standard deviation)]: maximum facet depth (μm)—Z, 59.5 (14.7); HU, 99.3 (16.3); SU, 102.8 (13.8); HD, 110.2 (13.3); VD, 114.0 (10.3); TB, 125.5 (12.1); SF, 195.9 (16.9); volume loss (mm3)— Z, 0.013 (0.002); SU, 0.026 (0.006); HU, 0.043 (0.008); VD, 0.057 (0.009); HD, 0.058 (0.014); TB, 0.061 (0.010); SF, 0.135 (0.024). Generalized wear simulation results were as follows: mean depth of facet (μm)—Z, 9.3 (3.4); SU, 12.8 (3.1); HU, 15.6 (3.2); TB, 19.2 (4.8); HD, 26.8 (6.5); VD, 29.1 (5.5); SF, 35.6 (8.4); volume loss (mm3)—Z, 0.132 (0.049); SU, 0.0179 (0.042); HU, 0.224 (0.044); TB, 0.274 (0.065); HD, 0.386 (0.101); VD, 0.417 (0.076); SF, 0.505 (0.105). The ANOVA showed a significant difference among materials (p&lt;0.001) for facet depth and volume loss for both localized and generalized wear. The post hoc test revealed differences (p&lt;0.05) in localized and generalized wear values among the seven resin composites examined in this study. The findings provide valuable information regarding the relative wear characteristics of the materials in this study.

The E-Id protein axis modulates the activities of the PI3K-AKT-mTORC1-Hif1a and c-myc/p19Arf pathways to suppress innate variant TFH cell development, thymocyte expansion, and lymphomagenesis

Miyazaki et al. show that Id2 and Id3 suppress the development and expansion of innate variant T_FH cells by acting upstream of the Hif1a/Foxo/AKT/mTORC1 pathway as well as the c-myc/p19Arf module. Mice depleted for Id2 and Id3 expression developed colitis and αβ T-cell lymphomas, and the transcription signatures of Id2- and Id3-depleted lymphomas revealed similarities to genetic deficiencies associated with Burkitt lymphoma.

It is now well established that the E and Id protein axis regulates multiple steps in lymphocyte development. However, it remains unknown how E and Id proteins mechanistically enforce and maintain the naïve T-cell fate. Here we show that Id2 and Id3 suppressed the development and expansion of innate variant follicular helper T (T_FH) cells. Innate variant T_FH cells required major histocompatibility complex (MHC) class I-like signaling and were associated with germinal center B cells. We found that Id2 and Id3 induced Foxo1 and Foxp1 expression to antagonize the activation of a T_FH transcription signature. We show that Id2 and Id3 acted upstream of the Hif1a/Foxo/AKT/mTORC1 pathway as well as the c-myc/p19Arf module to control cellular expansion. We found that mice depleted for Id2 and Id3 expression developed colitis and αβ T-cell lymphomas. Lymphomas depleted for Id2 and Id3 expression displayed elevated levels of c-myc, whereas p19Arf abundance declined. Transcription signatures of Id2- and Id3-depleted lymphomas revealed similarities to genetic deficiencies associated with Burkitt lymphoma. We propose that, in response to antigen receptor and/or cytokine signaling, the E–Id protein axis modulates the activities of the PI3K–AKT–mTORC1–Hif1a and c-myc/p19Arf pathways to control cellular expansion and homeostatic proliferation.

Phase I study of weekly nab-paclitaxel combined with S-1 in patients with human epidermal growth factor receptor type 2-negative metastatic breast cancer

We conducted a phase I study of a weekly nab-paclitaxel and S-1 combination therapy in patients with human epidermal growth factor receptor type 2-negative metastatic breast cancer. The primary objective was to estimate the maximum tolerated and recommended doses. Each treatment was repeated every 21 days. Levels 1, 2a, 2b, and 3 were set depending on the S-1 dose (65 or 80 mg/m(2) ) and nab-paclitaxel infusion schedule (days 1 and 8 or days 1, 8, and 15). Fifteen patients were enrolled. Dose-limiting toxicity was observed in one patient at Level 3 (100 mg/m(2) nab-paclitaxel on days 1, 8, and 15 with 80 mg/m(2) S-1 daily for 14 days, followed by 7 days of rest). Although the maximum tolerated dose was not reached, the recommended dose was determined to be Level 3. Neutropenia was the most frequent grade 3-4 treatment-related adverse event. For patients with measurable lesions, the response rate was 50.0% and the median time to treatment failure and median progression-free survival was 13.2 and 21.0 months, respectively. The present results show the feasibility and potential for long-term administration of this combination therapy.

Evaluation of cigarette smoke-induced emphysema in mice using quantitative micro-computed tomography

Chronic cigarette smoke (CS) exposure provokes variable changes in the lungs, and emphysema is an important feature of chronic obstructive pulmonary disease. The usefulness of micro-computed tomography (CT) to assess emphysema in different mouse models has been investigated, but few studies evaluated the dynamic structural changes in a CS-induced emphysema mouse model. A novel micro-CT technique with respiratory and cardiac gating has resulted in high-quality images that enable processing for further quantitative and qualitative analyses. Adult female C57BL/6J mice were repeatedly exposed to mainstream CS, and micro-CT scans were performed at 0, 4, 12, and 20 wk. Emphysema was also histologically quantified at each time point. Air-exposed mice and mice treated with intratracheal elastase served as controls and comparisons, respectively. End-expiratory lung volume, corresponding to functional residual volume, was defined as the calculated volume at the phase of end-expiration, and it evaluated air trapping. The end-expiratory lung volumes of CS-exposed mice were significantly larger than those of air controls at 12 and 20 wk, which was in line with alveolar enlargement and destruction by histological quantification. However, CS exposure neither increased low attenuation volume nor decreased the average lung CT value at any time point, unlike the elastase-instilled emphysema model. CS-exposed mice had rather higher average lung CT values at 4 and 12 wk. This is the first study characterizing a CS-induced emphysema model on micro-CT over time in mice. Moreover, these findings extend our understanding of the distinct pathophysiology of CS-induced emphysema in mice.