Association between voiding lower urinary tract symptoms and findings on dynamic magnetic resonance imaging with regard to pelvic organs and their supportive structures

OBJECTIVES

Pelvic organ prolapse (POP) causes voiding lower urinary tract symptoms (vLUTS). In the present study, we investigated the association between vLUTS and pelvic organ mobility (POM), including relevant supportive structures, on dynamic magnetic resonance imaging (dMRI).

METHODS

We included 118 patients who had POP of stage II or less before straining and stage III or more when straining during dMRI. The presence of vLUTS and overactive bladder (OAB) was determined by a voiding subscore of the International Prostate Symptom Score (vIPSS) ≥5 and the OAB symptom score, respectively. POM was measured by dMRI before and during straining, and patients with and without vLUTS as well as patients with and without vLUTS and/or OAB were compared. p < .05 was considered to be statistically significant.

RESULTS

According to vIPSS, 42 patients (35.6%) had vLUTS. On dMRI, patients with vLUTS showed a significantly more ventral position and/or movement of the bladder and cervix. Moreover, patients with vLUTS and OAB had significantly more ventral movement of the uterine cervix and a larger strain on imaginary uterosacral and cardinal ligaments than those without these symptoms. In addition, patients with vLUTS and OAB had significantly higher vIPSS than those with vLUTS alone.

CONCLUSIONS

vLUTS may be associated with the proximity of the bladder and cervix to the pubic bone and consequent compression of the urethra by the prolapsed organs. vLUTS with OAB might indicate more advanced lower urinary tract dysfunction than vLUTS alone.

Age-specific effect of transurethral holmium laser enucleation of the prostate on overactive bladder in men with benign prostatic hyperplasia: An investigation using an overactive bladder symptom score

OBJECTIVES

To investigate the age-specific effect of transurethral holmium laser enucleation of the prostate (HoLEP) on overactive bladder (OAB).

METHODS

A total of 186 consecutive patients who underwent HoLEP were included. They were divided into three groups: patients aged less than 65 years, between 65 and 74, and 75 or older. The OAB symptom score as well as other relevant variables of lower urinary tract symptoms and function were assessed before and 1, 3, 6, and 12 months after surgery. Age-specific prevalence of OAB, the proportion of resolution of OAB, and de novo OAB were evaluated.

RESULTS

The mean age of patients was 70.7 years, and the mean total prostate volume was 75.8 ml. The mean OAB symptom scores before surgery of patients aged less than 65 years, between 65 and 74, and 75 or older were 6.0, 5.2, and 5.7, respectively. At 12 months after surgery, the scores for the respective groups had significantly decreased to 2.1, 2.5, and 3.5. The prevalence of OAB based on the score in the respective groups was 45.8%, 56.9%, and 54.0% (p = .6391) preoperatively and 9.1%, 11.3%, and 15.8% at 12 months after the surgery (p = .7613). Of those with preoperative OAB, 75.0%, 79.2%, and 75.0% of the respective groups showed resolution of OAB at 12 months postoperatively (p = .9427).

CONCLUSIONS

In candidates for surgical deobstruction of benign prostatic hyperplasia, HoLEP has potential to improve OAB symptoms regardless of age.

Nonreciprocal Directional Dichroism in Magnetoelectric Spin Glass

Optical absorption spectra in the visible and near-infrared light were measured for magnetoelectric spin glass Ni_{0.4}Mn_{0.6}TiO_{3} under various field-cooled conditions. Despite the absence of long-range magnetic-dipole order, this spin-glass system exhibits nonreciprocal directional dichroism (NDD) at zero external field after a magnetoelectric field-cooled procedure. This result is distinct from previous studies on NDD in systems with magnetic toroidal moments induced either by long-range magnetic-dipole order or by applying crossed electric and magnetic fields. The present Letter conclusively demonstrates that the observed NDD originates from magnetoelectrically induced ferroic order of magnetic toroidal moments without conventional magnetic-dipole order.

Do fathers have sufficient knowledge to administer medicine to children correctly?

Background

Recently, the father's involvement in childcare is increasing in Japan. Inappropriate use of medication for children at home has been reported worldwide, however, the most responsible person was likely to be the mother. We aimed to compare the knowledge related to administering medication to children between fathers and mothers among Japanese parents.

