Dynamic helical CT-guided needle localization of non-palpable and mammographically occult breast lesions: Case reports

Dynamic helical CT-guided needle localization of non-palpable and mammographically occult breast lesions is described. Dynamic helical CT-technique enabled fast volume scanning of the whole breast during the early contrast enhancement phase, which provided sufficient contrast to localize the target lesions. The procedures were successfully completed without complications.

Follow-up Study on Intra-Aneurysmal Embolization for Unruptured Cerebral Aneurysms

We describe follow-up clinical and angiographical results in patients with unruptured cerebral aneurysms treated with IDC or GDC. In 28 patients who underwent intra-aneurysmal occlusion for unruptured aneurysms, there were no permanent neurological deficits in the periprocedural period, while three transient neurological deficits were observed.

On the angiograms obtained immediately after the procedure, complete aneurysmal occlusion was achieved in three patients (10.7%), a small neck remnant was detected in two cases (7.1%), a body filling in 12 cases (42.9%) and both of them were detected in 11 patients (39.3%). On the follow up angiograms (median angiographical follow-up period 15.6 months), 46.4% of incompletely obliterated aneurysms showed aneurysmal recanalization, and a incompletely embolized aneurysm ruptured 15 months after initial embolization.

Detachable platinum coil embolization is a safe treatment for unruptured aneurysms with a lower incidence of peri-procedural morbidity, wheareas follow-up results are less satisfactory in cases involving incompletely obliterated lesions. With this limitation in mind, patients need to be very carefully chosen for GDC embolization and strict follow-up angiography is mandatory when a complete embolization is not achieved.

Severe or life-threatening asthma exacerbation: patient heterogeneity identified by cluster analysis

BACKGROUND

Severe or life-threatening asthma exacerbation is one of the worst outcomes of asthma because of the risk of death. To date, few studies have explored the potential heterogeneity of this condition.

OBJECTIVES

To examine the clinical characteristics and heterogeneity of patients with severe or life-threatening asthma exacerbation.

METHODS

This was a multicentre, prospective study of patients with severe or life-threatening asthma exacerbation and pulse oxygen saturation < 90% who were admitted to 17 institutions across Japan. Cluster analysis was performed using variables from patient- and physician-orientated structured questionnaires.

RESULTS

Analysis of data from 175 patients with severe or life-threatening asthma exacerbation revealed five distinct clusters. Cluster 1 (n = 27) was younger-onset asthma with severe symptoms at baseline, including limitation of activities, a higher frequency of treatment with oral corticosteroids and short-acting beta-agonists, and a higher frequency of asthma hospitalizations in the past year. Cluster 2 (n = 35) was predominantly composed of elderly females, with the highest frequency of comorbid, chronic hyperplastic rhinosinusitis/nasal polyposis, and a long disease duration. Cluster 3 (n = 40) was allergic asthma without inhaled corticosteroid use at baseline. Patients in this cluster had a higher frequency of atopy, including allergic rhinitis and furred pet hypersensitivity, and a better prognosis during hospitalization compared with the other clusters. Cluster 4 (n = 34) was characterized by elderly males with concomitant chronic obstructive pulmonary disease (COPD). Although cluster 5 (n = 39) had very mild symptoms at baseline according to the patient questionnaires, 41% had previously been hospitalized for asthma.

CONCLUSIONS & CLINICAL RELEVANCE

This study demonstrated that significant heterogeneity exists among patients with severe or life-threatening asthma exacerbation. Differences were observed in the severity of asthma symptoms and use of inhaled corticosteroids at baseline, and the presence of comorbid COPD. These findings may contribute to a deeper understanding and better management of this patient population.

