Salvage Endoscopic Submucosal Dissection for Local Recurrence of Superficial Esophageal Squamous Cell Cancer after Photodynamic Therapy

Photodynamic therapy is useful as organ-preservation salvage therapy for residual recurrence of esophageal squamous cell carcinoma after chemoradiation therapy. However, the high residual recurrence rate of photodynamic therapy poses a problem. We herein report a patient who underwent photodynamic therapy for recurrence of superficial esophageal squamous cell carcinoma after chemoradiation therapy. The patient later exhibited another episode of recurrence of superficial esophageal squamous cell carcinoma, and R0 curative resection was obtained with endoscopic submucosal dissection. This suggests that endoscopic submucosal dissection may be an effective treatment option that can achieve R0 resection even for residual superficial cancer after salvage photodynamic therapy.

Whole circumferential endoscopic submucosal dissection of superficial adenocarcinoma in long-segment Barrett's esophagus: A case report

BACKGROUND

Esophageal adenocarcinoma (EAC) derived from long-segment Barrett’s esophagus (LSBE) is extremely rare in Asia. LSBE-related EAC is often difficult to diagnose in the horizontal extent. If the tumor has spread throughout the LSBE, whole circumferential endoscopic submucosal dissection (ESD) should be performed, which is difficult to complete safely. Additionally, whole circumferential ESD can bring refractory postoperative stenosis. We hereby report a case of EAC involving the whole circumference of the LSBE, achieving complete endoscopic removal without complications.

CASE SUMMARY

An 85-year-old man with the chief complaint of dysphagia underwent esophagogastroduodenoscopy. We suspected a flat-type cancerous lesion that extended the whole circumference of the LSBE (C 3.5, M 4.0) using narrow-band imaging magnification endoscopy (NBI-M). We achieved circumferential en bloc resection of the lesion safely with special ESD techniques. Histology of the ESD specimens demonstrated that the superficial EAC extended the whole circumference of the LSBE, and papillary or well-differentiated tubular adenocarcinoma was confined in the lamina propria mucosa showing a vertical negative margin. To prevent post-ESD stenosis, we performed endoscopic local injection of steroids, followed by oral administration of steroids. There was no evidence of esophageal refractory stenosis or tumor recurrence 30 mo after ESD. In summary, we experienced a rare case of LSBE-related EAC. The horizontal tumor extent was accurately diagnosed by NBI-M. Additionally, we achieve whole circumferential ESD safely without postoperative refractory stenosis.

CONCLUSION

NBI-M, ESD, and steroid therapy enabled the curative resection of superficial full circumferential LSBE-related EAC without refractory postoperative stenosis.

Huge Amoebic Liver Abscess in the Left Lobe Treated by Oral Administration of Metronidazole

A man in his 60s visited a clinic with chief complaints of a fever and general malaise. Suspecting a liver abscess in the left lobe with infiltration into the subcutaneous fat tissue under the rectus abdominis muscle based on computed tomography findings, we performed fine-needle aspiration. An amoebic liver abscess was diagnosed. Remission was achieved by the oral administration of metronidazole alone without placement of a drainage tube. The results obtained in this case suggest that the first line of treatment should be a non-invasive approach with oral administration alone. Invasive intervention should then be considered depending on subsequent progress.

A Case of Bilateral Acute Inferior Limb Ischemia in a Patient With Ulcerative Colitis

A patient was diagnosed with ulcerative colitis (UC) in 2010. In March 2015, she had abdominal pain, diarrhea, bloody stool, and UC has relapsed. In June 2015, pain and sensory disturbance of both lower limbs appeared. Blood flow at the distal femoral artery was not confirmed with magnetic resonance angiography, and it was diagnosed as bilateral acute inferior limb ischemia. Arterial thrombolectomy with Fogarty’s balloon catheter was performed and blood flow was improved. The severity of UC was moderate with Mayo score 8. Thrombosis is considered to be a complication with a high incidence in inflammatory bowel disease. Reports of arterial thrombosis are very rare. It is important to evaluate the risk of bleeding and thrombosis in active or severe cases in UC and need to do thrombotic prophylactic treatment simultaneously with UC treatment.

Quantitation of Tubotympanal Mucociliary Clearance in Otitis Media with Effusion

In an attempt to analyze the tubotympanal mucociliary function in otitis media with effusion (OME), human serum albumin labeled with technetium 99m was instilled into 36 ears with effusion and 16 without. The clearance function of the tubotympanum was measured quantitatively. The viscoelasticity of the effusions was measured and was compared with the clearance rate. The clearance rate was significantly lower in ears with effusion than in those without. A significant negative correlation was observed between clearance rate and dynamic viscosity at dynamic viscosities above 2 poise. It is concluded that ears with effusion have significantly lower mucociliary clearance than those without, and that the viscosity of the effusions plays an important role in the mucociliary dysfunction in OME.

