Matrix metalloproteinase‑1 and microRNA‑486‑5p in urinary exosomes can be used to detect early lung cancer: A preliminary report

The present study describes a novel molecular-genetic method suitable for lung cancer (LC) screening in the work-place and at community health centers. Using urinary-isolated exosomes from 35 patients with LC and 40 healthy volunteers, the expression ratio of MMP-1/CD63, and the relative expression levels of both microRNA (miRNA)-21 and miRNA-486-5p were measured. MMP-1/CD63 expression ratio was significantly higher in patients with LC than in the healthy controls {1.342 [95% confidence interval (CI): 0.890-1.974] vs. 0.600 (0.490-0.900); P<0.0001}. The relative expression of miRNA-486-5p in male healthy controls was significantly different from that in female healthy controls, whereas there was no significant difference in miRNA-21. Receiver operating characteristic curve (ROC) analysis of MMP-1/CD63 showed 92.5% sensitivity and 54.3% specificity, whereas miRNA-486-5p showed 85% sensitivity and 70.8% specificity for men, and 70.0% sensitivity and 72.7% specificity for women. The logistic regression model used to evaluate the association of LC with the combination of MMP-1/CD63 and miRNA-486-5p revealed that the area under the ROC curve was 0.954 (95% CI: 0.908-1.000), and the model had 89% sensitivity and 88% specificity after adjusting for age, sex and smoking status. These data suggested that the combined analysis of MMP-1/CD63 and miRNA-486-5p in urinary exosomes may be used to detect patients with early-stage LC in the work-place and at community health centers, although confirmational studies are warranted.

Palivizumab prophylaxis in preterm infants and subsequent wheezing/asthma: 10-year follow-up study

BACKGROUND

Respiratory syncytial virus (RSV) causes not only infantile recurrent wheezing but also the development of asthma. To investigate whether palivizumab, an anti-RSV monoclonal antibody, prophylaxis given to preterm infants during the first RSV season reduces the incidence of subsequent recurrent wheezing and/or development of asthma, at 10 years of age.

METHODS

We conducted an observational prospective multicenter (52 registered hospitals in Japan) case-control study in preterm infants with a gestational age between 33 and 35 weeks followed for 6 years. During the 2007-2008 RSV season, the decision to administer palivizumab was made based on standard medical practice (SCELIA study). Here, we followed these subjects until 10 years of age. Parents of study subjects reported the patients' physician's assessment of recurrent wheezing/asthma, using a report card and a novel mobile phone-based reporting system using the internet. The relationship between RSV infection and asthma development, as well as the relationship between other factors and asthma development, were investigated.

RESULTS

Of 154 preterm infants enrolled, 113 received palivizumab during the first year of life. At 10 years, although both recurrent wheezing and development of asthma were not significantly different between the treated and untreated groups, maternal smoking with aeroallergen sensitization of the patients was significantly correlated with physician-diagnosed asthma.

CONCLUSIONS

In contrast to the prior study results at 6 years, by 10 years palivizumab prophylaxis had no impact on recurrent wheezing or asthma, but there was a significant correlation between maternal passive smoking with aeroallergen sensitization and development of asthma by 10 years of age.

Lung sound analysis for predicting recurrent wheezing in preschool children

Background

In young healthy children, assessing airflow limitation may be difficult because of narrowing of the airways, which is a pathology of asthma, and responsiveness to bronchodilators.

Objective

We investigated whether lung sound analysis could predict the development of recurrent wheezing (RW), which is one of the signs of asthma.

Methods

In healthy children aged 3 to 24 months, we recorded and analyzed lung sounds before and after inhalation of bronchodilators and conducted a questionnaire survey. The children were followed up and assessed for the development of RW at age 3 years.

Results

Of the 62 patients analyzed, 19 (30.6%) developed RW. The parameters ratio of power and frequency at 50% of the highest frequency of the dB power spectrum (RPF50) and ratio of power and frequency at 75% of the highest frequency of the dB power spectrum (RPF75), calculated by lung sound analysis, were lower in the RW group, with odds ratios of 0.77 (95% CI = 0.61-0.98) and 0.81 (95% CI = 0.66-0.99), respectively. The rate of change of lung sound analysis parameters after bronchodilator inhalation did not differ among the participants as a group; however, in the subgroup of children with a history of atopic dermatitis, the fourth area under the curve (B4) divided by the total area under the curve of 100 Hz to the highest frequency of the dB power spectrum (AT) and difference between the values of the ratio of power and frequency at 50% of the highest frequency of the dB power spectrum (ΔRPF50) were elevated in the RW group (P = .015 and P = .041, respectively). In the subgroup of children with total a IgE level greater than 20 kUA/L, the sensitivities and specificities for predicting the development of RW were 85.7% (95% CI = 48.7-99.3) and 68.8% (95% CI = 44.4-85.8), respectively, when the cutoff value of ΔRPF50 was set at 10.5%.

Conclusion

The method of lung sound analysis allows noninvasive assessment of the airway, including airway hypersensitivity, in young children and may predict the risk of development of RW.

Effect of wheeze and lung function on lung sound parameters in children with asthma

BACKGROUND

In children with asthma, there are many cases in which wheeze is confirmed by auscultation with a normal lung function, or in which the lung function is decreased without wheeze. Using an objective lung sound analysis, we examined the effect of wheeze and the lung function on lung sound parameters in children with asthma.

METHODS

A total of 114 children with asthma (males to females = 80: 34, median age 10 years old) were analyzed for their lung sound parameters using conventional methods, and wheeze and the lung function were checked. The effects of wheeze and the lung function on lung sound parameters were examined.

RESULTS

The patients with wheeze or decreased forced expiratory flow and volume in 1 s (FEV1) (% pred) showed a significantly higher sound power of respiration and expiration-to-inspiration sound power ratio (E/I) than those without wheeze and a normal FEV1 (% pred). There was no marked difference in the sound power of respiration or E/I between the patients without wheeze and a decreased FEV1 (% pred) and the patients with wheeze and a normal FEV1 (% pred).

CONCLUSIONS

Our data suggest that bronchial constriction in the asthmatic children with wheeze similarly exists in the asthmatic children with a decreased lung function. A lung sound analysis is likely to enable an accurate understanding of airway conditions.

Shoulder function after neck dissection with level IIb preservation: a prospective observational study

BACKGROUND

Shoulder syndrome can be reduced by preserving the spinal accessory nerve (SAN). However, it is unclear whether performing level IIb preservation will decrease the risk of SAN injury and shoulder syndrome.

AIMS/OBJECTIVES

We investigated whether neck dissection with level IIb preservation can reduce shoulder dysfunction and postoperative quality of life (QOL) in head and neck cancer patients.

MATERIAL AND METHODS

This prospective observational study enrolled patients who underwent neck dissection from 2011 to 2014. Patients were divided into three groups (level IIb preservation group [group 1], IIb dissection group [group 2], and IIb and V dissection group [group 3]). Postoperative shoulder function and QOL were evaluated among the three groups.

RESULTS

There were a total of 35 neck sides in three groups, with nine neck sides in group 1, 16 neck sides in group 2, and 10 neck sides in group 3. Although the results showed less shoulder dysfunction in group 1 at early postoperative period. The QOL in group 1 was preserved in the early postoperative period.

CONCLUSIONS AND SIGNIFICANCE

Neck dissection with level IIb preservation may help reduce shoulder syndrome and maintain QOL in the early postoperative period.

