Pimitespib in patients with advanced gastrointestinal stromal tumor (CHAPTER-GIST-301): a randomized, double-blind, placebo-controlled phase 3 trial

BACKGROUND

Prognosis of advanced gastrointestinal stromal tumors (GIST) refractory to tyrosine kinase inhibitors (TKIs) is poor. This randomized, placebo-controlled, phase 3 trial evaluated the efficacy and safety of pimitespib, a novel heat shock protein 90 inhibitor, in advanced GIST refractory to standard TKIs.

PATIENTS AND METHODS

Patients with histologically confirmed GIST refractory to imatinib, sunitinib, and regorafenib were randomized 2:1 to oral pimitespib 160 mg/day or placebo for five consecutive days per week in 21-day cycles. Following disease progression by blinded central radiological review (BCRR), crossover to open-label pimitespib was permitted. The primary endpoint was progression-free survival (PFS) by BCRR in the full analysis set. Secondary endpoints included overall survival (OS) adjusted using the rank preserving structural failure time method to reduce the expected confounding impact of crossover.

RESULTS

From Oct 31, 2018 to Apr 30, 2020, 86 patients were randomized to pimitespib (n=58) or placebo (n=28). Median PFS was 2.8 months (95% CI 1.6-2.9) with pimitespib versus 1.4 months (0.9-1.8) with placebo (hazard ratio [HR] 0.51 [95% CI 0.30-0.87]; one-sided p=0.006). Pimitespib showed an improvement in crossover-adjusted OS compared with placebo (HR 0.42 [0.21-0.85], one-sided p=0.007). Seventeen (60.7%) patients receiving placebo crossed-over to pimitespib; median PFS after crossover was 2.7 (95% CI 0.7-4.1) months. The most common (≥30%) treatment-related adverse events (AEs) with pimitespib were diarrhea (74.1%) and decreased appetite (31.0%); the most common (≥10%) grade ≥3 treatment-related AE was diarrhea (13.8%). Treatment-related AEs leading to pimitespib discontinuation occurred in 3 (5.2%) patients.

CONCLUSION

Pimitespib significantly improved PFS and crossover-adjusted OS compared with placebo and had an acceptable safety profile in patients with advanced GIST refractory to standard TKIs.

809Sodium/potassium ratio change was associated with blood pressure change: finding from health check-up data

Background

The sodium (Na)/potassium (K) ratio was reported to be associated with blood pressure (BP). Recently, the Na/K ratio self-monitoring device using spot urine was established. We assessed whether the urinary Na/K ratio change measured using the Na/K device was positively associated with BP change in a health check-up setting.

Methods

We targeted 12,890 participants who attended the annually health check-up in Tome City, Miyagi Prefecture, Japan between 2017 and 2018. Tome city introduced urinary Na/K ratio measurement during health check-up since 2017. We assessed the relationship between change in urinary Na/K ratio and BP change using multiple regression analyses adjusted for age, sex, and change in body mass index (BMI) and alcohol intake. For each year, we compared the baseline characteristics according to the urinary Na/K ratio and BP level.

Results

The change in systolic BP and diastolic BP was positively associated with the change in urinary Na/K ratio. The average urinary Na/K ratio was significantly lower in 2018 than in 2017 (5.4±3.0 to 4.9±2.2, p < 0.01). Moreover, their systolic BP in 2018 (130.9±17.4 mmHg) was lower than that in 2017 (132.1±17.9 mmHg) (p < 0.01).

Conclusions

The positive association of change in urinary Na/K ratio with hypertension and change in systolic and diastolic BP can be explained by a change in alcohol intake, BMI, and urinary Na/K ratio.

Key messages

Measuring the urinary Na/K ratio in community settings is a potential population approach for counteracting hypertension.