Retroperitoneal Hematoma: Rupture of Aneurysm in the Arc of Bühler Caused by Median Arcuate Ligament Syndrome

We herein report a case with aneurysm rupture in the arc of Bühler (AOB) caused by median arcuate ligament syndrome (MALS). The patient experienced a sudden onset of upper abdominal pain. Contrast-enhanced abdominal computed tomography (CT) showed an iso- to hyper-enhancing area mainly ranging from the dorsal aspect of the pancreatic head to the retroperitoneum around the right kidney. Abdominal angiography revealed marked stenosis in the origin of the celiac artery caused by MALS and a 7-mm saccular aneurysm in the AOB. Thus, we diagnosed the pain as having been caused by aneurysm rupture in the AOB due to MALS. The patient's symptoms and anemia also improved to normal range without surgery. Careful follow-up, considering possible recurrence of aneurysm at other sites in the future, is essential.

Particle Deposition of Therapeutic Aerosols in the Nose and Paranasal Sinuses after Transnasal Sinus Surgery: A Cast Model Study

Background

The topical administration of steroids or antibiotics to the nose and the sinuses is one of the important postsurgical therapies of endoscopic sinus surgery (ESS).

Methods

To investigate the effective deposition of aerosols in the paranasal sinuses after ESS, we restored the human nasosinus model that underwent ESS and studied the particle depositions on the ostiomeatal complex (OMC), maxillary, and ethmoid sinuses quantitatively.

Results

A 45° nozzle insertion angle significantly increased the particle depositions more than the 30° angle (p < 0.05). A computer simulation-assisted analysis shows that the inertial deposition at OMC increased with a nozzle angle of 45° versus 30°. The particles with 5.63 mm in diameter significantly deposit on OMC and maxillary sinus compared with the particles with 16.37 mm (p < 0.05).

Conclusion

The topical administration of drugs to the paranasal sinuses postoperatively must be performed in consideration with aerodynamics of aerosols.

Mucociliary Transport Function and Damage of Ciliated Epithelium

The influence of epithelial damage on mucociliary transport was studied in relation to the amount of mucus. The mucosal epithelium of mucus-depleted frog palate was dissected and mounted on a plastic plate. Mechanical damages were created on the frog mucosa by pressing a different thickness of boards (2, 3, 5, and 8 mm). Two different amounts of frog mucus (7.9 L [small amount of mucus {S-mucus}]) and 51.0 L [large amount of mucus {L-mucus}])were applied on the frog mucosa with and without mucosal damage. There was no difference in mucociliary transport rate (MTR) on undamaged frog mucosa between S-mucus and L-mucus. However, on the damaged mucosa, MTR of S-mucus was significantly decreased compared with that of L-mucus. Moreover, capability of mucus transportation across the mucosal damage was significantly lower in S-mucus than in L-mucus. Results indicate that the larger the mucus amount becomes, the more the mucus travels the damaged epithelium. Moreover, MTR of L-mucus was decreased with increasing the degree of epithelial damage. This study indicates that the degree of loss of cilia is an important factor of mucociliary deceleration. (American Journal of Rhinology 16, 215–219, 2002)

Rheologic Properties of Nasal Mucus from Patients with Chronic Sinusitis

The rheologic properties of nasal mucus from the patients with chronic sinusitis was determined by the oscillating sphere magnetic rheometer. The increase in the elastic modulus (G’) and the decrease in the dynamic viscosity (η’) of mucoid and mucopurulent nasal mucus indicate that both types of nasal mucus possess the network of transient cross-links between macromolecules. The G’ and the η’ of 12 mucopurulent nasal mucus was significantly high compared with those of 13 mucoid mucus (p < 0.01), and those of mucopurulent mucus were out of the optimal range for mucociliary transport. Results suggest that abnormally high viscoelasticity of nasal mucus is one of the causes of reduced nasal mucociliary clearance in chronic sinusitis.

Complementary and alternative medicine for allergic rhinitis in Japan

BACKGROUND

Complementary and alternative medicine (CAM) is extensively used in patients with allergic diseases worldwide. The purpose of this study was to investigate the actual situation of CAM practice in the treatment of allergic rhinitis.