Risk of Sports-associated Long-range Airborne Transmission of SARS-CoV-2: A Mathematical Modeling Study

OBJECTIVE

The worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants remains a health threat. As sports event-related outbreaks due to long-range airborne transmission in ventilation have been reported, the present study aimed to quantify infection risk using available data and apply the results to an outbreak in an ice hockey arena.

METHODS

A mathematical modeling approach was used to estimate the risk of airborne infection.

RESULTS

A quantum was defined as the dose of airborne droplet nuclei required to cause infection in 63% of susceptible persons. The estimated quanta emission rate per infector showed a log-normal distribution with a geometric mean (GM) of 28.81, geometric deviation (GD) of 5.78, and median of 22.65 quanta/h. The estimated average time-average quanta concentration (C_avg; quanta/m³) showed a log-normal distribution with a GM of 0.08, GD of 5.80, and median of 0.06. The outdoor ventilation rate per infected person for the scenario showed a log-normal distribution with a GM of 710.96, GD of 6.22, and median of 169.17 m³/h. A higher C_avg value indicated exposure to SARS-CoV-2 due to the lower ventilation rate in the a rena a nd the large expiratory volume of athletes caused by intensive exercise.

Clinical application of a lung sound analysis in infants with respiratory syncytial virus acute bronchiolitis

BACKGROUND

Objective investigation of the characteristics of acute bronchiolitis in infants is important for its diagnosis and treatment.

METHODS

Lung sound data of 50 patients diagnosed with respiratory syncytial virus (RSV) acute bronchiolitis (m:f = 29:21, median of age 7 months), 20 patients with RSV acute respiratory tract infections without acute bronchiolitis (m:f = 10:10, 5 months) and 38 age-matched control infants (m:f = 23:15, 8 months) were analyzed using a conventional method and compared. Furthermore, the relationships between lung sound parameters and clinical symptoms (clinical score, length of hospital stay and SpO2 level) in the bronchiolitis and the non-bronchiolitis patients were examined.

RESULTS

Results of lung sound analysis showed that the inspiratory sound power of patients with RSV respiratory tract infections was low and the expiratory sound power was high compared with those of the controls. When the patients with RSV respiratory tract infections were divided into the bronchiolitis and non-bronchiolitis groups, the expiratory/inspiratory ratio of the bronchiolitis patients was greater than that of the non-bronchiolitis patients. There was no difference in the clinical symptoms, clinical score and length of hospital stay between the bronchiolitis and non-bronchiolitis patients, except for the SpO2 level on admission.

CONCLUSION

Lung sound analysis confirmed that patients with RSV acute bronchiolitis present with marked airway narrowing. Considering these results as a characteristic of acute bronchiolitis, it would be meaningful to reflect it in the improvement of diagnosis, treatment and subsequent management.

Breath sound analyses of infants with respiratory syncytial virus acute bronchiolitis

INTRODUCTION

The reliability of a breath sound analysis using an objective method in infants has been reported.

OBJECTIVE

Breath sounds of infants with respiratory syncytial virus (RSV) acute bronchiolitis were analyzed via a breath sound spectrogram to evaluate their characteristics and examine their relationship with the severity.

SUBJECTS AND METHODS

We evaluated the inspiratory and expiratory breath sound parameters of 33 infants diagnosed with RSV acute bronchiolitis. The sound powers of inspiration and expiration were evaluated at the acute phase and recovery phase of infection. Furthermore, the relationship between the breath sound parameters and the clinical severity of acute bronchiolitis was examined.

RESULTS

Analyses of the breath sound spectrogram showed that the power of expiration as well as the expiration-to-inspiration sound ratio in the mid-frequency (E/I MF) was increased in the acute phase and decreased during the recovery phase. The E/I MF was inversely correlated with the SpO₂ and positively correlated with the severity score.

CONCLUSION

In infants with RSV acute bronchiolitis, the sound power of respiration was large at the acute phase, significantly decreasing in the recovery phase. In 61% of participants, nonuniform, granular bands were shown in the low-pitched region of the expiratory spectrogram.

Characteristics of Breath Sounds During Methacholine-induced Bronchoconstriction in Children with Asthma

OBJECTIVE

The utility of an analysis of breath sounds as a non-invasive lung function test in children and adults has been studied. Analyzing specific breath sounds during methacholine inhalation challenge is useful for evaluating airway constriction in asthmatic patients.

PATIENTS AND METHODS

The study population included 57 children with atopic asthma (male: female = 38: 19; median age, 10 years [range, 5-16 years]). The breath sound spectrum was measured before a methacholine inhalation test, just after the methacholine inhalation challenge and after β₂ agonist inhalation. The values of breath sound parameters were analyzed and the direct changes of the sound spectrum during methacholine inhalation challenge were evaluated.

RESULTS

The values of breath sound parameters, RPF₇₅ and RPF₅₀, were significantly decreased after methacholine inhalation (P < 0.001, p < 0.001, respectively), indicationg bronchoconstriction, and increased after β₂ agonist inhalation (P < 0.001, p < 0.001, respectively), indicating bronchodilation. The high-pitch area of the sound spectrum curve around 1,500 Hz was significantly increased after methacholine inhalation (P < 0.001). The values returned to the baseline level after β₂ agonist inhalation.

CONCLUSIONS

Bronchoconstriction by methacholine inhalation induced a reversible high-pitch sound. The assessment of changes in the high-pitch area of the breath sound spectrum may be useful for the detection of airway narrowing in asthmatic patients.

Risk of Airborne Transmission During Home Isolation: A Modeling Study

OBJECTIVE

The worldwide pandemic of SARS-CoV-2 and its B.1.1.529 variant, Omicron, remain a threat to health. In Japan, self-isolation in a room at home has been recommended in some prefectures to reduce the burden on hospitals. With the aim of preventing the infection of family members in other rooms, this study quantified the risk of infection by airborne transmission to mask-wearing, non-infected members of the household.

METHODS

A mathematical modeling approach was used to estimate the risk of airborne infection.

RESULTS

For pre-SARS-CoV-2 variants of concern (VOC), the risk of infection of non-mask-wearing family members had an LN distribution with GM of 0.11, GD of 5.38, and median of 0.11; whereas that of mask-wearing members had an LN distribution with GM of 0.05, GD of 5.46, and median of 0.05. For Delta variant, the risk of infection of non-mask-wearing family members had an LN distribution with GM of 0.39, GD of 76.30, and median of 0.40, and that of mask-wearing members had an LN distribution with GM of 0.18, GD of 76.30, and median of 0.18. The difference of these medians was 0.22, which suggests that family members wearing masks is effective for preventing infection, even for highly infectious variants.