Methods

An online survey regarding medication administration to children was conducted in March 2022. Parents living with preschool children were recruited and categorized by four factors: sex (fathers and mothers), age of children, regular medication, and the difficulty level in giving medicine to their own children. The cross-sectional data were collected for each category. The knowledge related to administering medication to children was measured using ten statements such as “Children can be given a reduced dose of adult medicine” using a 5-point Likert scale. The answer “disagree” was defined as correct understanding and was compared between fathers and mothers (Chi-square test).

Results

The participants were 145 fathers and 128 mothers. The percentage of fathers who answered all questions correctly or all questions incorrectly was 9.0% (mothers = 13.3%) and 25.5% (mothers = 13.3%) respectively. Each statement was answered correctly by fathers 20.0-57.9% and by mothers 25.8-71.9% and fathers were less likely to have the correct knowledge than mothers (6 items, p &lt; 0.05). The biggest difference between those two groups was the statement of “Children should be given more than the proper dose for rapid effect”. Furthermore, the fathers having some difficulties in giving medicine had lower awareness about appropriate medication use than fathers having no difficulties.

Conclusions

Fathers were more likely to have lower knowledge related to administering medication to children than mothers. Medical professionals like pharmacists will need to support fathers.

Key messages

The first case of Veillonella atypica bacteremia in a patient with renal pelvic tumor

We report the first case of bacteremia caused by Veillonella atypica in a morbid elderly female patient who developed obstructive pyelonephritis. She was treated with ceftriaxone and ureteral stenting; this is the first report of V. atypica infection in humans. Species identification was performed by multiplex PCR and sequencing of rpoB. The strain was susceptible to metronidazole and clindamycin but resistant to benzylpenicillin, ampicillin, ampicillin/sulbactam, and moxifloxacin.

Awareness of knowledge related to administering medication for children by mothers among pharmacists

Background

Inappropriate medication use for children by caregivers such as mothers and nursery staff has been reported in Japan. The pharmacists have the responsibility to support adequate medication administration and should consult effectively. However, it is not clear how much pharmacists are aware of the knowledge of medication use by caregivers. This study aimed to examine the knowledge related to administering medication for children among mothers and nursery staff and to evaluate the awareness of that understanding among pharmacists.

Methods

Three online surveys involving 600 mothers living with nursery school children, 558 nursery staff at nursery schools, and 584 pharmacists in Japan were conducted separately (Cross-sectional data, in 2019/2021). Ten statements about the knowledge related to administering medication for children such as “You could give the medicine that has been prescribed before if similar symptoms are shown”, “You should give children the medicine using favorite beverages such as milk and juice, regardless of the kind of medicine” were shown and measured using a 5-point Likert scale. The answer: “disagree”, was considered as correct understanding. The pharmacists were asked how much they think mothers/nursery staff answered correctly using a 5-point Likert scale.

Results

The proportion of correct answers for ten statements by mothers and nursery staff were 35.8%-76.0% and 43.0%-69.9%, respectively. Most answers from pharmacists were in the category range of 40%-59%. Only 11.5%-33.0% of pharmacists chose the correct category in each of ten items with mothers' answers and 24.0%-83.4% of them had lower awareness.

Conclusions

Overall, the pharmacists were less likely to be aware of the mothers'/nursery staff members' knowledge related to administering medication. The pharmacists need to instruct mothers to administer medication after confirming their understanding at the pharmacy.

Key messages

The awareness of knowledge related to administering medication for children by mothers and nursery staff among pharmacists was lower than the answers. The pharmacists need to instruct mothers to administer medication at the pharmacy after confirming their understanding of medication use.

Association between maternal factors and appropriate medication for nursery school children in Japan

Background

Inappropriate medication use for children by caregivers has been reported in Japan. We focused on the factors which could be associated with health literacy (HL) and knowledge of medication (KM). We aimed to examine the association between appropriate use for nursery school children and maternal socioeconomic status (SES) or behavior related to medication adherence among mothers in Japan.

Methods

The data regarding the conditions of medication for children (aged from six months to six years old) at home and in nursery school by the online survey from April to May 2019 was used. Maternal SES, such as education, occupational status, and economic conditions, were asked via a self-administered questionnaire. Maternal behaviors were measured using a 5-point Likert scale and classified into two groups. HL and KM were scored and divided into two categories. Appropriate medication use was evaluated using a 5-point Likert scale for the statement “I give my child medicine as per instructions,” and the answers were classified into two groups. Poisson regression was employed to investigate the association. Age, maternal SES, chronic disease of children, birth order, HL, and KM were used as covariates.