Trans-collateral angioplasty for the treatment of long chronic total occlusions of superficial femoral arteries: a novel wiring technique

Endovascular therapy (EVT) utilizing percutaneous transluminal angioplasty has become a standard technique to re-establish sufficient blood flow in ischemic limbs of patients with peripheral arterial disease (PAD). Long chronic total occlusion (CTO) of the superficial femoral artery (SFA) remains one of the challenging lesions in the field of EVT for PAD patients, despite the recent introduction of many dedicated interventional devices such as high-performance guidewires. In this article, we report a novel interventional technique, trans-collateral angioplasty (TCA), to improve the initial success rate of EVT for long SFA-CTO lesions. We present one representative case, and describe the technical tips and appropriate device selection criteria for the TCA procedure. The outcomes of TCA for long SFA-CTO performed last year at our institution are also summarized and discussed.

Serum levels of hepatocyte growth factor and epiregulin are associated with the prognosis on anti-EGFR antibody treatment in KRAS wild-type metastatic colorectal cancer

Background:

Ligands of transmembrane receptor tyrosine kinases have important roles in cell proliferation, survival, migration and differentiation in solid tumours. We conducted this study to evaluate the relationship between concentration of serum ligands and prognosis of patients with metastatic colorectal cancer (mCRC) treated with anti-epidermal growth factor receptor (EGFR) antibodies.

Methods:

Between August 2008 and August 2011, serum samples were obtained from KRAS wild-type patients who met the inclusion criteria and received an anti-EGFR antibody treatment. Serum concentration of ligands was measured by an enzyme-linked immunosorbent assay, and somatic mutations of KRAS, BRAF, PIK3CA and BRAF were analysed by direct sequencing.

Results:

A total of 103 patients were enrolled in the present study. At the pretreatment serum levels, patients with high levels of hepatocyte growth factor (HGF) had shorter progression-free survival (PFS) and overall survival (OS) compared with those with low levels of HGF (median PFS: 6.4 months vs 4.4 months; P<0.001, median OS: 15.3 months vs 8.0 months; P<0.001, respectively). Patients with high levels of epiregulin (EREG) also had shorter PFS and OS compared with those with low levels of EREG (median PFS: 6.6 months vs 4.9 months; P=0.016, median OS: 13.8 months vs 7.4 months; P=0.048, respectively). In addition, patients whose serum levels of ligands were elevated at progressive disease had shorter PFS and OS compared with other patients.

Conclusions:

Our study indicated that high levels of HGF and EREG were associated with resistance to treatment with anti-EGFR antibodies in KRAS wild-type patients with mCRC. Our findings will contribute to the newly combination therapy on the treatment of anti-EGFR antibodies.

Retrospective analysis of first-line chemotherapy in 132 patients with advanced small-bowel adenocarcinoma

260

Background: No standard care has been established for advanced small-bowel adenocarcinoma (SBA). The aim of this study is to explore a most promising chemotherapy regimen for advanced SBA.

Methods: All data were collected from medical records of patients with advanced or recurrent SBA who received chemotherapy between April 1999 and March 2009 at 41 hospitals in Japan. Selection criteria were as follows: 1) histologically proven SBA, excluding ampullary carcinoma, 2) no previous chemotherapy or radiotherapy, 3) ECOG PS 0-2, 4) adequate bone marrow, hepatic and renal functions, 5) no concomitant malignancy. Patients were divided into the five groups by regimens: group A, fluoropyrimidine alone; group B, fluoropyrimidine + cisplatin; group C, fluoropyrimidine + oxaliplatin; group D, fluoropyrimidine + irinotecan; group E, others. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method.

Results: Demographics of selected 132 patients were: median age (range), 59 (23-78) years; male/female, 87/45; location of primary tumor, duodenum/jejunum/ileum/unknown, 80/32/17/3; advanced/recurrent disease, 91/41. The numbers of the patients in group A, B, C, D and E were 60, 17, 22, 11 and 22, and objective response rates (ORR) in the patients with target lesions were 20% (9/46), 38% (5/13), 42% (8/19), 25% (2/8), 21% (4/19), respectively. Median PFS and OS were 6.0 and 14.0 months for the whole population, and those in each group are shown in the Table.In comparison with fluoropyrimidine alone (A), oxaliplatin-combined regimens (C) associated with better PFS (HR=0.53 [0.31-0.93], p=0.03) and OS (HR=0.64 [0.33-1.25], p=0.19), while cisplatin-combined regimens (B) did not (HR=1.54 [0.88-2.68], p=0.13 for PFS and HR=1.67 [0.94-2.97], p=0.08 for OS) by univariate analysis.