METHODS

We distributed questionnaires to otolaryngologists at 114 facilities in Japan. The subjects who participated in this study included children <16 years of age and adults ≥16 years of age diagnosed with allergic rhinitis by otolaryngologists. The survey was performed in the period from September 2007 to August 2009. Furthermore, we performed the same investigation out of the hospital setting, such as during general health examinations. All questionnaires were returned to Chiba University and analyzed.

RESULTS

The proportions of patients who had ever experimented with CAM in the hospital survey were 7.1% (225/3170) and 19.2% (1416/7363) of children and adults, respectively. Approximately 36.2% of the adult patients thought that the treatments were effective. The main reasons for CAM use were safety, convenience and low price. However, the group who spent more than $1000 on CAM felt more dissatisfaction and anxiety related to treatment at the hospital. The situation of CAM practice was not consistent and was instead influenced by the backgrounds of the subjects.

CONCLUSIONS

Many patients who receive CAM report feeling that the effects of treatment provided by hospitals are insufficient and have concerns about the side effects of such treatments. Information regarding standard treatments, as described in the guidelines, should become widely known and diffused, and strong communication with patients should be considered.

Fabrication and characterization of fully flattened carbon nanotubes: a new graphene nanoribbon analogue

Graphene nanoribbons (GNR) are one of the most promising candidates for the fabrication of graphene-based nanoelectronic devices such as high mobility field effect transistors (FET). Here, we report a high-yield fabrication of a high quality another type of GNR analogue, fully flattened carbon nanotubes (flattened CNTs), using solution-phase extraction of inner tubes from large-diameter multi-wall CNTs (MWCNTs). Transmission electron microscopy (TEM) observations show that flattened CNTs have width of typically 20 nm and a barbell-like cross section. Measurements of the low-bias conductance of isolated flattened CNTs as a function of gate voltage shows that the flattened CNTs display ambipolar conduction which is different from those of MWCNTs. The estimated gap based on temperature dependence of conductivity measurements of isolated flattened CNTs is 13.7 meV, which is probably caused by the modified electronic structure due to the flattening.

Effect of prehydration on nasal mucociliary clearance in low relative humidity

OBJECTIVE

Nasal mucociliary clearance, which plays an important role in defending the respiratory system, tends to decrease under conditions of low relative humidity (RH). The purpose of this randomized cross-over study was to investigate the preventive effect of prehydration on nasal mucociliary clearance under low RH conditions.

METHODS

Fourteen young healthy subjects were assigned to three interventions: prehydration (6ml/kg body weight) using water (W), prehydration using a carbohydrate-electrolyte beverage (CE), and control conditions (Cont) with no prehydration. For each intervention trial, subjects sat for 4h in an environmental chamber (23°C, 10% RH). Nasal mucociliary clearance was measured by the saccharin transit time (ST). Furthermore, a dry sensation of the mucosa, urine volume, and body weight were measured at the baseline, 2h and 4h after entering the environmental chamber, respectively.

RESULTS

ST was prolonged under the Cont conditions after entering the environmental chamber. Prehydration with CE led to a significantly lower ST compared to the Cont pretreatment at 2h, whereas the W trial showed no significance difference in comparison to the Cont values.

CONCLUSION

These results suggest that prehydration with a carbohydrate-electrolyte beverage is therefore beneficial for maintaining better nasal mucociliary clearance at least for 2h under low RH conditions.

Effects of clarithromycin and dexamethasone on mucus production in isografted rat trachea

OBJECTIVES

The purpose of this study was to develop an animal model for the study of mucus overproduction and to assess the effect of a 14-membered macrolide antibiotic and a glucocorticoid on lipopolysaccharide (LPS)-induced mucus production.

METHODS

Tracheas from donor rats were homografted to recipient rats for 4 weeks, and the usefulness of this tracheal homograft model in the study of mucus production was examined.

RESULTS

Oral administration of clarithromycin (CAM) to recipient rats for 4 weeks significantly reduced LPS-induced mucus production in the homografted trachea. Dexamethasone administered for 4 weeks also significantly reduced the mucus volume in LPS-treated homografted trachea compared with that in the control rats. The implanted trachea containing control medium was not histologically different from normal trachea. When the medium instilled into the implanted trachea contained 1 μg/ml LPS, the volume and spinability of mucus produced in the tracheal lumen were significantly increased compared to those in the trachea instilled with control medium. Goblet cell metaplasia was also observed in the implanted trachea containing LPS.

CONCLUSIONS

The present study shows that LPS-administered homografted trachea is a good animal model of chronic hypersecretory diseases of the upper and lower airways. CAM and dexamethasone could be treatment choices in such hypersecretory diseases.