Results

A total of 233 (38.8%) of 600 mothers aged 24-48 years, reported appropriate medication use for children. None of the maternal SES was statistically significant. After adjustment, the individuals, who consent to prescribed medications for children, were 2.16 times (95% confidence interval [CI]:1.64-2.86) more likely to use medicine appropriately compared with their counterparts. ’To be able to consult with pharmacists’ were also statistically significant (Prevalence Ratio=2.14, 95% CI:1.63-2.81).

Conclusions

The mothers, who consent to prescribed medications for children, who consult with pharmacists were more likely to use medicine appropriately. Community pharmacists could support those to improve their skills.

Key messages

The maternal behaviors related to adherence were associated with appropriate medication for children among Japanese mothers, although none of the maternal SES was statistically significant. Community pharmacists could support mothers and contribute appropriate medical treatment for children.

Mechanical regulation of bone homeostasis through p130Cas-mediated alleviation of NF-κB activity

Mechanical loading plays an important role in bone homeostasis. However, molecular mechanisms behind the mechanical regulation of bone homeostasis are poorly understood. We previously reported p130Cas (Cas) as a key molecule in cellular mechanosensing at focal adhesions. Here, we demonstrate that Cas is distributed in the nucleus and supports mechanical loading-mediated bone homeostasis by alleviating NF-κB activity, which would otherwise prompt inflammatory processes. Mechanical unloading modulates Cas distribution and NF-κB activity in osteocytes, the mechanosensory cells in bones. Cas deficiency in osteocytes increases osteoclastic bone resorption associated with NF-κB-mediated RANKL expression, leading to osteopenia. Upon shear stress application on cultured osteocytes, Cas translocates into the nucleus and down-regulates NF-κB activity. Collectively, fluid shear stress-dependent Cas-mediated alleviation of NF-κB activity supports bone homeostasis. Given the ubiquitous expression of Cas and NF-κB together with systemic distribution of interstitial fluid, the Cas-NF-κB interplay may also underpin regulatory mechanisms in other tissues and organs.

Visualization of von Willebrand Factor Multimers by Immunoenzymatic Stain Using Avidin-Biotin Peroxidase Complex

A technique for the detection of von Willebrand factor multimers separated by discontinuous SDS agarose electrophoresis has been developed using non-radioactive com-v pounds. The multimeric patterns were visualized by monospecific anti-human vWF:Ag followed by incubation with biotinylated antibody. After addition of avidin-biotin-peroxidase complex, the peroxidase activitiy was detected by 4-chloro-l-naphthol, giving sharp bands with a clear background.

By this method, the differences of vWF : Ag multimers could be easily observed between normal plasma and the plasmas from variant type vWD (IIA, IIB, platelet-type). Large and intermediate multimers were absent in the plasma with vWD type IIA, while only large multimers were absent in the plasma with vWD IIB and platelet-type. The absence of large multimers was also observed in two commercial F VIII preparations having the ratio of vWF/vWF : Ag 0.18 and 0.63. The preparation with the ratio of 0.63 showed the presence of larger intermediate multimers.

Electrophoresis in SDS 1.5% agarose gel revealed triplet structure of each small multimer, and a relative increase of the smallest subband was observed in vWD IIA plasma, platelet-type vWD plasma and commercial F VIII preparations.

The procedures described are easy and safe to perform and are useful for screening or classifying cases with vWD in general laboratories.

Increased ghrelin signaling prolongs survival in mouse models of human aging through activation of sirtuin1