Voltammetric behavior of 1- and 4-[S₂V(V)W₁₇O₆₂]⁵⁻ in acidified acetonitrile

Data derived from a voltammetric and spectroscopic study of the V(V/IV) couple associated with the initial reduction of the Wells-Dawson-type mono vanadium-substituted polyoxometalates, 1- and 4-[S2V(V)W17O62](5-) in CH3CN as a function of CF3SO3H acid concentration have been obtained. (51)V NMR (V(V) component) and EPR (V(IV) component) spectra were measured in CH3CN in the presence and absence of an acid. These data showed a small fraction of the 1-isomer in the 4-[S2V(V)W17O62](5-) sample and that protonation could occur at both redox levels for both isomers. On the basis of the mechanism postulated from the voltammetric and spectroscopic data, simulations of cyclic voltammograms were undertaken for the reduction of the isomerically pure 1-[S2V(V)W17O62](5-) isomer over a wide acid concentration range, and the results were compared with experimental data. Cyclic voltammograms of the V(V/IV) couple derived from the reduction of 1- and 4-[X2V(V)W17O62](7-) (X = P, As) were also obtained in CH3CN and the results were compared with those for 1- and 4-[S2V(V)W17O62](5-). Reversible potentials for the V(V/IV) couple are dependent on the anion charge of the polyoxometalate. Analysis of cyclic voltammograms obtained for 1- and 4-[S2V(V)W17O62](5-) in acetonitrile, acetone, dimethyl sulfoxide, dimethyl formamide and nitromethane showed that these V(V/IV) reversible potentials are also dependent on the acceptor numbers and the polarity index (E(T)(N)) values of the organic solvents.

Objective tumor response to denosumab in patients with giant cell tumor of bone: a multicenter phase II trial

A RANK ligand-specific inhibitor, denosumab, was predicted to reduce osteolysis and control disease progression in patients with giant cell tumor of bone (GCTB). We report, for the first time, the results of the response of GCTB to denosumab obtained from a prospective independent imaging assessment. The findings demonstrate that denosumab has robust clinical efficacy in the treatment of GCTB.

Background

Giant cell tumor of bone (GCTB) is a rare primary bone tumor, characterized by osteoclast-like giant cells that express receptor activator of nuclear factor-kappa B (RANK), and stromal cells that express RANK ligand (RANKL), a key mediator of osteoclast activation. A RANKL-specific inhibitor, denosumab, was predicted to reduce osteolysis and control disease progression in patients with GCTB.

Patients and methods

Seventeen patients with GCTB were enrolled. Patients were treated with denosumab at 120 mg every 4 weeks, with a loading dose of 120 mg on days 8 and 15. To evaluate efficacy, objective tumor response was evaluated prospectively by an independent imaging facility on the basis of prespecified criteria.

Results

The proportion of patients with an objective tumor response was 88% based on best response using any tumor response criteria. The proportion of patients with an objective tumor response using individual response criteria was 35% based on the modified Response Evaluation Criteria in Solid Tumors (RECIST) criteria, 82% based on the modified European Organization for Research and Treatment of Cancer (EORTC) criteria, and 71% based on inverse Choi criteria. The median time of study treatment was 13.1 months.

Conclusion

The findings demonstrate that denosumab has robust clinical efficacy in the treatment of GCTB.

Cytochemical studies of acute tubular necrosis caused by simultaneous administration of dextran and kanamycin

The increased nephrotoxicity of simultaneously administered kanamycin and low molecular weight dextran was studied in rats. The simultaneous administration of the two drugs showed an increase of nephrotoxicity, and caused pronounced vacuolation of the cytoplasm in the proximal tubular cells. The vacuoles were confirmed to be phagolysosomes by electron microscopic, histochemical and cell fractionation methods. The cell fractionation technique indicated that these phagolysosomes contained both kanamycin and dextran. The alteration of membrane was observed in the phagolysosomes, and these lysosomes of damaged renal tissue seemed to be more fragile than normal. The possible role played by lysosomes in the pathogenesis of acute tubular necrosis was discussed.