Effect of vitamin K2 on the development of hepatocellular carcinoma in type C cirrhosis

BACKGROUND/AIMS

Hepatocellular carcinoma occurs frequently in cirrhosis related to hepatitis C virus (type C cirrhosis), and preventative treatment with interferon is costly and likely to cause adverse reactions. Menatetrenone, a vitamin K2 preparation, has recently been reported to inhibit the posttreatment relapse of hepatocellular carcinoma. We therefore examined whether menatetrenone could prevent the development of hepatocellular carcinoma in patients with type C cirrhosis.

METHODOLOGY

This prospective, randomized trial recruited patients with type C cirrhosis, platelet count of 10 x 10(4) microl or less, and no history of hepatocellular carcinoma. Patients were assigned to a menatetrenone group (n = 22, 4 5mg of menatetrenone daily, orally) or a control group (n = 18). Follow-up with image diagnosis was performed every 3-6 months.

RESULTS

No adverse events of menatetrenone treatment were observed. Hepatocellular carcinoma occurred in 2 of 22 patients in the menatetrenone group (9.1%) and 5 of 18 patients in the control group (27.8%); however, this difference did not reach statistical significance.

CONCLUSIONS

The present findings suggest that menatetrenone has some inhibitory effect on development of hepatocellular carcinoma in patients with type C cirrhosis. Consequently, to further validate its benefits, we believe that menatetrenone should be actively administered to patients with intractable (interferon-resistant) cirrhosis.

Prostaglandin E2 receptor EP2, EP3, and EP4 agonists inhibit antigen-induced mucus hypersecretion in the nasal epithelium of sensitized rats

OBJECTIVES

Prostaglandin (PG) E2 is a potential anti-inflammatory mediator that attenuates airway inflammation. To elucidate the functions of the PGE2 receptors (EP1, EP2, EP3, and EP4) in allergic inflammation, we examined the in vivo effects of EP agonists on mucus hypersecretion and eosinophil infiltration in rat nasal epithelium.

METHODS

We induced hypertrophic and metaplastic changes in goblet cells in nasal epithelium of ovalbumin-sensitized rats by intranasal challenge with ovalbumin. The effects of subcutaneous injections of EP agonists on mucus production and eosinophil infiltration were examined.

RESULTS

The EP4 agonist (1 to 100 microg/kg) dose-dependently inhibited ovalbumin-induced mucus production. The EP2 and EP3 agonists (100 microg/kg) also significantly inhibited mucus production. The EP3 agonist inhibited antigen-induced eosinophil infiltration, whereas the EP1 agonist showed no effect. This suppression of mucus production by the EP4 agonist was only effective when the EP4 agonist was given in the effector phase; administration in the induction phase resulted in no effect.

CONCLUSIONS

These results indicate that PGE2 acts as an anti-inflammatory mediator via the EP receptors of airways in allergic inflammation. Selective EP agonists may provide a new therapeutic strategy for airway mucus hypersecretion.

Remodeling of nasal mucosa by allergen exposure in guinea pigs is suppressed by steroid and pranlukast

BACKGROUND

It is unclear whether remodeling exists in allergic rhinitis in man. The aim of this study was to establish a guinea pig model of allergic rhinitis with remodeling and to examine the effects of dexamethasone and pranlukast on nasal mucosa remodeling.

METHODS

In the first experiment, three groups of ovalbumin-sensitized Hartley guinea pigs received intranasal challenges with ovalbumin for 1, 8, 12 weeks, respectively. In the second experiment, to examine the effect of dexamethasone and pranlukast, the animals were divided into 4 groups: negative control group; ovalbumin-sensitized group; ovalbumin + dexamethasone group; and ovalbumin + pranlukast group. During 12 weeks of intranasal exposure to ovalbumin, the latter two groups received daily intraperitoneal injections of dexamethasone and pranlukast, respectively.

RESULTS

In the first experiment, in contrast to the negative control group, the ovalbumin-sensitized group exhibited significant goblet cell hyperplasia, epithelial damage and deposition of extracellular matrix in the nasal septal mucosa and conchae. In the second experiment, these changes were significantly inhibited by dexamethasone and pranlukast, respectively.

CONCLUSIONS

We have established a model of upper airway remodeling in guinea pigs. The tissue remodeling was inhibited by early intervention with the antiallergic-inflammatory agents dexamethasone and pranlukast.