Caloric restriction (CR) is known to retard aging and delay functional decline as well as the onset of diseases in most organisms. Ghrelin is secreted from the stomach in response to CR and regulates energy metabolism. We hypothesized that in CR ghrelin has a role in protecting aging-related diseases. We examined the physiological mechanisms underlying the ghrelin system during the aging process in three mouse strains with different genetic and biochemical backgrounds as animal models of accelerated or normal human aging. The elevated plasma ghrelin concentration was observed in both klotho-deficient and senescence-accelerated mouse prone/8 (SAMP8) mice. Ghrelin treatment failed to stimulate appetite and prolong survival in klotho-deficient mice, suggesting the existence of ghrelin resistance in the process of aging. However, ghrelin antagonist hastened death and ghrelin signaling potentiators rikkunshito and atractylodin ameliorated several age-related diseases with decreased microglial activation in the brain and prolonged survival in klotho-deficient, SAMP8 and aged ICR mice. In vitro experiments, the elevated sirtuin1 (SIRT1) activity and protein expression through the cAMP-CREB pathway was observed after ghrelin and ghrelin potentiator treatment in ghrelin receptor 1a-expressing cells and human umbilical vein endothelial cells. Furthermore, rikkunshito increased hypothalamic SIRT1 activity and SIRT1 protein expression of the heart in the all three mouse models of aging. Pericarditis, myocardial calcification and atrophy of myocardial and muscle fiber were improved by treatment with rikkunshito. Ghrelin signaling may represent one of the mechanisms activated by CR, and potentiating ghrelin signaling may be useful to extend health and lifespan.

Ferroelectricity by Bose-Einstein condensation in a quantum magnet

The Bose–Einstein condensation is a fascinating phenomenon, which results from quantum statistics for identical particles with an integer spin. Surprising properties, such as superfluidity, vortex quantization or Josephson effect, appear owing to the macroscopic quantum coherence, which spontaneously develops in Bose–Einstein condensates. Realization of Bose–Einstein condensation is not restricted in fluids like liquid helium, a superconducting phase of paired electrons in a metal and laser-cooled dilute alkali atoms. Bosonic quasi-particles like exciton-polariton and magnon in solids-state systems can also undergo Bose–Einstein condensation in certain conditions. Here, we report that the quantum coherence in Bose–Einstein condensate of the magnon quasi particles yields spontaneous electric polarization in the quantum magnet TlCuCl₃, leading to remarkable magnetoelectric effect. Very soft ferroelectricity is realized as a consequence of the O(2) symmetry breaking by magnon Bose–Einstein condensation. The finding of this ferroelectricity will open a new window to explore multi-functionality of quantum magnets.

Magnons, quantized spin excitations in magnetic materials, may undergo Bose-Einstein condensation into a macroscopic correlated quantum state at low temperature. Here, the authors demonstrate how magnon condensation in quantum magnet TlCuCl₃ generates an electrical polarization.

[Association between Proposed Cancer Foci from the Results of Systematic 12-Core Transrectal Needle Biopsies and Actual Cancer Foci from Radical Prostatectomy Specimens]

We investigated the diagnostic yield for systematic 12-core transrectal prostate needle biopsies. Subjects were 56 prostatic cancer patients who were diagnosed with transrectal ultrasound-guided 12 core prostate needle biopsies and who underwent open retropubic radical prostatectomy. Pathological findings were compared between needle biopsy specimens and total prostatectomy specimens in terms of the presence or absence of cancer foci. For the comparison, the prostate was divided into 5 regions : the apical, middle, basal, far lateral and transitional regions. Then, based on the pathological findings of the biopsies, the sensitivity, specificity, positive predictive value and negative predictive value were calculated for each region. As a result, the sensitivity and the specificity in the transitional region tended to be lower than in other regions, and six of ten false positive lesions were located in the transitional region on the biopsy specimens. Also, the negative predictive value tended to be lower in the apical and far lateral regions. In conclusion, thorough punctures in the apical, transitional, and far lateral regions of the prostate at the systematic transrectal biopsy were paramount important for improving the detection of cancer foci in these regions.

Expression dynamics of CXCL12 and CXCR4 during the progression of mycosis fungoides

BACKGROUND

Mycosis fungoides (MF) classically presents from patch stage to plaque stage over a number of years and finally progresses to tumour stage with nodal or visceral involvement. The mechanism of progression remains incompletely elucidated. Chemokines and their receptors are known to be involved in disease mechanisms, with CXCL12 and CXCR4 playing a critical role in carcinogenesis, invasion and cancer cell migration in various carcinomas.

OBJECTIVES

To investigate the expression of CXCL12 and CXCR4 in different cutaneous stages of MF.

METHODS

Formalin-fixed, paraffin-embedded skin samples from 40 patients with MF (21 patch stage, 10 plaque stage, nine tumour stage) and 30 non-neoplastic control skin samples were analysed. CXCL12 and CXCR4 were assessed by quantitative reverse-transcription polymerase chain reaction and immunohistochemical staining.