Descriptive study of chest x-ray examination in mandatory annual health examinations at the workplace in Japan

The utility of chest x-ray examination (CXR) in mandatory annual health examinations for occupational health is debatable in Japan. This study aimed to provide basic data to consider future policies for mandatory annual health examinations in the workplace. A nationwide descriptive survey was performed to determine the rate of detection of tuberculosis, lung cancer, and other diseases through CXR in organizations associated with National Federation of Industrial Health Association. The rate of finding on CXR conducted during annual health examinations in FY2016 was evaluated. Data regarding diagnosis based on follow-up examination findings were obtained and compared with the national statistics. In addition, CXR findings were compared with the results of low-dose lung computed tomography performed at the Hitachi Health Care Center. From 121 surveyed institutions, 88 institutions with 8,669,403 workers were included. For all ages, 1.0% of examinees required follow-up examination. Among 4,764,985 workers with diagnosis data, the tuberculosis detection rate was 1.8–5.3 per 100,000 persons. For Lung cancer, 3,688,396 workers were surveyed, and 334 positive cases were detected. The lung cancer detection rate using CXR was 9.1–24.4 per 100,000 persons. From 164 cases with information regarding the clinical stage, 72 (43.9%) had Stage I lung cancer. From 40,045 workers who underwent low-dose computed tomography multiple times, 31 lung cancer cases, all with Stage I disease, were detected (detection rate: 77.4 per 100,000 persons). Our findings suggest that CXR plays a little role in the detection of active tuberculosis. With regard to LC screening, the detection rate of LC by CXR was lower, approximately 50%, than the expected rate (41.0 per 100,000 persons) of LC morbidity based on the age–sex distribution of this study population. However, the role of CXR for LC screening cannot be mentioned based on this result, because assessment of mortality reduction is essential to evaluate the role.

Evaluation of Erastin as a Therapeutic Agent Under Hypoxic Conditions in Pancreatic Cancer Cells

BACKGROUND/AIM

In pancreatic cancer tissues, hypoxic areas exist due to poor blood flow. Attenuation of the pharmacological efficacy of existing anticancer drugs in these hypoxic areas necessitates the search for novel anticancer compounds. We aimed to determine whether erastin exhibits anticancer effects in a hypoxic environment.

MATERIALS AND METHODS

Pancreatic cancer cell lines were subjected to cobalt chloride, a hypoxia-mimicking agent. Cell viability assay, measurement of reactive oxygen species, and western blotting analysis were conducted to investigate the efficacy of erastin under hypoxic environments.

RESULTS

Erastin exhibited remarkable cytotoxicity and induced apoptosis under hypoxic conditions. Furthermore, erastin triggered the intracellular accumulation of reactive oxygen species in a hypoxic environment. Subsequent treatment with N-acetylcysteine, an antioxidant, markedly attenuated cytotoxicity, and apoptosis.

CONCLUSION

Erastin induces cell death by accumulation of intracellular reactive oxygen species and inducing apoptosis under hypoxic conditions, proving its potential for further development as a novel anticancer compound.

Lung sound analysis in infants with risk factors for asthma development

BACKGROUND AND OBJECTIVES

Using a lung sound analysis, the prognosis of asthma was investigated in infants with risk factors for asthma development by a long-term observation.

METHODS

A total of 268 infants were included (median age: 8 months old). The lung sound parameters (the ratio of the third and fourth area to the total area under the curve [A3/AT and B4/AT], and the ratio of power and frequency at 50% and 75% of the highest frequency [RPF50 and RPF75]) were evaluated at the first visit. At 3 years old, using a questionnaire, we examined the relationship between the lung sound parameters and risk factors of asthma development.

RESULTS

Among the 268 infants, 175 infants were in good health and 93 had a history of acute respiratory infection (ARI) within 7 days at the first visit. Among the 3- to 12-month-old infants with an ARI, the A3/AT, B4/AT values in those with a history of asthma/asthmatic bronchitis, atopic dermatitis, and atopy were smaller than in the infants without such histories. Among the 13- to 24-month-old infants with an ARI, the A3/AT and B4/AT values in those with a wheezing history were larger than in the infants without such a history.

CONCLUSIONS

The characteristics of the lung sounds in infants with risk factors for asthma development were demonstrated over long-term follow-up. Lung sound analyses may be useful for assessing the airway condition of infants.

AB0065 HGF/C-MET SIGNALING PROMOTE ANGIOGENESIS THROUGH CXCL16 IN RHEUMATOID ARTHRITIS

Background:

Hepatocyte growth factor (HGF) binds to the receptor tyrosine kinase c-Met and is a multifunctional cytokine that promotes processes such as cell proliferation, survival, differentiation, migration and angiogenesis [1]. We previously reported that HGF is produced by inflammation in the RA synovium, and activates monocyte migration to the synovium and promotes bone destruction through its own chemotactic effect and enhanced chemokine production in the synovium [2].

Objectives:

Therefore, we next aimed to determine the role of HGF in RA angiogenesis.

Methods:

The expression of HGF / c-Met in the serum and synovial tissues (STs) of RA patients and controls and human umbilical vein endothelial cells (HUVECs) was evaluated by ELISA and immunostaining. The effect of HGF/c-Met signaling on the promotion of CXCL16 production from HUVECs and RA fibroblast-like synoviocytes (FLSs) was determined by ELISA. To examine the role of HGF in angiogenesis, we performed in vitro Matrigel assays using HUVECs treated with HGF.

Results:

HGF in serum in treatment-naive RA patients was significantly higher than that in controls and HGF in serum in treatment-resistant RA showed a significant positive correlation with CXCL16. c-Met were expressed on vascular endothelial cells of RA STs and HUVECs. Stimulation of HUVECs with HGF dose-dependently increased CXCL16 production. c-Met signal inhibition by SU11274 suppressed TNF-α stimulation-enhanced CXCL16 production by RA FLSs in a dose-dependent manner. Furthermore, HGF induced HUVEC tube formation by 1.8-fold.

Conclusion:

HGF is produced by inflammation in the RA synovium, and activates angiogenesis through its own potent angiogenic effect and enhanced production of CXCL16 in the synovium. These results indicate that a strategy targeting c-Met signalling may be important for resolving treatment-resistant RA.

References:

[1]Nakamura T, Nishizawa T, Hagiya M, et al. Molecular cloning and expression of human hepatocyte growth factor. Nature. 1989 Nov 23;342(6248):440-3.

[2]Hosonuma M, Sakai N, Furuya H, et al. Inhibition of hepatocyte growth factor/c-Met signalling abrogates joint destruction by suppressing monocyte migration in rheumatoid arthritis. Rheumatology (Oxford). 2021 Jan 5;60(1):408-419.

Disclosure of Interests:

None declared

POS0429 INTERLEUKIN-4 ACTIVATES EOSINOPHILS AND CCR3-POSITIVE T HELPER CELLS MIGRATION TO FASCIA AND PROMOTES FIBROSIS IN EOSINOPHILIC FASCIITIS

Background:

Eosinophilic fasciitis (EF) is a rare disease that causes inflammation and fibrosis mainly in the fascia of the extremities with eosinophilia. It has been reported that the hypertrophied fascia in EF shows inflammatory cell infiltration by the lymphocytes and eosinophils and increased expression of fibrosis-related cytokines genes in fibroblast [1]. However, its pathophysiology in the fascia remains unresolved.

Objectives:

Therefore, we focused on fascial fibroblasts and aimed to determine the role of interleukin-4 (IL-4) in eosinophil and helper T cell infiltration and fibrosis in fascial fibroblast in EF.

Methods:

Fascial fibroblasts were obtained from fascia biopsy of a patient with EF, and were stimulated with pre- and post-treatment serum of a patient with EF and healthy control, followed by microarray to analyze gene expression. Fascial fibroblasts were stimulated with IL-4 10 ng/mL, and gene expression of IL-4 receptor and CCR3 ligands, CCL7 and CCL11 were measured by qPCR. Transforming growth factor (TGF) -β and periostin in the pre- and post-treatment serum of a patient with EF and conditioned medium of fascial fibroblasts stimulated with IL-4 were measured by ELISA. To examine the role of IL-4 in proliferation, we performed in proliferation assays using fascial fibroblasts treated with IL-4. CCR3-positive T cells in the fascial tissue of EF, dermatomyositis, and polymyositis patients were evaluated by immunostaining.