[Clinical analysis of hyposmia-associated taste dysfunction]

We clarified the clinical features of "flavor dysfunction," defined as olfactory dysfunction with self-reported hypogeusia but normal taste function in gustatory tests compared to those of "smell and taste dysfunction" hyposmia and hypogeusia in olfactory and gustatory tests. Patients with flavor dysfunction reported significantly milder taste loss than those with other smell and taste dysfunction. The major smell and taste loss etiology was upper respiratory tract infection (URI) in the flavor dysfunction group and the URI rate was significantly higher in the flavor dysfunction group than in the smell and taste dysfunction group. Smell identification thresholds in T & T olfactometry were not different between groups. Flavor dysfunction, hyposmia was treated medically but not with conventional hypogeusia medication. Medication including zinc was administered for other smell and taste dysfunction. Both groups significantly recovered from taste dysfunction. Our results indicate that treating olfactory dysfunction effectively improves flavor dysfunction but hypogeusia need not necessarily be treated. Hyposmia and hypogeusia must be treated together for other smell and taste dysfunction, making it vital that we conduct appropriate gustatory testing to correctly differentiate between flavor and other smell and taste dysfunctions.

Th2 cytokine inhibitor suplatast tosilate inhibits antigen-induced mucus hypersecretion in the nasal epithelium of sensitized rats

OBJECTIVES

Th2 cytokines such as interleukin (IL) 4 and IL-13 are potential mediators for mucus hypersecretion in allergic inflammation. To elucidate the functions of Th2 cytokines in allergic rhinitis, we examined the in vivo effects of the Th2 cytokine inhibitor suplatast tosilate on mucus hypersecretion and eosinophil infiltration in rat nasal epithelium.

METHODS

We induced hypertrophic and metaplastic changes in goblet cells in the nasal epithelium of ovalbumin-sensitized rats by intranasal challenge with ovalbumin. The effects of orally administered suplatast tosilate on mucus production and eosinophil infiltration were examined.

RESULTS

Suplatast tosilate (30 and 100 mg/kg) dose-dependently inhibited ovalbumin-induced mucus production and eosinophil infiltration. These suppressions of mucus production and eosinophil infiltration were only effective when suplatast tosilate was given in the effector phase; administration in the induction phase resulted in no effect.

CONCLUSIONS

These results indicate that Th2 cytokines are important mediators of mucus hypersecretion and eosinophil infiltration in allergic rhinitis. Suplatast tosilate may be useful for the treatment of allergic rhinitis by attenuating the inflammation of the effector phase.

Measurement of nasal patency by acoustic rhinometry in Japanese school children

OBJECTIVE

The present study was planned in order to evaluate: (1) the reference value of Japanese school children at a certain grade, (2) the relationship between subjective sensation of nasal obstruction and acoustic rhinometry, and (3) relationship of acoustic rhinometry with gender and body status.

METHODS

Seventy-five school children in the second grade, which include 39 girls (52%) and 36 boys (48%), ranging in age from 7 to 8 were studied in July 2006.

RESULTS

The normal mean values of the minimal cross-sectional area and nasal volume were 0.389 and 2.63cm(3) in this group, respectively. In those with nasal obstruction sensation, the cross-sectional areas at the third and the fourth notches were significantly smaller than those without nasal obstruction sensation (p<0.05). Nasal volume weakly correlated to body weight and body mass index. The distance from the nostril to the i-notch was significantly higher in the girls than in the boys (p<0.01). The area at the i-notch was significantly higher in the boys than in the girls. Height, weight, body mass were significantly higher in the boys than in the girls (p<0.01).

CONCLUSION

Acoustic rhinometry is a useful method for evaluation of nasal patency in school children.

Cochlear implantation in complete remission in a patient with leukemia

Patients with leukemia have an increased risk of developing sensorineural hearing loss. This is a retrospective review of a profoundly deafened patient with acute myelogenous leukemia who underwent cochlear implantation. The 26-year-old patient was successfully implanted with a Nucleus cochlear implant in the complete remission after peripheral blood stem cell transplantation. To date, with a follow-up of 1 year, the patient has not experienced any complication and has regained useful open-set speech perception. To our knowledge, this is the first reported case of successful cochlear implantation in a patient deafened by acute myelogenous leukemia.

Localization and function of histamine H3 receptor in the nasal mucosa

BACKGROUND

Histamine is an important chemical mediator of allergic rhinitis (AR). Histamine H(3) receptors (H(3)R) are located on cholinergic and NANC neurons of the myenteric plexus, and activation of H(3)R regulates gastric acid secretion. However, little is known about the localization and function of H(3)R in the upper airway.

OBJECTIVE

The objective of this study was to examine the localization and possible function of H(3)R in the nasal mucosa.

METHODS

We extracted total RNA from the inferior turbinate mucosa of patients with AR. H(3)R mRNA and beta-actin mRNA were amplified by RT-PCR. We used immunohistochemistry to examine localization of H(3)R protein in the inferior turbinate mucosa excised during clinically indicated surgery. We used alcian blue/periodic acid-shiff staining to examine the effects of the H(3)R agonist (R)-alpha-methylhistamine and the H(3)R antagonist thioperamide on secretion from rat submucosal glands.