Conclusions: It is suggested that oxaliplatin-combined regimens might be the most promising regimen for advanced SBA.

[Table: see text]

No significant financial relationships to disclose.

Association of development of chronic lung disease of newborns with neonatal colonization of Ureaplasma and cord blood interleukin-8 level

BACKGROUND

The aim of the present study was to investigate the association of chronic lung disease (CLD), neonatal Ureaplasma colonization, and interleukin-8 (IL-8) level of cord blood in preterm infants.

METHODS

In 77 infants of <32 weeks gestation, the relationship between IL-8 level of cord blood, neonatal colonization of Ureaplasma, histological chorioamnionitis (CAM), and development of CLD was studied.

RESULTS

Five infants died and 29 infants developed CLD. The CLD group had significantly lower gestation (mean ± SD: 26.6 ± 1.8 weeks) compared with the infants without CLD (28.9 ± 1.9 weeks, P < 0.0001). Logistic analysis showed that the development of CLD was associated with gestational age (odds ratio [OR], 0.5; 95% confidence interval (CI): 0.4-0.8) and Ureaplasma colonization (OR, 4.1; 95%CI: 1.2-14.4). Ureaplasma colonization was also associated with CAM (OR, 6.5; 95%CI: 1.8-23.5), absence of respiratory distress syndrome (OR, 6.2; 95%CI: 1.3-30.5), and development of CLD (OR, 4.0; 95%CI: 1.1-15.3). Elevated cord blood IL-8 ≥100 pg/mL was associated with female sex and the isolation of microorganisms (OR, 49.4; 95%CI: 4.6-525).

CONCLUSION

The development of CLD defined by oxygen requirement at 36 weeks was associated with neonatal Ureaplasma colonization but not with IL-8 level of cord blood. Elevated cord blood IL-8 was associated with neonatal microorganisms isolation.

Selectively high levels of serum interleukin 17 in a newborn infant with progressive severe cholestasis

We present here the unusual case of a male newborn infant who showed progressive severe cholestasis. The infant's gestational age was 37 weeks, and his birth weight was 2134 g. His serum level of direct bilirubin gradually increased from the 6th day of life and reached 257.5 micromol/L on the 22nd day of life. We could not find any cause for his cholestasis, but his serum level of ferritin was extremely elevated at 9211.0 ng/mL. Because we felt that his clinical condition might be related to hypercytokinemia caused by an immunologic reaction, steroid pulse therapy and cyclosporine were administered. His condition improved, and his direct bilirubin and ferritin levels declined. From the investigation of his cytokine profile, we found a preferentially elevated level of serum interleukin 17 (IL-17) (96.1 pg/mL) and high level of chemokines IL-8 and macrophage inflammatory protein 1beta. The IL-17 level gradually decreased to 7.5 pg/mL by the 124th day of life. The infant was successfully discharged from the children's hospital but later developed epilepsy at 11 months and asthma at 1 year, 2 months of age. Although we have not yet reached a definitive diagnosis, this case may be the first to show a relationship between cholestasis and an elevated serum IL-17 level in the neonatal period.

Prolonged maternal magnesium administration and bone metabolism in neonates

BACKGROUND

Magnesium sulfate (MgSO(4)) has been used as a tocolytic agent in cases of refractory preterm labor. Prolonged maternal administration of MgSO(4) may induce bone demineralization in the neonate. However, the effects of MgSO(4) on serum biochemistry related to bone metabolism in neonates remain unclear.

AIM

To assess the effects of prolonged maternal administration of MgSO(4) on fetuses and neonates.

STUDY DESIGN

This retrospective case-control study examined 167 neonates. Cases comprised 58 neonates whose mothers had received intravenous MgSO(4) administration for >5 days. Neonatal serum levels of magnesium (Mg), calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) were reviewed. We also investigated whether subject neonates showed appearance of osteopenia at the metaphyseal lines on radiography at birth.