Results:

By microarray analysis, CCL7 and CCL11 expression of fascial fibroblasts stimulated with pre-treatment EF serum was higher than that in post-treatment EF serum and control serum. CCL7 and CCL11 mRNA in IL-4 stimulated facial fibroblasts were increased by 5.1-fold and 7.3-fold, respectively. TGF-β and periostin in IL-4 stimulated facial fibroblast conditioned medium were also increased. In addition, TGF-β and periostin in EF serum were gradually decreased by treatment for 4 and 10 weeks, compared to before treatment. Finally, fascial fibroblast proliferation was significantly increased by stimulation with IL-4. Furthermore, infiltration of CCR3-positive T cells was specific to the fascial tissue of EF.

Conclusion:

In EF, IL-4 enhances the production of CCR3 ligands, TGF-β, and periostin from fascial fibroblasts. As a result, it promotes the migration of eosinophils and CCR3-positive T helper cells to the fascia and fibrosis. These results suggest that inhibition of IL-4 pathway could be a novel strategy for eosinophilic fasciitis.

References:

[1]Igarashi A, Nashiro K, Kikuchi K, et al. Connective tissue growth factor gene expression in tissue sections from localized scleroderma, keloid, and other fibrotic skin disorders. J Invest Dermatol. 1996 Apr;106(4):729-33.

Disclosure of Interests:

None declared

Prediction of Potential Respiratory Tract Infection from SARS-CoV-2 Through Hand-to-face Contact Transmission

OBJECTIVE

The Ministry of Health of China reported a cluster of severe pneumonia cases of unknown etiology in Wuhan city, the cause of which was later identified as a novel coronavirus. However, the risk of infection through indirect transmission routes remains unclear.

METHODS

A mathematical modeling approach was used to estimate the risk of infection through hand-to-face contact. The probability of infection for various routes of transmission through face-touching behavior was then calculated.

RESULTS

The probabilities of infection through hand-to-mouth transmission from nonporous and porous environments had log-normal (LN) distributions with geometric means (GMs) of 0.0116 and 0.0002, geometric deviations (GDs) of 2.9822 and 3.5560, and medians of 0.0127 and 0.0002, respectively, while those through hand-to-nose transmission from nonporous and porous environments had LN distributions with GMs of 0.0006 and 0.0000, GDs of 43.2310 and 47.3372, and medians of 0.0009 and 0.0000, respectively. The probability of infection through hand-to-eye transmission from a nonporous environment had a beta distribution with α = 2.38803, β = 13.60457, a minimum of 0.0045, a maximum of 0.9021, and a median of 0.1179, while that from a porous environment had a Weibull distribution with a scale parameter of 0.0030, a shape parameter of 1.323, and a median of 0.0023.

CONCLUSION

SARS-CoV-2 infection will occur through hand-to-face contact via contaminated environment.

New Technique to Analyze the Breath Sound Spectrum in Children with Asthma

OBJECTIVE

Breath sound parameters have been reported as useful biomarkers for evaluating the airway condition.

METHODS

The reliability of breath sound analysis using an improved method was investigated. Eighty-three asthmatic children were included in the present study. After adjusting the 0 level based on the background noises of the breath sound spectrum, the total area under the curve of the dBm (A_T), the roll-off from 600-1200 Hz (Slope), the ratio of the third and fourth area to the A_T (A₃/A_T and B₄/A_T), and the ratio of power and frequency at 50% and 75% of the highest frequency (RPF₇₅ and RPF₅₀), were evaluated before and after β₂ agonist inhalation. Spirography and the forced oscillation technique were also used to evaluate all subjects.

RESULTS

Using the new method, A₃/A_T, B₄/A_T, RPF₇₅ and RPF₅₀, were significantly increased after β₂ agonist inhalation. The increase in A₃/A_T and B₄/A_T were significantly correlated with the increase in FEV₁ and FEE_25-75, and the increase in RPF₇₅ was reversibly correlated with that in R5-R20.

CONCLUSIONS

The spectrum curve indices using the adjusted 0 level can indicate bronchial dilation with β₂ agonist inhalation. These parameters may be useful for the assessment of bronchial reversibility in asthmatic children.

Randomized Controlled Trial of High-Flow Nasal Cannula in Preterm Infants After Extubation

OBJECTIVES

Our aim is to compare the efficacy and safety of high-flow nasal cannula (HFNC) against those of nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive-pressure ventilation (NIPPV) after extubation in preterm infants.

METHODS

This prospective, randomized, noninferiority trial was conducted in 6 tertiary NICUs. Infants born at <34 weeks who needed noninvasive ventilation after extubation were enrolled. We randomly assigned infants to an HFNC group when HFNC was used or to an NCPAP/NIPPV group when NCPAP or NIPPV was used. The primary outcome was treatment failure within 7 days after extubation. We then examined clinical aspects of treatment failure with HFNC use.

RESULTS

In total, 176 and 196 infants were assigned to the HFNC and NCPAP/NIPPV groups, respectively. The HFNC group showed a significantly higher rate of treatment failure than that of the NCPAP/NIPPV group, with treatment failure occurring in 54 infants (31%) compared with 31 infants (16%) in the NCPAP/NIPPV group (risk difference, 14.9 percentage points; 95% confidence interval, 6.2-23.2). Histologic chorioamnionitis (P = .02), treated patent ductus arteriosus (P = .001), and corrected gestational age at the start of treatment (P = .007) were factors independently related to treatment failure with HFNC use.

CONCLUSIONS

We found HFNC revealed a significantly higher rate of treatment failure than NCPAP or NIPPV after extubation in preterm infants. The independent factors associated with treatment failure with HFNC use were histologic chorioamnionitis, treated patent ductus arteriosus, and a younger corrected gestational age at the start of treatment.

A Lung Sound Analysis in Infants with Risk Factors for Asthma During Acute Respiratory Infection

Background: The parameters of lung sounds have been suggested as biomarkers of airway changes. Using a commercially available lung sound analyzer, we investigated the characteristics of the lung sounds in infants with acute respiratory infection (ARI). Methods: Infants with ARI who were 6 to 18 months of age were included in this study. The lung sound parameters, the ratio of the third area and fourth areas to the total area under the curve of the sound spectrum (A₃/A_T and B₄/A_T), and the ratio of power and frequency at 75% and 50% of the highest frequency of the power spectrum (RPF₇₅ and RPF₅₀) were evaluated. With an original Japanese questionnaire based on American Thoracic Society-Division of Lung Disease, the risk factors of asthma development in infants were examined. Results: One hundred ten infants with ARI and 248 infants in good health for comparison were included. All infants were completely analyzed, and then divided into 2 age groups for a stratification analysis (6-12 and 13-18 months). In the overall analysis, among infants with a history of wheezing, recurrent wheezing, allergy, and atopic dermatitis, the values of RPF₅₀ of infants with ARI were significantly lower compared with those without ARI. In the 6- to 12-month-old group, the RPF₅₀ values of atopy-positive infants with ARI were lower compared with those without ARI (P = 0.003). Conclusions: The lung sounds of the infants with asthma-developing risk factors were more affected by ARI than those of infants without risk factors. Analyzing the changes in the lung sounds induced by ARI may be useful for evaluating the characteristics of the airways in infants.