Serum levels of toxic AGEs (TAGE) may be a promising novel biomarker in development and progression of NASH

Nonalcoholic fatty liver disease (NAFLD) ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), leads to fibrosis and potentially cirrhosis, liver failure, and hepatocellular carcinoma, and is one of the most common causes of liver disease worldwide. NAFLD has also been implicated in other medical conditions such as insulin resistance, obesity, metabolic syndrome, hyperlipemia, hypertension, cardiovascular disease, and diabetes. Continuous hyperglycemia has been implicated in the pathogenesis of diabetic micro- and macro-vascular complications via various metabolic pathways, and numerous hyperglycemia-induced metabolic and hemodynamic conditions exist, including the increased generation of various types of advanced glycation end-products (AGEs). We recently demonstrated that glyceraldehyde-derived AGEs (Glycer-AGEs), the predominant components of toxic AGEs (TAGE), played an important role in the pathogenesis of angiopathy in diabetic patients. Moreover, a growing body of evidence suggests that the interaction between TAGE and the receptor for AGEs may alter intracellular signaling, gene expression, and the release of pro-inflammatory molecules and also elicits the generation of oxidative stress in numerous types of cells including hepatocytes and hepatic stellate cells. Serum levels of TAGE were significantly higher in NASH patients than in those with simple steatosis and healthy controls. Moreover, serum levels of TAGE inversely correlated with adiponectin (adiponectin is produced by adipose tissue and is an anti-inflammatory adipokine that can increase insulin sensitivity). Furthermore, immunohistochemical staining of TAGE showed intense staining in the livers of patients with NASH. Serum levels of TAGE may be a useful biomarker for discriminating NASH from simple steatosis. The administration of atorvastatin (10 mg daily) for 12 months significantly improved NASH-related metabolic parameters and significantly decreased serum levels of TAGE. The steatosis grade and NAFLD activity score were also significantly improved. These results demonstrated that atorvastatin decreased the serum levels of TAGE in NASH patients with dyslipidemia and suggest the usefulness of TAGE as a biomarker for the attenuation of NASH. Serum levels of TAGE were significantly higher in non-B or non-C hepatocellular carcinoma (NBNC-HCC) patients than in NASH subjects without HCC or control subjects. TAGE may be involved in the pathogenesis of NBNC-HCC, and could, therefore, be a biomarker that could discriminate NBNC-HCC from NASH. We propose that serum levels of TAGE are promising novel targets for the diagnosis of and therapeutic interventions against NASH.

Spontaneous redox synthesis and characterization of the tetrathiafulvalene-vanadium-substituted polyoxometalate charge-transfer material TTF4[SVW11O40]: comparison with the Mo analogue

Both conventional solution-phase and direct solid-solid redox reactions between tetrathiafulvalene (TTF) and the vanadium-substituted polyoxometalate (n-Bu4N)3[SV(V)W11O40] give rise to microcrystalline or powdered semiconducting charge transfer solid material. A single-crystal X-ray structure derived from growing crystals from a MeCN-CH2Cl2 solution-phase redox reaction gives a stoichiometry of TTF4[SVW11O40]·2H2O·2CH2Cl2 and reveals that there are two crystallographically different TTF cation moieties based on (TTF2)(2+) dimers. While the color and morphology of the microcrystalline or powdered TTF4[SVW11O40] differ from the single crystals prepared for structural analysis, all materials are spectroscopically (infrared (IR), Raman with respect to the TTF bands, and electron paramagnetic resonance (EPR)) indistinguishable. Raman spectra suggest that the charge transfer is unevenly distributed across the (TTF2)(2+) dimers, which is postulated to give rise to enhanced mixed-valence features. Structural, spectral, and other properties, such as conductivity, are compared with results available on the recently published molybdenum TTF4[SVMo11O40]·2H2O·2CH2Cl2 analogue, where the charge distribution is uniform on all TTF cations. In both examples, the position of the V atom is located over several sites. Elemental analysis and voltammetric data also are consistent with the formulations deduced from structural and spectroscopic studies. The conductivity at room temperature is in the semiconducting range, but significantly greater than that for the Mo analogue. EPR spectra at temperatures down to the liquid helium regime confirm the presence of paramagnetic V(IV) and paramagnetic oxidized TTF. The newly isolated TTF-SV(IV)W11O40 material also has magnetic functionality derived from the cationic and anionic components.