RESULTS

Mean serum Mg and P levels were significantly higher, and Ca levels were significantly lower, in cases than in controls at birth. Mean serum ALP level was 1188.5IU/l in cases, significantly higher than that in controls at birth. Bone abnormalities were noted on radiography in 2 subjects. By 3 weeks old, serum ALP levels did not differ significantly between cases and controls. Logistic regression analysis revealed maternal administration of MgSO(4) and multiple pregnancies were significantly related to serum ALP level in neonates at birth.

CONCLUSION

Prolonged maternal administration of MgSO(4) significantly affects neonatal serum biochemistry related to bone metabolism. Potential long-term adverse effects on neonates and how Mg affects fetal bone metabolism in utero need to be investigated in future studies.

An autopsy case of sporadic amyotrophic lateral sclerosis with 16-year survival without artificial ventilation

An autopsy case of a 65-year-old male diagnosed as having classic amyotrophic lateral sclerosis (ALS) and who survived for 16 years without artificial ventilation is described. The progression of the disease was remarkably slow, and the bulbar and respiratory functions remained relatively well preserved. Pathologically, both upper and lower motor neurons were affected, the latter much more than the former. The volume of the spinal anterior horn of the fourth cervical cord (C4) was relatively well preserved compared to those of the thoracic cords, which were the most severely affected. This preservation of C4 may have been compatible with the relatively good preservation of respiratory muscle. Despite the long clinical course, the involvement was restricted to the motor and related systems, which was compatible with classic ALS. However, this case was distinctive in the lack of myelin pallor and the absence of macrophages in the pyramidal tracts, where large myelinated fibers were markedly decreased. Further-more, no identification was made of any Bunina bodies or skein-like inclusions despite a survey of almost the entire spinal cord. No abnormalities were found in superoxide dismutase 1 complementary DNA sequences. Among the previously reported long surviving cases, certain cases showed relatively uniform neuropathologic findings including the lack of Bunina bodies and macrophage activation in the pyramidal tracts. Such cases as well as ours may represent a form of ALS. Further study is required to determine the significance of these long sur-viving cases for understanding the pathomechanisms underlying motor neuron diseases.

Hypothyroxinemia and effectiveness of thyroxin supplementation in very low birth weight infants with abdominal distension and poor weight gain

BACKGROUND

Very low birth weight (VLBW) infants sometimes develop abdominal distension and poor weight gain. The influence of thyroid function on these symptoms in VLBW infants has not been reported.

METHODS

In a retrospective study, 18 VLBW infants whose abdominal distension and poor weight gain did not improve with standard treatment were enrolled as subjects. Serum levels of free thyroxin (fT(4)) and thyroid stimulating hormone (TSH) were measured. Subjects with serum fT(4) levels less than 1.3 ng/dl received thyroxin supplementation. Another 18 VLBW infants were recruited as age- and weight-matched controls. We compared degree of intestinal dilation on X-ray, weight gain, and quantity of milk tolerated before and after starting thyroxin supplementation in the subjects and the controls.

RESULTS

All subjects had serum fT(4) levels less than 1.3 ng/dl (mean, 0.72 ng/dl). TSH values varied widely and were less than 8 microU/ml in 12 subjects. Therefore, all subjects received thyroxin supplementation; after starting this, mean serum fT(4) level increased significantly to 1.31 ng/dl. In parallel with fT(4) increase, intestinal dilation improved in 16 of 18 subjects (mean grade of dilation decreased from 2.8 to 1.6). Weight gain and quantity of tolerated milk were significantly increased with thyroxin supplementation in all and 17 of the 18 subjects, respectively.

CONCLUSIONS

Thyroxin supplementation was effective in improving abdominal symptoms in VLBW infants whose serum fT(4) level was less than 1.3 ng/dl.

Analysis of the intensity of radio-frequency signals in intracranial ultrasonography of preterm infants

PURPOSE

The purpose of this study was to evaluate the usefulness of analysis of the intensity of radio-frequency (RF) signals in intracranial ultrasonography of preterm infants.