[EFFECT OF INSPIRATORY FLOW ON BREATH SOUND ANALYSIS IN CHILDREN WITH ASTHMA]

BACKGROUND

In order to determine the optimal breathing method for childhood lung sound analyses, it is important to study the effect of airflow on the parameters of lung sounds.

METHODS

Sixty-one well-controlled children with atopic asthma (median; 12 years) participated. After confirming that there was no wheezing or respiratory symptoms, the lung sound spectrums of the inspiratory flow before and after inhalation of a β₂ stimulant were analyzed. At the same time, their lung function was measured by a spirogram and the forced oscillation technique.

RESULTS

Before β₂ agonist inhalation, the area under the entire curve (A_T) and 99% frequency (F₉₉) in the lung sound of inspiratory flow around 2.0L/s due to slightly strong breathing were significantly higher than the lung sound of inspiratory flow around 1.0L/s due to rest breathing. However, no marked differences were observed in the lung sound parameters based on the lung sound spectrum. The improvement in the lung sound parameters after β₂ agonist inhalation was clearer at an inspiratory flow around 1.0L/s than that around 2.0L/s.

CONCLUSION

The present study showed that changes after β₂ agonist inhalation and the correlation with the lung function parameters were clear during resting breathing. This method may be used for the long-term montoring of children with asthma.

SAT0005 INHIBITION OF HEPATOCYTE GROWTH FACTOR/C-MET SIGNALING ABROGATES JOINT DESTRUCTION BY SUPPRESSING MIGRATION OF MONOCYTES TO SYNOVIUM IN RHEUMATOID ARTHRITIS

Background:

Hepatocyte growth factor (HGF), originally discovered as a mitogen of hepatocytes, binds to receptor-tyrosine kinase c-Met and has been shown to be a multi-functional cytokine that promotes processes such as cell proliferation, survival, differentiation, migration, and angiogenesis1. Since HGF/c-Met signaling also leads to tumorigenesis and cancer invasion, that has recently attracted attention as a target for anticancer agents2. However, in reports of rheumatoid arthritis (RA), though anti-inflammatory and antiangiogenic mechanisms related to HGF/c-Met signal inhibition have been reported, the role of HGF in RA bone destruction through monocyte migration remains unclear3.

Objectives:

To determine the expression of HGF in RA biological fluids, the role it plays in monocyte migration and the therapeutic effect of a savolitinib, a specific c-Met inhibitor, in arthritis model mice.

Methods:

HGF/c-Met expression in serum, synovial fluid (SF), and synovial tissues (STs) obtained from RA patients and control subjects, as well as RA fibroblast-like synoviocytes (FLSs) was evaluated by ELISA and immunostaining. To determine the function of HGF in RA SFs, we preincubated RA SFs with a neutralizing anti-HGF antibody and measured the ability of these SFs to induce the human acute monocytic leukemia cell line (THP-1) chemotaxis. Additionally, examinations of SKG mice treated with savolitinib (2.5 mg/kg/day) for 4 weeks were conducted.

Results:

HGF level in serum from RA patients was significantly higher as compared to the controls (930 ± 97 vs. 476 ± 97 pg/mL, p <0.01) and decreased by drug treatment for 24 weeks (1147 ± 284 vs. 539 ± 160 pg/mL, p <0.05). Additionally, HGF level in SF from RA patients was higher as compared to SF from osteoarthritis patients (1632 ± 366 vs. 566 ± 140 pg/mL, p <0.05). HGF and c-Met expressions were also noted in RA STs. Stimulation of RA-FLS with TNF-α increased HGF/c-Met expression in a concentration-dependent manner, and c-Met signal inhibition by SU11274 suppressed production of fractalkine/CX3CL1, CXCL16, and MIP-1α/CCL3 (mean 50%, 56%, 90%, respectively). When HGF was removed by immunoprecipitation, migration of THP-1 in RA-SF was suppressed (mean 23%). In SKG mice, savolitinib significantly suppressed ankle bone damage on µCT, with an associated reduction in number of tartrate-resistant acid phosphatase-positive osteoclasts.

Conclusion:

HGF is produced by inflammation in synovium associated with RA, and then activates monocyte migration to synovium tissue and promotes bone destruction through its own chemotactic effect as well as enhanced chemokine production. These results indicate that a strategy that targets c-Met signaling may be important for resolving bone destruction in RA.

References:

[1] Nakamura T, Nishizawa T, Hagiya M, Seki T, Shimonishi M, Sugimura A, Tashiro K, Shimizu S. Molecular cloning and expression of human hepatocyte growth factor. Nature. 1989 Nov 23;342(6248):440-3

[2] Lee D, Sung ES, Ahn JH, An S, Huh J, You WK. Development of antibody-based c-Met inhibitors for targeted cancer therapy. Immunotargets Ther. 2015 Feb 9;4:35-44.

[3] Koch AE, Halloran MM, Hosaka S, Shah MR, Haskell CJ, Baker SK, Panos RJ, Haines GK, Bennett GL, Pope RM, Ferrara N. Hepatocyte growth factor. A cytokine mediating endothelial migration in inflammatory arthritis. Arthritis Rheum. 1996 Sep;39(9):1566-75

Disclosure of Interests:

None declared

Changes in the Breath Sound Spectrum with Bronchodilator Inhalation in Asthmatic Children with Long-term Management

OBJECTIVE

Using a commercially available breath sound analyzer, the airway reversibility in asthmatic children during healthy periods was investigated.

METHODS

Fifty samples of 34 children with asthma (median age, 11 years; range, 6-16 years) who visited our hospital and whose lung function was normal were included. The breath sound parameters, the frequency limiting 99% of the power spectrum (F₉₉) and spectrum curve indices, the total area under the curve of the dBm data (A₃/A_T and B₄/A_T) and the ratio of power and frequency at 50% and 75% of the highest frequency of the power spectrum (RPF₇₅ and RPF₅₀) were evaluated before and after β₂ agonist inhalation.

RESULTS

The values of spectrum curve indices were significantly increased after β₂ agonist inhalation. The changes in these parameters were more marked than the changes in the FOT parameters. The changes in A₃/A_T and B₄/A_T were significantly related to two FOT parameters: R5-R20 and X5.

CONCLUSIONS

Our study suggested that significant changes in breath sound parameters were present in asthmatic children during the period of good control. A breath sound analysis may be useful for assessing the airway condition of asthmatic children during long-term management.

The Evaluation of Changes in the Breath Sound Spectrum with Bronchoconstriction and Bronchodilatation in Asthmatic Children

OBJECTIVE

Focusing on the relative-middle sound area of the breath sound spectrum, the relationship between airway changes and breath sounds in asthmatic children was investigated.

METHODS

In Study 1, 77 children (6-16 years old) were included. The breath sound parameters, the ratio of the second area to the third area of the power spectrum (A₂/A₃) and the ratio of the third area to the fourth area (B₃/B₄) were evaluated 3 times, before and just after methacholine inhalation and after β₂ agonist inhalation. Other breath sound parameters, the frequency limiting 99% of the power spectrum (F₉₉), the rolloff from 600-1200 Hz (Slope) and the ratio of the third and fourth area to the total area under the curve (A₃/A_T and B₄/A_T), and the ratio of power and frequency at 50% and 75% of the highest frequency of the power spectrum (RPF₇₅ and RPF₅₀), were also evaluated. In Study 2, 91 children (6-16 years old) were included, with evaluations performed twice: before and after β₂ a gonist inhalation. Spirography a nd forced o scillation technique were also performed.