RESULTS

The expression level of mRNA for CXCL12 in plaque-stage MF was significantly higher than in control skin (P = 0.0035), or patch-stage (P = 0.0108) or tumour-stage disease (P = 0.0089). The CXCR4 mRNA expression level in plaque-stage disease was significantly higher than in control skin (P = 0.0090) or patch-stage disease (P = 0.0387). CXCL12- and CXCR4-positive cell rates in patch-stage and plaque-stage MF were significantly higher than those in control skin (P < 0.0001). CXCL12- and CXCR4-positive cell rates in tumour-stage MF were significantly lower than those in patch- and plaque-stage disease (P = 0.0274 and P = 0.0492, respectively).

CONCLUSIONS

Our data suggest that neoplastic T cells in MF are exposed to the microenvironment, given the abundance of CXCL12 during its progression, and also that neoplastic T cells express CXCR4, especially in the pretumour stage. We reveal that the CXCL12-CXCR4 axis plays a critical role in MF progression.

[A case of mixed epithelial and stromal tumor (MEST) of the kidney monitored as angiomyolipoma (AML) : a case report]

A 32-year-old woman presented with left abdominal pain. Intratumoral hemorrhage within a renal angiomyolipoma (AML) was suspected and embolization was performed. However, the patient declined surgery and was thus kept under observation. During the next 5 years, the tumor increased in size, and upper left abdominal pain appeared. Therefore, left radical nephrectomy was performed. The histopathological diagnosis was mixed epithelial and stromal tumor (MEST) of the kidney. A retrospective examination of imaging findings indicated that the fat which had been regarded as evidence of AML was actually either perinephric fat displaced by either the tumor or the renal sinus. In fact, the tumor consisted mainly of a cystic component containing a solid component. The possibility of MEST must be kept in mind when distinguishing renal tumors consisting mainly of cystic components in young to middle-aged women.

[In two patients with economic and social issues stage I giant seminoma]

The first case was in a 39-year-old man who complained of painless, left hemiscrotal swelling. The patient's serum β human chorionic gonadotropin (β-hCG) was elevated. A chest X-ray and computerized tomography (CT) did not reveal any abnormal findings. The patient underwent left high orchiectomy. The tumor weighed 440 g, and was pathologically diagnosed as a seminoma. The patient chose surveillance as the management strategy. Five months after the operation, the patient stopped attending his periodic checkups. After 21 months, the patient complained of abdominal distention. A CT showed a para-aortic lymph node mass. The patient achieved a complete response following chemotherapy with etoposide and cisplatin for 4 cycles. Three months after the adjuvant chemotherapy, hospital visits stopped again due to financial difficulties. The second case was in a 36-year-old man who complained of painless, right hemiscrotal swelling and difficulty in walking. Clinical examination revealed an adult-head-sized testicular tumor with elevation of serum lactic dehydrogenase (LDH) and β-hCG. A chest X-ray and abdominal CT did not reveal any abnormal findings. Despite a recommendation that the patient undergo immediate orchiectomy, the patient did not undergo surgery due to his unstable lifestyle. After 1 month, the patient presented with more difficulty in walking. The patient underwent right high orchiectomy. The tumor weighed 1,926 g, and was pathologically diagnosed as a seminoma. The patient chose surveillance. There has been no recurrence for 19 months postoperatively.

[Hyaline vascula type Castleman's disease in the pelvic cavity : a case report]

A 48-year-old man was admitted to our hospital in order to treat a right lower abdominal tumor which was detected by ultrasonography in a general health check. The tumor was considered to be a pelvic sarcoma from computed tomography and magnetic resonance imaging findings, then, resection of the tumor was performed. Pathological diagnosis was a hyaline vascular type of Castleman's disease. The patient remained well without any evidence of local recurrence 12 months after surgery. The hyaline vascular type of Castleman' s disease is characterized by a solitary hypervascular tumor which is prone to adhere to neighboring great vessels. This tendency makes dissection from great vessels difficult and should be kept in mind when surgery is planned.

Prediction of time-dependent interaction of aspirin with ibuprofen using a pharmacokinetic/pharmacodynamic model

WHAT IS KNOWN AND OBJECTIVE

Low-dose aspirin is widely used for prevention of thrombosis, but combined use of aspirin with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, reduces the antiplatelet effect of aspirin. However, there has been no report describing the effects of the timing of the ibuprofen dose on the degree of interaction between low-dose aspirin and ibuprofen. The purpose of this study was to predict the time-course of the antiplatelet effect of low-dose aspirin when ibuprofen is administered as a single dose or repeatedly in combination with aspirin at various time intervals.