METHODS

Twenty neonatal infants admitted to the neonatal intensive care unit of our hospital were included in this study. Their gestational age was 33-35 weeks. The studies were performed with a System 5 ultrasound system with 3.0-and 5.0-MHz transducers. The transducer was placed on the anterior fontanel to obtain images. Regions of interest were determined based on B-mode images and were positioned at the thalamus, caudate nucleus, cerebral white matter, cerebellum, brain stem, and lateral ventricle. The software used for analysis of the RF signals was EchoMAT (Vingmed Ultrasound).

RESULTS

The RF signals of the ventricle and the choroid plexus showed the lowest and the highest intensities, respectively. The intensities of the brain stem and vermis signals were the same, and were higher than the intensity of the cerebellar hemisphere. The thalamus and caudate nucleus showed macroscopically identical brightness levels; however, the intensity of the thalamus was lower than that of the caudate nucleus. The intensity of subependymal hemorrhage was lower than that of the caudothalamic groove. The intensity of subependymal cyst was the same as that of the lateral ventricle. The RF signal frequencies and intensities were distinctive in each tissue.

CONCLUSION

The results of this study suggest that measurement of RF signal intensity may be useful to differentiate macroscopically similar lesions.

Developmental characteristics of very low-birthweight infants at 18 months' corrected age according to birthweight

BACKGROUND

The objective of the present study was to describe developmental profiles of very low-birthweight (VLBW) infants compared by birthweight, because those of infants with birthweight <750 g might be different from other VLBW infants.

METHODS

VLBW infants from four medical centers were followed at each site with the same protocol at 18 months' corrected age. The protocol by the Society for the Study of Follow up for High-Risk Infants, which includes a standardized developmental test, the Kyoto Scale of Psychological Development (KSPD), was used. Five hundred and sixty-four VLBW infants without neurological or neurosensory impairment were divided into four groups using 250 g birthweight intervals and outcomes were compared between the four groups.

RESULTS

Developmental characteristics of extremely low-birthweight infants (birthweight <750 g) in comparison with other VLBW infants were as follows: (i) more infants were judged clumsy in their fine motor skills; (ii) fewer were able to speak meaningful words although they were able to understand oral simple orders; (iii) developmental quotients (DQ) of KSPD was significantly lower; and (iv) more infants were judged as hyperactive.

CONCLUSION

Developmental profiles of VLBW infants without major handicaps at 18 months' corrected age correlated significantly with their birthweight sequence. These results provide useful information on developmental outcomes of VLBW infants.

Protein factors that regulate the growth and differentiation of mouse myeloid leukaemia cells

We have purified and characterized several protein factors that regulate the growth and differentiation of mouse myeloid leukaemia M1 cells. The differentiation factor (D-factor) from conditioned medium (CM) of Ehrlich ascites tumour cells is a glycoprotein of Mr 40,000-50,000. Its amino acid sequence was found to be almost identical to that of leukaemia inhibitory factor (LIF) from Krebs II ascites cells. The differentiation inhibitory factor (I-factor) from the CM of variant M1 cell clones which were resistant to several differentiation inducers is a basic protein of apparent Mr 68,000. The growth inhibitory factor (GI-factor) that specifically inhibits the partially differentiated and still growing monocytic leukaemia M1 cells was isolated from the CM of a clone of M1 cells resistant to the differentiation inducers. This GI-factor is a basic protein with an Mr of 25,000. Regulation by these protein factors together with other known cytokines of growth and differentiation of M1 cells is reported.

Certain type of chronic lung disease of newborns is associated with Ureaplasma urealyticum infection in utero

BACKGROUND

Recent studies of chronic lung disease (CLD) of newborns emphasize the contribution of antenatal infection. However, the association of Ureaplasma urealyticum infection and CLD has been controversial. The purpose of the present paper was to determine whether U. urealyticum is associated with chorioamnionitis (CAM) and a certain type of CLD.

METHODS

One hundred and five infants <32 weeks of gestation who were admitted to the neonatal intensive care unit at Jichi Medical School Hospital, who underwent both histological and microbiological examinations and who survived to discharge were included. CAM was determined by histological examination. Placenta, gastric and tracheal aspirates, and nasopharyngeal swabs were cultured for Mycoplasma and other microorganisms. CLD was defined as oxygen needed at 28 days of age with symptoms of persistent respiratory distress and hazy or emphysematous and fibrous appearance upon X-ray. CLD was further divided into two subtypes according to the presence of antenatal infection.

