[A Case of Mediastinal Small Cell Lung Cancer in a Patient Receiving Mechanical Ventilation Who Was Successfully Treated with Chemotherapy and Finally Extubated]

BACKGROUND

The efficacy and safety of chemotherapy for patients with lung cancer who are in need of intensive care, such as invasive mechanical ventilation, have not been established.

CASE

A 59-year-old woman consulted a doctor with complaints of dyspnea.She was intubated because of acute respiratory failure and transferred to our hospital.Enhanced CT images revealed advanced stenosis of her trachea due to a bulky mediastinal tumor.Cervical lymph node biopsy was performed, and she was diagnosed with mediastinal small cell lung cancer.She received combination chemotherapy with carboplatin and etoposide along with invasive mechanical ventilation.Chemotherapy was effective, and extubation was performed under careful bronchoscopic observation.Her general condition improved gradually, and she was discharged from our hospital on foot with ambulatory chemotherapy.

CONCLUSION

Even though patients with lung cancer develop respiratory failure and need invasive mechanical ventilation, they may be treated with effective chemotherapy and may be weaned from ventilation.

Studies of Fibrinogen Metabolism in Healthy and Hypertensive Female Subjects with the Use of Autologous I-125-Fibrinogen

10 healthy female subjects and 15 female patients with essential hypertension were studied with respect to fibrinogen metabolism in a steady state. Autologous I-125-labeled fibrinogen (I-125-fibrinogen) was used as a tracer. Comparison of the results showed that plasma volume, t½ of plasma I-125-fibrinogen and fractional catabolic rate (j3p) of plasma fibrinogen were not appreciably different in both groups of subjects, but plasma fibrinogen concentration, and catabolic flux of (synthesis rate) were significantly higher in hypertensive subjects, whereas extravascular fibrinogen and fractional transcapillary transfer rate (j1) of were significantly decreased in the patients. Further analyses of the data in both groups showed that there were significant correlations between diastolic blood pressure (P) and j1 with a regression equation of j1 = e−0.0285P, between 1 and between and j1 with a regression equation of 1. These results indicate that the observed decrease of j1 triggered the transition from normal to pathological steady state and is responsible for the altered metabolism and distribution of fibrinogen in hypertensive subjects.

Effects of Heparin, Typhoid Vaccine and Thrombophlebitis on Factor X Metabolism in the Dog

Studies were made of the effects of heparin, typhoid vaccine and thrombophlebitis on factor X (F.X) metabolism in dogs, using 125-labelled F.X (125I-F.X) as a tracer. 10 healthy male dogs were used for control study and 5 male dogs were used for each of other studies. Plasma F.X concentration was measured by a solid-phase radioimmunoassay. In the control dogs, the plasma F.X concentration was 2.4 ± 0.2 (SD) mg per dl, the plasma F.X (x) was 1.2 ± 0.1(SD) mg per kg, the halflife of plasma 125I-F.X(t½) was 0.5 ± 0.01 (SD) days, the fractional catabolic rate (j3p) was 2.4 ± 0.1 (SD) per day and the catabolic flur (J3pX) (synthesis rate) was 2.9 ± 0.7 (SD) mg per kg per day. These results were not appreciably altered in heparinized dogs. However, a single intravenous injection of 2 ml typhoid vaccine caused a shortened t½ of 0.38 ± 0.01 (SD) days and a decrease of plasma F.X concentration to 1.3 ± 0.13 (SD) mg per dl. Studies in heparinized dogs showed similar effects of typhoid vaccine. Next, thrombophlebitis was produced by a previous method and its effects on F.X metabolism were studied. No detectable alterations of F.X metabolism were found. These results indicate that in health most F. X is directly catabolized without the formation of activated F.X (F.Xa), that the observed effects of typhoid vaccine are mostly due to an acceleration of the direct catabolism of F.X without F.Xa formation and finally that localized thrombophlebitis has no appreciable effects on F.X metabolism.