METHODS

We simulated ex vivo platelet aggregation using a previously developed pharmacokinetic (PK)/pharmacodynamic (PD) model.

RESULTS AND DISCUSSION

The antiplatelet effect of low-dose aspirin (81 mg) was predicted to be markedly reduced when ibuprofen (200 mg; the usual prescribed dose in Japan) was administered 1 h or less after aspirin, but not when it was administered more than 2 h after the administration of aspirin. Moreover, the administration of ibuprofen up to 12 h before aspirin completely abrogated the antiplatelet effect of aspirin. When ibuprofen (200 mg) was administered three times daily for 3 days (day 1 to day 3) on a background of continuous low-dose aspirin (81 mg) once daily, 2 h after aspirin, no reduction in the antiplatelet effect of aspirin was predicted on day 1, but a reduction is predicted from day 2, with no return to the initial level until more than 3 days after discontinuation of ibuprofen. A marked reduction in the antiplatelet effect of aspirin was also seen on the same schedule when the dosage of ibuprofen was 150 mg, which is the dose used in over-the-counter (OTC) preparations.

WHAT IS NEW AND CONCLUSION

This study indicates that the antiplatelet effect of low-dose aspirin can be markedly reduced with combined use of ibuprofen, depending on the timing of co-administration. As even the lower OTC dose of ibuprofen (150 mg) was enough to affect the antiplatelet effect of aspirin, health professionals should take into account patients' use of OTC ibuprofen when prescribing low-dose aspirin.

Erythroderma as a paraneoplastic cutaneous disorder in systemic anaplastic large cell lymphoma

BACKGROUND

  Paraneoplastic cutaneous disorders (PCDs) or dermadromes are skin conditions that have an association with internal malignancies but are not themselves malignant. We report the first two cases of systemic anaplastic large cell lymphoma (s-ALCL) accompanied by erythroderma and multiple leg ulcers as PCDs. CASE 1:  A 52-year-old Japanese man presented with disseminated itchy papular erythemas which he had over his entire body for the preceding 5 years that later exacerbated to erythroderma. Multiple punched-out ulcers also developed on his lower legs. Superficial lymph nodes (LNs) were swollen, and a left axillary LN biopsy demonstrated dense CD30(+) atypical large cell (ALC) infiltration. By contrast, lymphocytes infiltrating into the erythroderma and leg ulcers were CD30(-) , and T-cell receptor β (TCRβ) chain gene rearrangement was negative in skin biopsy specimens. Thus, he was diagnosed with s-ALCL. Not only his s-ALCL but also his erythroderma and leg ulcers responded well to chemotherapy. CASE 2:  A 71-year-old Japanese woman presented with erythroderma that persisted for approximately 20 years after mastectomy. At her initial hospital visit, she was diagnosed with s-ALCL by biopsy of swollen left inguinal LNs. Similar to Case 1, CD30(+) ALCs were negative in skin samples with normal TCRβ chain gene rearrangement. As the erythrodermic skin lesion responded well to chemotherapy for s-ALCL, it was considered a PCD.

CONCLUSION

  s-ALCL development may be predicted by the precedence and concurrence of intractable paraneoplastic erythrodermic and ulcerative skin lesions, as reported in our two cases.

[A case of giant hemorrhagic adrenal pseudocystectomy with a flank incision]

The patient was a 43-year-old woman who underwent detailed examinations for a retroperitoneal cystic lesion that was incidentally found during orthopedic treatment. Although the tumor was a non-functioning tumor, and diagnostic imaging was negative for malignancy, the tumor was surgically resected with a flank incision. The histopathological diagnosis was adrenal pseudocyst.

Increased circulating Th17 frequencies and serum IL-22 levels in patients with acute generalized exanthematous pustulosis

BACKGROUND/OBJECTIVE

Acute generalized exanthematous pustulosis (AGEP) is a diffuse pustular disorder that usually begins in intertriginous folds with widespread erythema. The causes in the majority of the cases are drugs. T cells and interleukin (IL)-8 play roles in the development of AGEP, but the mechanism remains to be elucidated. We investigated the involvement of Th17 cells and their cytokine IL-22 in the pathogenesis.