RESULTS

CAM was associated with premature rupture of membrane (odds ratio [OR], 10.19; 95% confidence interval [CI]: 3.10-33.56), placental colonization of U. urealyticum (OR 6.73, 95%CI: 1.89-23.91), neonatal colonization of other microorganisms (OR 7.33, 95%CI: 1.22-44.13) and level of IgM (OR 1.06, 95%CI: 1.01-1.11). Comparisons between CLD and non-CLD patients showed that gestational age (OR 0.43, 95%CI: 0.30-0.61) and white blood cell count (WBC) at birth (OR 1.06, 95%CI: 1.01-1.11) were risk factors for CLD, while gestational age (OR 0.38, 95%CI: 0.23-0.64), neonatal colonization of U. urealyticum (OR 5.98, 95%CI: 1.17-30.6) and WBC (OR 1.08, 95%CI: 1.01-1.15) were independent risk factors for infection-related CLD compared with non-CLD. Within CLD, infection-related CLD was associated with neonatal colonization of U. urealyticum (OR 43.7, 95%CI: 2.84-673.8) and WBC (OR 1.27, 95%CI: 1.07-1.50).

CONCLUSIONS

Placental colonization of U. urealyticum was significantly related to CAM; and neonatal colonization of U. urealyticum and leukocytosis at birth were risk factors for infection-related CLD.

Role of prostaglandins on mechanical scratching-induced cutaneous barrier disruption in mice

The role of prostaglandins (PGs) on mechanical scratching-induced cutaneous barrier disruption in mice was investigated by comparing the observed effects of arachidonic acid (AA) application. Scratching of the mouse skin with a stainless-steel wire brush (mechanical scratching) was associated with significant, scratch-count-dependent elevation of the transepidermal water loss (TEWL) and skin PG levels (especially PGD(2) and PGE(2)). Histological evidence of inflammation (crusta, acanthosis and neutrophilic infiltration) in the skin also became evident 24 h after mechanical scratching. On the other hand, while topical application of 0.1% AA to the mouse skin also increased the skin PG levels, but did not produce any increase of TEWL or histological evidence of inflammation in the skin. Topical application of cyclooxygenase inhibitors (indomethacin, piroxicam, aspirin, diclofenac and ketoprofen) decreased the spontaneous recovery rates from cutaneous barrier disruption. These results suggest that the elevation of cutaneous PG production induced by mechanical scratching is involved in the repair of the skin damage caused by the scratching.

Cyclooxygenase-1 inhibition delays recovery of the cutaneous barrier disruption caused by mechanical scratching in mice

BACKGROUND

Atopic dermatitis is a chronic inflammatory disease characterized by severe pruritus, and cutaneous barrier disruption by scratching contributes to further aggravation of the condition. We have previously shown that indomethacin delayed recovery from the effects of cutaneous barrier disruption caused by mechanical scratching in mice.

OBJECTIVES

This study was designed to assess the role of cyclooxygenase (COX)-1 and COX-2 inhibitors on recovery from the effects of cutaneous barrier disruption induced by mechanical scratching in mice.

METHODS

We examined the effects of SC-560 (a COX-1-selective inhibitor) or NS-398 (a COX-2-selective inhibitor) on recovery from the effects of cutaneous barrier disruption in mice induced by a wire brush, in terms of the skin prostaglandin (PG) levels.

RESULTS

While SC-560 significantly delayed recovery from the effects of cutaneous barrier disruption, NS-398 had no such effect. SC-560 was significantly more effective than NS-398 in reducing skin PG levels at 6 and 24 h after cutaneous barrier disruption. SC-560 strongly inhibited biosynthesis of cutaneous PGD(2) to a greater extent than that of other PGs.

CONCLUSIONS

COX-1-coupled PGD(2) biosynthesis may be an important factor in the recovery of cutaneous barrier disruption.