Studies of Heparin Affinity to Antithrombin III and Other Proteins in Vitro and in Vivo

Properties of human, canine, and porcine heparin and S-35-heparin were first studied. Their electrophoretic mobility through 10 g % polyacrylamide gels, specific activity and their filtration patterns through Sephadex G-200 columns were closely similar. Then, S-35-heparin (0.5 mg) and cold heparin (27 mg) were simultaneously injected intravenously into 5 dogs and their plasma behavior was compared. The plasma half-lives of S-35-heparin averaged 1.18 ± 0. 13 (SD) hr and was identical with that of cold heparin, but the half-lives were much shorter and averaged 0.46 ± 0.08 (SD) hr in 5 dogs when S-35-heparin alone was injected. Studies were next made of heparin affinity to proteins including canine antithrombin III (AT) by the use of Sephadex G-200 chromatography, polyacrylamide gel electrophoresis, and S-35-heparin as a tracer. It was found that S-35-heparin-binding to alpha1, beta, and gammaglobulins and fibrinogen was readily separable upon addition of 5 mg cold heparin, but that the binding to AT was inseparable by addition of cold heparin or by electrophoresis. However, in canine plasma, both S-35-heparin and cold heparin were mostly bound to proteins other than AT, suggesting that this might be the case in vivo. To further substantiate this, studies were made of the comparative behavior of I-125-labeled AT (I-125-AT) and S-35-heparin in dogs with the idea that the plasma half-lives of both should be equal if they were irreversibly bound to each other. The plasma half-lives of I-125-AT averaged 2.10 ± 0.05 (SD) days in 5 male dogs and 1.99 ± 0.04 (SD) days in 5 female dogs, and were much different from the half-life values of S-35-heparin as given above. These results indicate that heparin in vitro is more tightly bound to AT than to other proteins, that heparin in vivo is not irreversibly bound to AT and suggest that it is mostly bound to proteins other than AT in vivo.

Studies of the Effects of Estradiol, Progesterone, Cortisol, Thrombophlebitis, and Typhoid Vaccine on Synthesis and Catabolism of Antithrombin III in the Dog

Effects of estradiol, progesterone, Cortisol, thrombophlebitis and typhoid vaccine on the synthesis and catabolism of antithrombin III (AT) in dogs were studied, using I-125-labeled AT (I-125-AT) as a tracer. Five dogs were used for each study. A single intramuscular injection of 20 mg estradiol caused a 20% decrease of plasma AT concentration in 6 days without appreciable changes in the plasma half-lives of I-125-AT but with a significant decrease in the fractional catabolic rate of I-125-AT (j3u). A single intramuscular injection of 250 mg progesterone did not produce any appreciable changes of plasma AT concentration, the plasma half-lives of I-125-AT or j3u. On the other hand, intravenous and intramuscular injections of a total of 750 mg Cortisol caused a 17 % increase of plasma AT concentration in a day after the injections without alterations of the plasma half-lives of I-125-AT or j3u. Next, thrombophlebitis was produced in dogs by a single intravenous injection of 1 ml 90% phenol into a leg vein occluded for 1 min by a gauze tourniquet and the effects of thrombophlebitis were studied. The results indicated that it did not cause appreciable changes of plasma AT concentration, the plasma half-lives of I-125-AT or j3u. However, studies of the effects of a single intravenous injection of 3 ml typhoid vaccine showed a 25 % decrease of plasma AT concentration in a day after the injection with a moderate acceleration of the decline rate of plasma I-125-AT and a 14% increase in j3u values. Further studies in heparinized dogs showed similar effects with typhoid vaccine. These results indicate that estradiol causes a decreased rate of AT synthesis, that progesterone has no appreciable effects on AT metabolism, that Cortisol increases the rate of AT synthesis, that localized thrombophlebitis has no appreciable effects on AT metabolism and that typhoid vaccine causes an increased j3u by unknown mechanisms which is not an accelerated coagulation process.