RESULTS

H(3)R protein was expressed around submucosal gland cells. Thioperamide induced degranulation in the submucosal gland in the nasal septum.

CONCLUSION

The present results suggest that H(3)R is localized mainly around submucosal glands, and that H(3)R plays an important role in the secretion of submucosal glands in the nose.

Squamous cell carcinoma of the nasolacrimal duct

Tumors originating from the nasolacrimal duct are exceedingly rare. Only a few cases have been reported previously. In advanced cases with extended tumor, differential diagnosis from lacrimal sac tumor is difficult. A 68-year-old Japanese man with intractable dacryocystitis was examined with intranasal endoscopy, computed tomography (CT) and magnetic resonance imaging (MRI). Squamous cell carcinoma extended from a medial site in the left orbit to the lacrimal orifice. En bloc resection was performed and histopathological examination of the surgical specimen using serial section suggested that the origin of the tumor was located in the nasolacrimal duct. This is the first case in nasolacrimal duct carcinoma whose differential diagnosis of origin has been studied in detail. We showed that pathological study using serial section along the duct provides useful information for diagnosing the tumor origin in addition to that obtained from imaging studies.

Influence of visual information and test paradigm on clinical olfactory test results

OBJECTIVE

The goal of this study was to determine if visual information and test paradigms affect clinical olfactory test results.

METHODS

Three hundred and ninety-seven Japanese patients with complaints of olfactory dysfunction were administered both a new clinical olfactory test, the Odor Stick Identification Test for Japanese (OSIT-J), and the Japanese benchmark olfactory test, T&T olfactometry. Four different methods were used to administer the OSIT-J combining paradigms using word or picture-word alternatives with the four-plus alternative method based on a top-down strategy or the two-step identification method based on a bottom-up strategy. OSIT-J scores were compared for the different methods, referring to benchmark scores obtained with T&T olfactometry.

RESULTS

OSIT-J scores using picture-word alternatives and the four-plus alternative method showed a stronger correlation with T&T olfactometry test scores than those using word alternatives and the two-step identification method, respectively. The average OSIT-J scores of the four-plus alternative method using picture-word alternatives were significantly higher than those using word alternatives in anosmic and severely hyposmic patients. The time required to administer the OSIT-J using both picture-word alternatives and the four-plus alternative method was the shortest of the four OSIT-J methods.

CONCLUSIONS

Visual information and test paradigms may affect clinical olfactory test results. The OSIT-J method using picture-word alternatives and the four-plus alternative method may be the most suitable for clinical practice.

EP4 agonist inhibits lipopolysaccharide-induced mucus secretion in airway epithelial cells

OBJECTIVES

We examined the in vivo effects of agonists for prostaglandin E2 receptors (EP1, EP2, EP3, and EP4) on mucus hypersecretion. We also examined the in vitro effects of EP agonists on airway epithelial cells.

METHODS

For the in vivo study, we induced hypertrophic and metaplastic changes of goblet cells in rat nasal epithelium by intranasal lipopolysaccharide (LPS) instillation. For the in vitro study, we used NCI-H292 cells and cultured human nasal epithelial cells.

RESULTS

Subcutaneous injection of the EP4 agonist (1 to 100 microg/kg) dose-dependently inhibited LPS-induced mucus production and neutrophil infiltration. The EP3 agonist (100 microg/kg) also had some inhibitory effects on mucus production, whereas the EP1 and EP2 agonists showed no effect. The LPS-induced mucus secretion was significantly inhibited by the EP3 and EP4 agonists at 10(-6) mol/L in cultured epithelial cells. The LPS-induced interleukin-8 secretion was also inhibited by the EP3 and EP4 agonists.

CONCLUSIONS

These results indicate that the EP4 agonist inhibited LPS-induced airway mucus hypersecretion directly or indirectly through the suppression of interleukin-8 secretion and neutrophil infiltration.

Leukotriene D4 upregulates MUC2 gene transcription in human epithelial cells

BACKGROUND/AIMS

Leukotriene (LT) D(4) has been shown to induce mucus secretion in the airways. Excessive mucus secretion characterizes airway inflammatory disease such as asthma, allergic rhinitis. However, little is known about the effect of LTD(4) on mucin gene expression. The aim of this study was to investigate the effect of LTD(4) on MUC2 gene expression in cultured epithelial cells (HM3-MUC2 cells).