METHODS

Three patients with AGEP were enrolled in this study. The percentages of IL-17(+) Th17 cells, interferon γ(+) T cells and IL-4(+) T cells were measured in the patients' peripheral blood lymphocytes by intracellular cytokine staining and flow cytometry. The concentration of IL-22 in the sera was measured by enzyme-linked immunosorbent assay.

RESULTS

The percentages of Th17 cells were markedly higher in all three patients than healthy control individuals. The frequencies of interferon γ(+) T cells were slightly high in the patients compared with the control, and there was no definite tendency in IL-4(+) T-cell frequencies. The concentration of IL-22 was remarkably high in all patients when compared with normal subjects with levels under detection.

CONCLUSION

Th17 cells and their produced cytokine IL-22 were elevated in the peripheral blood of patients with AGEP. As IL-17 and IL-22 cooperatively stimulate keratinocytes to produce IL-8, IL-8 may contribute to the accumulation of neutrophils in the lesional epidermis of AGEP.

Warfarin and miconazole oral gel interactions: analysis and therapy recommendations based on clinical data and a pharmacokinetic model

WHAT IS KNOWN AND OBJECTIVE

Miconazole is a strong inhibitor of CYP2C9, one of the main enzymes involved in the metabolism of warfarin. Concurrent use of the two drugs leads to potentially serious adverse effects. Although it is often assumed that use of the oral miconazole gel is acceptable with concomitant warfarin, because of the low bioavailability following buccal administration, drug-drug interactions have been reported following such use. We aimed to investigate case reports of such interactions and develop a pharmacokinetic model to model such interactions.

METHODS

The Medline database from 1966 to October 2010 was used for literature search. Case reports of the potentiation of the anticoagulant effects of warfarin, such as the elevation of prothrombin time (INR), by concomitant administration of warfarin and miconazole oral gel were collected. We quantitatively estimated the extent of inhibition of warfarin metabolism by orally administered miconazole gel and compared our findings with case reports.

RESULTS AND DISCUSSION

Metabolism of (S)-warfarin is inhibited potently following administration of a standard dose (200-400 mg/day in Japan) of miconazole gel. This may lead to in an increase in the blood concentration of warfarin and lead to serious adverse effects. The literature reports of clinical interactions with concomitant use of those drugs show that other factors may amplify the effects of any increase in blood concentration.

WHAT IS NEW AND CONCLUSION

We summarize all reported, clinically significant, cases of drug interaction between miconazole oral gel and warfarin. Pharmacokinetic modelling shows that concomitant administration of warfarin and miconazole oral gel can lead to substantial increase in warfarin concentration. However, our PK/PD model fails to capture the dramatic increases seen in INR values, and hence bleeding complications, reported in the literature. Taken together, the evidence suggests that concomitant use of miconazole gel and warfarin should be avoided. Even over-the-counter products containing miconazole should be used with caution by patients receiving warfarin.

Development of visual cells in the Pacific bluefin tuna Thunnus orientalis

The development of rod and cone photoreceptor cells was investigated in the retinas of Pacific bluefin tuna larvae and juveniles, using RET-P1 monoclonal antibody labeling to identify photoreceptors. At 60 h after hatching, which was about when feeding began, opsin (presumably green opsin (Rh2)) was expressed in the outer segments of cone cells. At 15 days after hatching (dah), although many labeled cone cells were observed in the dorsal retina, the same type of cone cells had partially appeared in the ventral retina. The presence of rod cell bodies was confirmed by the expression of Rh1 opsin at 15 dah. At 21 dah, the presence of outer segments of rod cells was confirmed by the expression of Rh1 opsin and by morphology. The observations suggest that the cone cells were substantially operable upon the development of their outer segment at around the beginning of the post-larval stage, and the rod cells began to function at around 15 to 21 dah, before and during metamorphosis.

Ontogenetic changes in schooling behaviour during larval and early juvenile stages of Pacific bluefin tuna Thunnus orientalis

Schooling was first observed at 25-27 days after hatching (26. 2-33. 8 mm, total length) in the Pacific bluefin tuna Thunnus orientalis. At this time, the mode of swimming changed from intermittent sprinting to continuous cruising, and this allowed the fish to adjust to an inertial hydrodynamic environment.