Properties of Human Tissue Thromboplastins from Brain, Lung, Arteries, and Placenta

Properties of purified and delipidated human tissue thromboplastins (TTPs) from brain (BTTP), lung (LTTP), arteries (ATTP) and placenta (PTTP) were studied. The extinction coefficients were closely similar with a mean value of 8.3 ± 0.01 (SD). The molecular weights were 200,000 ± 3,000 (SD) (BTTP), 90,000 ± 2,000 (SD) (LTTP), 110,000 ± 3,000 (SD) (ATTP) and 250,000 ± 4,000 (SD) (PTTP). The maximum activity of each delipidated TTP after relipidation was obtained when phospholipid-delipidated TTP ratio was 2.0, and the maximum specific activity was 440 units per mg BTTP, 270 units per mg LTTP, 80 units per mg ATTP and 600 units per mg PTTP. Ouchterlony analysis with anti-delipidated PTTP antibody showed the reaction of partial identity between delipidated TTPs and the antibody. Studies of the reactivity of I-125-delipidated TTPs with the antibody gave the following average values for % bound I-125-TTPs in 2 hours: 3.6± 0.2 (SD) % (I-125-BTTP), 11.0± 0.3 (SD) % (I-125-LTTP), 4.4±0.2 (SD) % (I-125-ATTP) and 13.7±0.3 (SD) % (I-125-PTTP). It was also found that the antibody markedly neutralized the coagulant activity of saline extracts of brain, lung and placenta. These results indicate that delipidated BTTP, LTTP, ATTP and PTTP are different while being similar in some aspects and that complete TTPs are not coated with lipids in a manner inaccessible to anti-delipidated PTTP antibody.

Studies of the Metabolism and Distribution of Prothrombin in Healthy Men with Homologous 125I-Prothrombin

A method was described for preparation of purified human prothrombin using repeated barium citrate adsorption and citrate elution, (NH4)2S04 fractionation, Sephadex chromatography and isoelectric precipitation. The produced prothrombins were then physicochemically analyzed. The extinction coefficient was 12.7 ± 0.82 (SD) and the specific activity, 2,563 ± 420 (SD) Iowa units per mg prothrombin. The amino acid composition in g% was as follows: aspartic acid, 8.64; threonine, 5.87; serine, 4.16; glutamic acid, 11.15; proline, 3.91; glycine, 3.96; alanine, 4.65; half cystine, 4.68; valine, 4.46; methionine, 1.14; isoleucine, 2.93; leucine, 6.18; tyrosine, 4.52; phenylalanin, 4.19; lysine, 4.78; histidine, 1.73; ammonia, 1.85; arginine, 6.91. The tryptophan and carbohydrate contents were not determined. The prothrombins were then labeled with 125I in a ratio of about 0.25 atom iodine per molecule of prothrombin and were used for studies of the metabolism and distribution of prothrombin in thirteen healthy men. A model was proposed for the human prothrombin system based on the assumptions that prothrombin is catabolized intravascularly without the formation of thrombin, and was tested against the observed behavior of injected 125I- prothrombin. The model closely predicted the observed behavior of 125I-prothrombin. The analytical results of the tracer data in thirteen healthy men by the methods derived from the model were as follows: The plasma prothrombin, 6.65 ± 1.10 (SD) mg per kg; the interstitial prothrombin, 6.0 ^ 1.9 (SD) mg per kg; the half-life of plasma 125I-prothrombin, 2.29 ± 0.14 (SD) days ; the transcapillary transfer rate of prothrombin, 10.2 ± 3.9 (SD) mg per kg per day; and the catabolic (synthetic) rate of prothrombin, 4.3 J: 1.0 (SD) mg per kg per day. These results support the concept that in healthy men prothrombin is degraded in plasma or spaces in rapid exchange with it generation of appreciable amounts of thrombin.