METHODS

HM3-MUC2 cells were treated with LTD(4) for 2 or 6 h. Reporter gene assay was mainly used for analysis.MUC2 protein levels were measured using an enzyme-linked immunosorbent assay.

RESULTS

LTD(4) significantly increased MUC2 gene transcriptional activity in a dose-dependent manner. Pranlukast, which is a selective antagonist of CysLT(1) receptor, inhibited LTD(4)-induced MUC2 gene transcriptional activity in a dose-dependent manner. LTD(4)-induced MUC2 gene transcriptional activity was also suppressed by a G-protein inhibitor (pertussis toxin),a protein kinase C (PKC) inhibitor (bisindolylmaleimide), a mitogen-activated protein/extracellular signal-regulated kinase kinase (MEK) inhibitor (PD98059), an extracellular signal regulated kinase-2 (ERK-2) inhibitor (AG126) and a nuclear factor kappaB (NF-kappaB) inhibitor. In addition, pranlukast inhibited LTD(4)-induced NF-kappaB activity.

CONCLUSION

These results suggest that LTD(4 )upregulates MUC2 gene transcription via a signaling pathway involving CysLT(1) receptor, G-protein, PKC, MEK, ERK and NF-kappaB.

[Influence of the difference in the pollen count on medical costs in an allergen-specific immunotherapy for Japanese cedar pollinosis]

BACKGROUND

We studied medical economic efficacy and influence by the different number of pollen scattering in patients treated with allergen-specific immunotherapy for Japanese cedar pollinosis.

METHODS

We calculated medical treatment costs and the medicine expense from medical records in eighteen cedar pollinosis patients treated with allergen-specific immunotherapy (IT-G) and with medications (M-G). We examined with the same patients for three years of different pollen scattering, mass scattering year (2005), moderate scattering year (2003), a few scattering year (2004). Furthermore, satisfaction of treatment and symptom score measured by visual analog scale in both subjects was studied in a mass scattering year.

RESULTS

Total medical costs at hospital was cheaper in IT-G than in M-G. The result was depended on prescribed medical costs. In addition, prescribed medicine agents and total medical costs did not increase by the mass scattering year of pollen. Satisfaction of treatment and symptom score in IT-G was better than that in M-G.

CONCLUSION

Immunotherapy had a benefit on a medical economy.

Histamine induces nasal obstruction via calcitonin gene-related peptide in sensitized guinea pigs

The purpose of this study was to characterize the late phase nasal obstruction that is induced by a nasal histamine challenge in sensitized guinea pigs. The volume of the nasal cavity was measured using an acoustic rhinometer. A nasal histamine challenge to unsensitized animals induced nasal obstruction at 30 minutes after the challenge while a challenge to sensitized animals induced nasal obstruction not only at 30 minutes but also at 4-6 hours. Histamine (measured by high-performance liquid chromatography), cysteinyl leukotriene (enzyme-linked immunosorbent assay (ELISA)), prostaglandin D2 (ELISA), eosinophils and basophilic cells of sensitized guinea pigs were not changed in the late phase after histamine challenge. Administration of pyrilamine, a histamine H1 receptor antagonist, and calcitonin gene-related peptide (CGRP) (8-37), a CGRP-1 receptor antagonist, significantly improved histamine-induced nasal obstruction at 30 minutes and in the late phase, respectively. These results suggest that a nasal histamine challenge induces nasal obstruction not only immediately through the histamine H1 receptors but also in a late phase via CGRP.

Non-recurrent inferior laryngeal nerve with multiple arterial abnormalities

Non-recurrent inferior laryngeal nerve (NRILN) is a rare embryologic anomaly that can increase the risk of injury during thyroid surgery. Although the association between the NRILN and an aberrant right subclavian artery has been reported, to date there have been no reports describing cases of NRILN with multiple vascular abnormalities. A 60-year-old man with papillary thyroid carcinoma and a history of right internal carotid artery occlusion by thrombosis was examined with magnetic resonance angiography (MRA). The right NRILN was found during a total thyroidectomy with surrounding lymph node dissection. MRA revealed an aberrant right subclavian artery and aplasia of the bilateral posterior communicating arteries composing the circle of Willis. This is the first clinical report demonstrating NRILN with multiple vascular abnormalities. Patients with NRILN must be examined for vascular anomalies and associated lesions such as aneurysms and thromboembolism.