RESULTS

In Study 1, A₂/A₃ and B₃/B₄ were significantly increased after methacholine inhalation and decreased after β₂ agonist inhalation (p < 0.001, P < 0.001, respectively). In Study 2, A₂/A₃ and B₃/B₄ were significantly decreased after β₂ agonist inhalation. These changes in A₃/A_T and B₄/A_T were the inverse of those in other spectrum curve indices.

CONCLUSIONS

A₂/A₃ and B₃/B₄, indicate the breath sound changes after bronchoconstriction and bronchodilatation. These parameters may be useful for assessing bronchial reversibility in asthmatic children.

Objective evaluation of wheezing in normal infants

BACKGROUND

To evaluate the frequency of wheezing in infants, the presence of wheezing was examined in normal infants using a breath sound analyzer, METHODS: A total of 443 infants (age range, 3-24 months) were included in the present study. The existence of audible wheezing and faint wheezing/inaudible wheezing-like noises (FW) was confirmed on chest auscultation and a sound spectrogram. The breath sound parameters of the sound spectrum, frequency limiting 99% of power spectrum (F₉₉ ), roll-off from 600 to 1,200 Hz (slope) and spectrum curve indices, total area under the curve of dB data (A₃ /A_T and B₄ /A_T ), and ratio of power and frequency at 50% and 75% of the highest frequency of the power spectrum (RPF₅₀ and RPF₇₅ ) were calculated. Using an original Japanese questionnaire, we examined the characteristics of the airway condition of all infants.

RESULTS

Finally, a total of 398 infants were analyzed in the present study, and 283 were in good health while 115 had acute respiratory infection (ARI) in the last 7 days. No infants had audible wheezing on auscultation. Three infants without ARI (1.1%) and 10 infants with ARI (8.7%) had FW. In the evaluation of breath sound parameters, there were no marked differences between the infants with and without FW.

CONCLUSIONS

Using a breath sound analyzer, wheezing and FW were recognized in only a few infants in good health. Infants recognized to have audible wheezing in daily practice may be at risk of developing recurrent wheezing/asthma.

Objective measurement of nocturnal cough in infants with acute bronchiolitis

OBJECTIVES

The objective measurement of the cough severity and the assessment of the pattern of nocturnal coughing could be useful in the treatment of respiratory diseases in children.

STUDY DESIGN

In children with respiratory syncytial virus (RSV)-induced acute bronchiolitis, coughs were recorded using our original system with a microphone and accelerometer, and analyzed using our customized software program. The number of coughs in every 30-minute interval was measured in patients with acute bronchiolitis (n = 20), and their results were compared with those of infants with asthma exacerbation (n = 16).

RESULTS

The cough count in children with acute bronchiolitis (median: 108.0/night) was almost as high as that in children with asthma exacerbation (median: 119/night). However, the time-dependent pattern of overnight cough was different in infants with acute bronchiolitis and those with asthma exacerbation. In the infants with asthma exacerbation, cough frequency significantly increased while falling asleep and waking up as compared to midnight (p < 0.001 and p < 0.001, respectively). However, these differences were not found in infants with acute bronchiolitis.

CONCLUSIONS

Our data demonstrated that the number of coughing events due to acute bronchiolitis was similar to that of acute asthma exacerbation, although the acute bronchiolitis did not show a characteristic overnight cough pattern.

Index extensor digitorum communis tendon entrapment in a growth plate injury of distal radius

Background

We report a rare case in which an epiphyseal injury of the distal radius caused entrapment and rupture of the index extensor digitorum communis tendon during conservative treatment.

Case presentation

A 16-year-old girl suffered epiphyseal injury of the right distal radius with palmar displacement during playing judo. Closed reduction and application of a short arm cast were performed. 4 weeks after injury, movement of her index finger was limited. Extensor tendons adhesion at the fracture site was suspected. It was found that the index extensor digitorum communis tendon had become trapped and ruptured at the site of epiphyseal injury, then reconstruction was done by tendon transfer. At 12 months after surgery, the patient had resumed judo at the same level as before the injury.

Conclusions

The present case suggested that there is a risk of extensor tendon entrapment associated with closed reduction.

High Detection Rate of Atrial Fibrillation With Insertable Cardiac Monitor Implantation in Patients With Cryptogenic Stroke Diagnosed by Magnetic Resonance Imaging

BACKGROUND

Detection and treatment of atrial fibrillation (AF) is a major goal in preventing secondary stroke. Insertable cardiac monitors (ICMs) are available for diagnosis of arrhythmia monitoring in patients with cryptogenic stroke. Magnetic resonance imaging (MRI)-based diagnostic evaluation for acute ischemic stroke subtype classification is common in Japan and can be useful for specific diagnosis of cryptogenic stroke.

PURPOSE

We aimed to investigate the detection rate of AF with an ICM in patients with cryptogenic stroke who were diagnosed by MRI.

METHODS

We performed a retrospective, multicenter, observational study. AF monitoring data of an ICM (Reveal LINQ) in patients with cryptogenic stroke were registered from 5 stroke centers in Japan between October 2016 and March 2018. ICM candidates in cryptogenic stroke were diagnosed by MRI-based evaluation and selected according to the criteria proposed by the Japan Stroke Society. Detection of AF was defined as AF for longer than 120 seconds.

RESULTS

Eighty-four consecutive patients (64 men; aged 38-90 years) underwent ICM implantation after diagnosis of cryptogenic stroke. AF was detected in 22 of 84 (26.2%) patients with an ICM during a median follow-up of 221.5 days (range: 93-365 days). The detection rate of AF within 3 months after ICM implantation was 21.4%.

CONCLUSIONS

The AF detection rate with an ICM is approximately one fifth within 3 months in patients with cryptogenic stroke as diagnosed by MRI. Our data suggest that the Japanese criteria based on MRI may be useful for selecting adequate candidates for ICM implantation.

Usefulness of the Universal Adapter for Smartphones® in a Mannequin Study

OBJECTIVE

Because of the shape of a double-lumen tube (DLT), it is more difficult to use for intubation than an ordinary endotracheal tube. We prospectively investigated the usefulness of the Airtraq DL^® attached to the Universal Adapter for Smartphones^® for DLT intubation.

METHOD

At Tokai University Hachioji Hospital, anesthesiologists with ≥ 5 years' clinical experience intubated a tracheal intubation training mannequin with DLTs using the Airtraq DL^® (Airtraq-alone phase) and the Airtraq DL^® attached to the Universal Adapter for Smartphones^® (adapter phase), and the time required was measured.

RESULT

The mean time required for intubation was shorter in the adapter phase than in the Airtraq-alone phase for all anesthesiologists (adapter phase, 9.05±2.48 seconds; Airtraq-alone phase, 10.67±2.19 seconds).

CONCLUSION

The use of Airtraq DL^® a ttached to t he Universal Adapter for Smartphones^® significantly reduced the time required for DLT intubation. Furthermore, the combination of these devices was found to be useful and safe for DLT intubation because they provide a significant amount of information on the area from the oral cavity to the opening of the trachea and have high educational value because their combined use allows several physicians to share imaging information.