Regioselectivity in Sulfation of Galactosides by Sulfuric Acid and Dicyclobexylcarbodi-imide

Methyl alpha- and beta-D-galactopyranosides and 4-O-beta-D-galactopyranosyl-3,6-anhydro-L-galactose dimethylacetal were sulfated with sulfuric acid and dicyclohexylcarbodiimide as a condensation reagent. The sulfated sugars were isolated by ion-exchange chromatography, characterized, and assigned by methylation analyses. On the basis of the yield of each sulfated product that was isolated, sulfation on O-6 appeared to be predominant.

Synthesis and characterization of novel Wells-Dawson-type mono vanadium(V)-substituted tungsto-polyoxometalate isomers: 1- and 4-[S2VW17O62](5-)

Two vanadium(V)-substituted tungsto-polyoxometalate isomers, 1- and 4-[S2VW17O62](5-), were prepared as their tetra-alkyl ammonium salts from a W(VI)-H2SO4-V(V) reaction mixture in aqueous CH3CN solution. X-ray crystallographic structural analysis revealed that both isomers have a Wells-Dawson-type structure with a higher occupancy of vanadium at polar sites and belt sites for 1- and 4-[S2VW17O62](5-), respectively. The isomers were also characterized by elemental analysis, infrared, Raman, UV-vis, and (51)V NMR spectroscopies as well as voltammetry, and the data obtained were compared with that derived from [S2W18O62](4-). Significantly, the reversible potentials for the vanadium(V/IV) couple for both 1- and 4-[S2VW17O62](5-) in CH3CN (0.1 M n-Bu4NPF6) are considerably more positive than the tungstate reduction process exhibited by the [S2W18O62](4-) framework, implying that the presence of vanadium should be useful in catalytic reactions. The one-electron-reduced [S2V(IV)W17O62](6-) forms of both isomers were prepared in solution by controlled potential bulk electrolysis and characterized by voltammetry and EPR spectroscopy.

Effects of eplerenone on the activation of matrix metalloproteinase-2 stimulated by high glucose and interleukin-1β in human cardiac fibroblasts

The aim of this study was to determine the influence of high glucose (HG) and interleukin (IL)-1β on human cardiac fibroblast (HCF) functions, and to evaluate the effects of eplerenone in these responses. HCFs were cultured in normal or HG media in the absence or presence of IL-1β and/or eplerenone. We assessed matrix metalloproteinase-2 (MMP-2) activity in the supernatant by in-gel zymography, and determined mRNA expression levels of MMP-2 and tissue inhibitor of metalloproteinase-2 (TIMP-2) by reverse transcription-polymerase chain reaction. Equimolar D-mannitol was used as an osmotic control. HG stimulated MMP-2 activity and promoted MMP-2 mRNA synthesis. Increased effects were also observed in equimolar D-mannitol treatments, but these effects were weaker compared to those of glucose. The combination of HG and IL-1β resulted in a 2-fold increase in MMP-2 activity and mRNA expression compared with HG or IL-1β alone. Increases in HG- or IL-1β-induced MMP-2 activity and mRNA expression were blocked by eplerenone. Neither HG nor IL-1β affected TIMP-2 mRNA expression. HG increased MMP-2 activity by regulation of MMP- 2 mRNA expression in HCFs through osmotic and non-osmotic pathways. Synergistic effects of IL-1β added to HG media on MMP-2 activity and mRNA expression were observed in HCFs. Eplerenone normalized the effect of MMP-2 activity and HG- or IL-1β-induced expression in HCFs.