Lysosomal Protein Lamtor1 Controls Innate Immune Responses via Nuclear Translocation of Transcription Factor EB

Amino acid metabolism plays important roles in innate immune cells, including macrophages. Recently, we reported that a lysosomal adaptor protein, Lamtor1, which serves as the scaffold for amino acid-activated mechanistic target of rapamycin complex 1 (mTORC1), is critical for the polarization of M2 macrophages. However, little is known about how Lamtor1 affects the inflammatory responses that are triggered by the stimuli for TLRs. In this article, we show that Lamtor1 controls innate immune responses by regulating the phosphorylation and nuclear translocation of transcription factor EB (TFEB), which has been known as the master regulator for lysosome and autophagosome biogenesis. Furthermore, we show that nuclear translocation of TFEB occurs in alveolar macrophages of myeloid-specific Lamtor1 conditional knockout mice and that these mice are hypersensitive to intratracheal administration of LPS and bleomycin. Our observation clarified that the amino acid-sensing pathway consisting of Lamtor1, mTORC1, and TFEB is involved in the regulation of innate immune responses.

Relationship between arthroscopic findings of synovitis and levels of tumour necrosis factor-alpha and matrix metalloproteinases in synovial lavage fluid from patients with unilateral high mandibular condyle fractures

Arthrocentesis has an effect of washing out inflammatory products that accumulate in the joint compartment of a dysfunctional temporomandibular joint (TMJ). The procedure removes inflammatory cytokines, which are pain-causing substances, for early reduction of TMJ pain and quick recovery of jaw function, thus increasing the possibility of a successful rehabilitation. The aim of this study was to investigate the relationship between arthroscopy synovitis grade in patients with unilateral high condylar fractures and concentrations of the pro-inflammatory cytokines tumour necrosis factor (TNF)-alpha as well as of matrix metalloproteinases (MMPs) in washed-out synovial fluid (SF) samples obtained from those patients. A total of 26 patients with unilateral high condylar fractures who underwent arthrocentesis for a therapeutic purpose were examined. SF samples were collected before performing arthroscopy to determine synovitis grade. The detection rates and concentrations of TNF-alpha and MMPs were determined, and their association with synovitis grade was analysed. TNF-alpha was detected in 23 and MMP-3 in 22 of the TMJs. There was a correlation between synovitis grade and concentration of TNF-alpha in the fracture group. Furthermore, the concentrations of TNF-alpha and MMP-3 were significantly higher as compared to the control group, comprised of TMJs on the non-fracture side of the same patients, while a correlation was also noted between TNF-alpha concentration and synovitis grade in the fracture group. The present findings may provide a biological/biochemical rationale for arthrocentesis as a reasonable treatment modality for high condylar fractures.

Double deletion of tetraspanins CD9 and CD81 in mice leads to a syndrome resembling accelerated aging

Chronic obstructive pulmonary disease (COPD) has been recently characterized as a disease of accelerated lung aging, but the mechanism remains unclear. Tetraspanins have emerged as key players in malignancy and inflammatory diseases. Here, we found that CD9/CD81 double knockout (DKO) mice with a COPD-like phenotype progressively developed a syndrome resembling human aging, including cataracts, hair loss, and atrophy of various organs, including thymus, muscle, and testis, resulting in shorter survival than wild-type (WT) mice. Consistent with this, DNA microarray analysis of DKO mouse lungs revealed differential expression of genes involved in cell death, inflammation, and the sirtuin-1 (SIRT1) pathway. Accordingly, expression of SIRT1 was reduced in DKO mouse lungs. Importantly, siRNA knockdown of CD9 and CD81 in lung epithelial cells additively decreased SIRT1 and Foxo3a expression, but reciprocally upregulated the expression of p21 and p53, leading to reduced cell proliferation and elevated apoptosis. Furthermore, deletion of these tetraspanins increased the expression of pro-inflammatory genes and IL-8. Hence, CD9 and CD81 might coordinately prevent senescence and inflammation, partly by maintaining SIRT1 expression. Altogether, CD9/CD81 DKO mice represent a novel model for both COPD and accelerated senescence.