Disseminated toxoplasmosis with atypical symptoms which developed with exacerbation of systemic lupus erythematosus

Toxoplasma is a common parasite worldwide that mainly affects the brain, lungs and eyes. Although toxoplasmic encephalitis is a lethal disease without treatment, past case reports show most patients with systemic lupus erythematosus who developed toxoplasmic encephalitis were misdiagnosed and treated as neuropsychiatric systemic lupus erythematosus, which led to unfavorable outcomes. We herein describe a case of disseminated toxoplasmosis affecting all the above organs with atypical symptoms, which developed with exacerbation of systemic lupus erythematosus. She had initially manifested with retinochoroiditis without vitritis, mild cognitive impairment and an isolated lung mass. These are completely different from the classic symptoms of toxoplasmosis that have been reported in patients with HIV infection and/or those after hematopoietic transplantation. Our case, together with previously reported cases, suggests the manifestation of toxoplasmosis that develops in systemic lupus erythematosus patients can be different from that seen in conventional cases and varies between individual patients. Our case highlights both the difficulty in and the importance of diagnosing toxoplasmosis in patients with systemic lupus erythematosus and provides helpful information to identify this rare, devastating, yet treatable disease.

Changes in the breath sound spectrum with bronchodilation in children with asthma

BACKGROUND

Breath sound parameters have been suggested to be new biomarkers of airway function in patients with asthma.

METHODS

We investigated the effect of bronchodilation on breath sound parameters in sixty-four children (mean age, 8.9 years; range, 6-16 years) using a breath sound analyzer. The breath sound parameters included frequency limiting 50% and 99% of the power spectrum (F₅₀ and F₉₉), roll-off from 600-1200 Hz (slope), and spectrum curve indices such as the ratios of the third and fourth power area to the total area of the power spectrum (P₃/P_T and P₄/P_T), total area under the curve (A₃/A_T and B₄/A_T), and the ratio of power and frequency at 50% and 75% of the highest frequency of the power spectrum (RPF₇₅ and RPF₅₀). Lung function was assessed using spirometry and the forced oscillation technique (FOT). All variables were assessed before and after inhalation of a β₂-agonist.

RESULTS

The spectrum curve indices, A₃/A_T, B₄/A_T, RPF₇₅, and RPF₅₀, showed statistically significant increase following β₂-agonist inhalation. The increase in RPF₅₀ was correlated with the decrease in the difference between resistance at 5 Hz and 20 Hz, R5-R20, measured by FOT. In the multiple regression analysis adjusted for the effect of ΔRPF₇₅, the changes in A₃/A_T and B₄/A_T were positively correlated with that in the forced expiratory volume in one second.

CONCLUSIONS

The spectrum curve indices indicated bronchodilation, and may be useful for the assessment of bronchial reversibility in children with asthma.

Verification of the International Society of Urological Pathology recommendations in Japanese patients with clear cell renal cell carcinoma

The aim of the present study was to evaluate the validity of potential prognostic parameters of clear cell renal cell carcinoma (ccRCC) recommended by the 2012 International Society of Urological Pathology (ISUP) Consensus Conference in the Japanese population. We reviewed 406 Japanese patients with localized or locally advanced ccRCC who underwent curative surgery during 2004-2014 at Tokai University Hospital (Isehara, Japan) and were followed up for >2 years after surgery. A single pathologist reviewed all the histological slides. Morphological subtype and pathological T stage were reassigned according to the 2016 World Health Organization and TNM classifications. Sarcomatoid differentiation (SD), rhabdoid differentiation (RD), tumor necrosis (TN) and microvascular invasion (MVI) were assessed according to the 2012 ISUP recommendations. Nuclear grade was reclassified according to both the Fuhrman and the ISUP grading systems. Recurrence‑free survival (RFS) and cancer-specific survival (CSS) were assessed through univariate and multivariate analyses. According to the Fuhrman grading system (group Fuhrman), TN and MVI were independent risk factors for postoperative recurrence in the multivariate analysis using the Cox proportional hazards model. According to the ISUP grading system (group ISUP), TN and MVI were independent risk factors for postoperative recurrence. In group Fuhrman, age, Fuhrman grade and TN were independent risk factors for CSS. In group ISUP, age, ISUP grade, and TN were independent risk factors for CSS. Furthermore, the group that was upgraded from Fuhrman grade 2 to ISUP grade 3 exhibited poorer CSS compared with the group that was reclassified from Fuhrman grade 2 to ISUP grade 2 (non-upgraded). Regardless of the nuclear grade, TN remained an independent predictor of RFS and CSS. To the best of our knowledge, this is the first report to prove the correlation between the 2012 ISUP recommendations and clinical outcomes in a Japanese ccRCC cohort. TN and upgrading to ISUP grade 3 were found to be potentially useful independent indicators of postoperative prognosis.

Estimating Vector-borne Viral Infections in the Urban Setting of the 2020 Tokyo Olympics, Japan, Using Mathematical Modeling

The first domestic outbreak of dengue fever in Japan since 1945 was reported in Tokyo in 2014. Meanwhile, daily mean summer temperatures are expected to continue to rise world-wide. Such conditions are expected to increase the risk of an arbovirus outbreak at the 2020 Tokyo Olympic Games. To address this possibility, the present study compared estimates of the risk of infection by dengue, chikungunya, and Zika viruses in urban areas. To compare the risk of infection by arboviruses transmitted by Ae. albopictus mosquitoes, the reproduction number for each of three arboviruses was estimated under the environmental conditions associated with the 2014 dengue outbreak in Tokyo, and additionally under conditions assuming a daily mean temperature elevation of 2° C. For dengue, chikungunya, and Zika, the estimated distributions of R₀ were independently fitted to gamma distributions yielding median R₀ values of 1.00, 0.46, and 0.36, respectively. If the daily mean temperature were to rise from 28° C to 30° C, our model predicts increases of the median R₀ of 18% for dengue, 4.3% for chikungunya, and 11.1% for Zika. Strengthening of the public health responsivity for these emerging arboviral diseases will be needed in preparation for the 2020 Olympic Games in Tokyo.

Pathogen screening and prognostic factors in children with severe ARDS of pulmonary origin

BACKGROUND

Acute respiratory distress syndrome (ARDS) is one of the most lethal diseases encountered in the pediatric intensive care unit (PICU). The etiological pathogens and prognostic factors of severe ARDS of pulmonary origin in children with respiratory virus infections were prospectively investigated.

METHODS

Enrolled children fulfilled the following criteria: (1) PICU admission; (2) age of 1 month to 16 years; (3) diagnosis of infectious pneumonia and respiratory virus infection; and (4) development of severe ARDS within 72 h after PICU admission. Pathogens were detected in the blood and tracheal lavage fluid using molecular techniques and a conventional culture system. The serum levels of inflammatory mediators on the day of PICU admission were examined.

RESULTS

Fifty-seven patients (32 boys; median age, 9 months) were enrolled. Multiple virus infections, co-infection with bacteria/fungus, and bacteremia/fungemia were observed in 60%, 49%, and 32% of children, respectively. Adenovirus-B, measles virus, and cytomegalovirus were detected predominantly in tracheal lavage fluid. There were no statistically significant differences between non-survivors and survivors regarding the types of pathogen, incidence of multiple virus infection, gender, age, clinical features, and treatment. The serum levels of interferon (IFN)-γ and the IFN-γ/interleukin (IL)-10 ratio were higher in non-survivors.

CONCLUSIONS

IFN-γ upregulation as detected on the day of PICU admission was found to be one of the possible prognostic factors affecting a fatal outcome. These results suggest that modulation of inflammatory responses is critical for the clinical management of children with ARDS.

Changes in the breath sound spectrum during methacholine inhalation in children with asthma

BACKGROUND AND OBJECTIVE

An effort-independent breath sound analysis is expected to be a safe and simple method for clinical assessment of changes in airway function. The effects of bronchoconstriction and bronchodilation on novel breath sound parameters in asthmatic children were investigated.