Role of COX-1 and COX-2 on skin PGs biosynthesis by mechanical scratching in mice

We examined the involvement of cyclooxygenase (COX)-1 and COX-2 on mechanical scratching-induced prostaglandins (PGs) production in the skin of mice. The dorsal regions of mice were scratched using a stainless brush. COXs expressions in the skin were analyzed using real-time PCR and Western blotting. The effect of acetylsalicylic acid (ASA) on the ability of PGs production were determined based on skin PGs level induced by arachidonic acid (AA) application. Mechanical scratching increased PGD2, PGE2, PGI2 and PGF(2 alpha). COX-1 was constitutively expressed and COX-2 expression was enhanced by scratching. Intravenous administration of ASA inhibited PGs biosynthesis in the normal skin. PGs levels of the skin 6h after ASA administration (ASA 6 h) were almost equal to those of the skin 10 min after ASA administration (ASA 10 min). In the scratched skin, AA-induced PGE2 and PGI2 of ASA 6 h were significantly higher than those of ASA 10 min. The skin PGD2 and PGF(2 alpha) of ASA 10 min were almost same to those of ASA 6 h. In the normal skin of COX-1-deficient mice, skin PGD2 level was lower than that of wild-type mice, although PGE2, PGI2 and PGF(2 alpha) levels were almost equal to those of wild type. In the scratched skin of COX-1-deficient mice, PGD2, PGE2, PGI2 and PGF(2 alpha) levels were lower than those of wild-type mice. These results suggested that cutaneous PGD2 could be mainly produced by COX-1, and PGE2 and PGI2 could be produced by COX-1 and COX-2, respectively, in mice.

Involvement of IL-31 on scratching behavior in NC/Nga mice with atopic-like dermatitis

Pruritus is an important symptom in atopic dermatitis (AD), but the major pruritogen has not been identified. NC/Nga mice, spontaneously develop an eczematous AD-like skin lesion when kept under conventional conditions, but not under specific pathogen-free (SPF) conditions, have been thought to be an animal model for AD. In this study, to determine whether newly identified cytokine, IL-31, may be involved in pruritus of AD, we examined the IL-31 expression in spontaneous dermatitis model which showed itch-associated long-lasting (over 1.5 s duration) scratching behavior and compared with that of hapten-induced contact dermatitis model without itch-associated long-lasting scratching behavior, using NC/Nga mice. In NC/Nga mice cohabited with NC/Nga mice which developed severe dermatitis for 2 weeks (conventional NC/Nga mice), the numbers of long-lasting scratching counts were significantly increased. Yet in 2,4,6-trinitrochlorobenzene (TNCB)-sensitized and challenged mice (TNCB-applied NC/Nga mice), no significant increase in long-lasting scratching counts was observed. In conventional NC/Nga mice with long-lasting scratching behavior, expression of IL-31 mRNA was increased, while in TNCB-applied NC/Nga mice without long-lasting scratching behavior, the expression of IL-31 mRNA were unchanged. There was a good correlation between the scratching counts and expression of IL-31 mRNA in conventional NC/Nga mice, but not so in TNCB-applied NC/Nga mice. These results suggest that IL-31 causes the itch-associated scratching behavior in conventional NC/Nga mice, an experimental animal model for AD.

Utility of a Doppler-derived index combining systolic and diastolic performance (Tei index) for detecting hypoxic cardiac damage in newborns

The purpose of this study was to assess cardiac function of newborns with mild asphyxia by a Doppler-derived index combining systolic and diastolic performance (Tei index). We studied 20 preterm infants with mild asphyxia. A control group consisted of 20 gestational age-matched preterm infants without asphyxia. Echocardiograms were performed during the fourth and seventh days after birth. Peak velocities of an early filling wave (E) and an atrial contraction wave (A) were measured from the mitral inflow velocity profile and the ratio of peak E to A was calculated. Ejection time was measured from the left ventricular outflow Doppler signal. The sum of isovolumetric times was obtained by subtracting the ejection time from the interval between cessation and onset of mitral inflow. The index was the sum of isovolumetric times divided by ejection time. Ejection fraction was also calculated. The ratio of peak E to A and ejection fraction were the same in both groups. The myocardial performance index in patients with asphyxia was higher than that in patients without asphyxia. We concluded that patients with mild asphyxia have a mild cardiac dysfunction and this change can be detected by a myocardial performance index.