METHODS

The study population included 49 children with atopic asthma (male = 33; mean age: 10.2 years). We evaluated breath sound parameters of the highest frequency of the power spectrum (HFp), frequency limiting 50% and 99% of the power spectrum (F₅₀ and F₉₉ ) and roll-off from 600 Hz to the HFp (Slope). We also assessed new parameters obtained using the ratios of sound spectrum parameters (spectrum curve indices), such as the ratio of the third and fourth power area to the total power area (P₃ /P_T and P₄ /P_T ), the ratio of the third and fourth areas to the total area under the curve (A₃ /A_T and B₄ /A_T ) and the ratio of power and frequency at 75% of HFp and 50% of HFp (RPF₇₅ and RPF₅₀ ). This was measured before and after methacholine inhalation challenge and after β₂ agonist inhalation.

RESULTS

The parameters, F₅₀ and F₉₉ , showed no changes after methacholine inhalation. Conversely, the A₃ /A_T (12.5-10.0%, P < 0.001), B₄ /A_T (7.6-5.5%, P < 0.001), RPF₇₅ (6.7-4.0 dBm/Hz, P < 0.001) and RPF₅₀ (5.8-4.3 dBm/Hz, P < 0.001) were significantly decreased. These values returned to the original level after β₂ agonist inhalation.

CONCLUSION

Spectrum curve indices indicate bronchoconstriction and bronchodilation. These parameters may play a role in the assessment of airway narrowing in asthmatic children.

Palivizumab Prophylaxis in Preterm Infants and Subsequent Recurrent Wheezing. Six-Year Follow-up Study

RATIONALE

Respiratory syncytial virus (RSV) induces not only infantile recurrent wheezing but also potentially atopic asthma.

OBJECTIVES

To test the effect of RSV infection on development of subsequent atopic asthma, we evaluated whether palivizumab, an anti-RSV monoclonal antibody, by preventing severe RSV disease in the first year of life, could impact subsequent recurrent wheezing and atopic asthma at 6 years of age.

METHODS

During the 2007 to 2008 RSV season, the decision to administer palivizumab was made based on standard medical practice and an observational prospective multicenter (n = 52) case-control study in preterm infants with a gestational age between 33 and 35 weeks followed from 0 to 3 years (preceding Committee on Recurrent Wheezing study). The 52 investigators at hospitals then followed these subjects until 6 years of age, reported here (Effects of Preventive Treatment for Respiratory Syncytial [RS] Virus Infection During Infancy on Later Atopic Asthma in Preterm Infants; Scientific Committee for Elucidation of Infantile Asthma). Parents of study subjects reported the infants' physicians' assessment of recurrent wheezing, using a report card and a novel mobile phone-based reporting system using the Internet. The primary endpoint was the incidence of atopic asthma.

MEASUREMENTS AND MAIN RESULTS

Of 444 preterm infants enrolled, 349 received palivizumab during the first year of life. At 6 years, atopic asthma was not different in the groups: 15.3 and 18.2% of infants in the treated and untreated groups, respectively (P = 0.57). On the other hand, physician-diagnosed recurrent wheezing was observed in 15.3 and 31.6% in the treated and untreated groups, respectively (P = 0.003).

CONCLUSIONS

Palivizumab prophylaxis administered to preterm infants did not suppress the onset of atopic asthma but resulted in a significantly lower incidence of recurrent wheezing during the first 6 years. Clinical trial registered with www.clinicaltrials.gov (NCT 01545245).

Preoperative Risk Levels and Vascular Access in Transcatheter Aortic Valve Implantation-A Single-Institute Analysis

Although transcatheter aortic valve implantation (TAVI) has been indicated for patients with high surgical risk, indications for or against the procedure become more difficult as vascular access becomes more proximal and/or invasive in order to accommodate patients with even higher risks. We compared preoperative factors including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score with postoperative survival in 195 patients undergoing TAVI during 2.5 years (January 2010 to June 2012), when vascular access routes were developed from iliofemoral (IL/Fm access, n = 149), axillo-clavicular, apical, and direct aortic approaches (alternative access, n = 46). Logistic regression analyses showed that alternative access was associated with reduced 30-day survival (P = 0.024), while high surgical risk (>15% in both EuroSCORE and STS score) was associated with reduced 1-year survival (P = 0.046). Thus, patients treated via IL/Fm access had acceptable outcome regardless of preoperative risk levels while patients with low surgical risk (<15%) had favorable outcome irrespective of access route. Since the remaining patients with combined risk factors, high preoperative risk level (>15%) requiring alternative access, had a prohibitive risk in our experience, they might have been considered untreatable or not amenable even to TAVI and offered medical or alternative managements.

A novel method for detecting airway narrowing using breath sound spectrum analysis in children

BACKGROUND

Using a breath sound analyzer, we investigated new clinical parameters that are rarely affected by airflow in young children.

METHODS

A total of 65 children with asthma participated in this study (mean age 9.6 years). In Study 1, the intra- and inter-observer variability was measured. Common breath sound parameters, frequency at 99%, 75%, and 50% of the maximum frequency (F99, F75, and F50) and the highest frequency of inspiratory breath sounds were calculated. In addition, new parameters obtained using the ratio of sound spectra parameters, i.e., the spectrum curve indexes including the ratio of the third and fourth area to the total area and the ratio of power and frequency at F75 and F50, were calculated. In Study 2, 51 children underwent breath sound analyses. In Study 3, breath sounds were studied before and after methacholine inhalation.

RESULTS

In Study 1, the data showed good inter- and intra-observer reliability. In Study 2, there were significant relationships between the airflow rate, age, height, and spirometric and common breath sound parameters. However, there were no significant relationships between the airflow rate and the spectrum curve indexes. Moreover, the spectrum curve indexes showed no relationships with age, height, or spirometric parameters. In Study 3, all parameters significantly changed after methacholine inhalation.

CONCLUSIONS

Some spectrum curve indexes are not significantly affected by the airflow rate at the mouth, although they successfully indicate airway narrowing. These parameters may play a role in the assessment of bronchoconstriction in children.

Estimation of reproduction number and probable vector density of the first autochthonous dengue outbreak in Japan in the last 70 years

OBJECTIVES

The first autochthonous case of dengue fever in Japan since 1945 was reported on August 27, 2014. Infection was transmitted by Aedes albopictus mosquitoes in Tokyo's Yoyogi Park. A total of 65 cases with no history of overseas travel and who may have been infected around the park were reported as of September 5, 2014. To quantify infection risk of the local epidemic, the reproduction number and vector density per person at the onset of the epidemic were estimated.

METHODS

The estimated probability distribution and the number of female mosquitoes per person (MPP) were determined from the data of the initial epidemic.

RESULTS

The estimated distribution R(0i) for the initial epidemic was fitted to a Gamma distribution using location parameter 4.25, scale parameter 0.19, and shape parameter 7.76 with median 7.78 and IQR (7.21-8.40). The MPP was fitted to a normal distribution with mean 5.71 and standard deviation 0.53.

CONCLUSIONS

Both estimated reproduction number and vector density per person at the onset of the epidemic were higher than previously reported values. These results indicate the potential for dengue outbreaks in places with elevated vector density per person, even in dengue non-endemic countries. To investigate the cause of this outbreak, further studies will be needed, including assessments of social, behavioral, and environmental factors that may have contributed to this epidemic by altering host and vector conditions in the park.