Inhaled Particle Deposition in Unsteady-State Respiratory Flow at a Numerically Constructed Model of the Human Larynx

To evaluate the clinical effectiveness of aerosol therapy for the lower and upper respiratory airways, particle deposition at the human laryngeal region has been analyzed with various unsteady-state respiratory flow-patterns. The flow profiles and trajectory of aerosol particles were calculated by 3-D thermo-fluid analysis of a finite volume method (FVM) with 8-CPUs parallel computational system. A reconstructed physical model of the real laryngeal airways was modified from 3-D CAM modeling function of Rhinoceros based on the images of Magnetic Resonance Imaging (MRI). By using 104 MRI images taken vertically and horizontally at intervals of 2 mm on the oral cavity and the pharynx-larynx respectively, 3-D physical model of the laryngeal airways was obtained. The numerical results of flow profile analyzed by the unsteady-state respiration model showed that vortex flow was occurred with time at near larynx, showing uniform flow profile in both the oral cavity and upper side of pharynx. The vortex was appeared at the anterior part of the epiglottis and downward of the vocal cord. However, it was confirmed that few particles deposit in the vocal cord. In these cases, the particle deposition was taken place mostly at the oral cavity and the oropharynx. On the other hand, the relationship between the particle deposition efficiency and the impaction in the laryngeal region was well agreement with the data sets of ICRP task group (1993) for the larynx deposition.

Generation of peptide-specific CD8+ T cells by phytohemagglutinin-stimulated antigen-mRNA-transduced CD4+ T cells

Functional analysis of antigen-specific CD8(+) T cells is important for understanding the immune response in various immunological disorders. To analyze CD8(+) T cell responses to a variety of antigens with no readily defined peptides available, we developed a system using CD4(+) phytohemagglutinin (PHA) blasts transduced with mRNA for antigen molecules. CD4(+) PHA blasts express MHC class I and II, and also CD80 and CD86 and are thus expected to serve as potent antigen presenting cells. EGFP mRNA could be transduced into and the protein expressed by more than 90% of either LCL or CD4(+) PHA blasts. Its expression stably persisted for more than 2 weeks after transduction. In experiments with HLA-A*2402 restricted CD8(+) CTL clones for either EBNA3A or a cancer-testis antigen, SAGE, mRNA-transduced lymphoid cells were appropriate target cells in ELISPOT assays or (51)Cr releasing assays. Finally, using CD4(+) PHA blasts transduced with mRNA of a cancer-testis antigen MAGE-A4, we successfully generated specific CTL clones that recognized a novel HLA-B*4002 restricted epitope, MAGE-A4(223-231). Messenger RNA-transduced CD4(+) PHA blasts are thus useful antigen presenting cells for analysis of CD8(+) T cell responses and induction of specific T cells for potential immunotherapy.

Determination of cellularly processed HLA-A2402-restricted novel CTL epitopes derived from two cancer germ line genes, MAGE-A4 and SAGE

PURPOSE

For identification of CTL epitopes useful for cancer vaccines, it is crucial to determine whether cognate epitopes are presented on the cell surface of target cancer cells through natural processing of endogenous proteins. For this purpose, we tried to use the cellular machinery of both mice and human to define naturally processed CTL epitopes derived from two "cancer germ line" genes, MAGE-A4 and SAGE.

EXPERIMENTAL DESIGN

We vaccinated newly produced HLA-A2402 transgenic mice with DNA plasmids encoding target antigens. Following screening of synthesized peptides by splenic CD8(+) T cells of vaccinated mice, we selected candidate epitopes bound to HLA-A2402. We then examined whether human CD8(+) T cells sensitized with autologous CD4(+) PHA blasts transduced by mRNA for the cognate antigens could react with these selected peptides in an HLA-A2402-restricted manner.

RESULTS

After DNA vaccination, murine CD8(+) T cells recognizing MAGE-A4(143-151) or SAGE(715-723) in an HLA-A2402-restricted manner became detectable. Human CTLs specific for these two peptides were generated after sensitization of HLA-A2402-positive CD8(+) T cells with autologous CD4(+) PHA blasts transduced with respective mRNA. CTL clones were cytotoxic toward tumor cell lines expressing HLA-A2402 and cognate genes. Taken together, these CTL epitopes defined in HLA-A24 transgenic mice are also processed and expressed with HLA-A2402 in human cells. The presence of SAGE(715-723)-specific precursors was observed in HLA-A2402-positive healthy individuals.

CONCLUSIONS

Two novel HLA-A2402-restricted CTL epitopes, MAGE-A4(143-151) and SAGE(715-723), were identified. Our approach assisted by cellular machinery of both mice and human could be widely applicable to identify naturally processed CTL epitopes.

Effect of thrombin on permeability of human epithelial cell monolayers

Epithelial cells play an important role in maintaining the airway barrier, which is impaired in inflammatory conditions. Recently, thrombin was reported to be increased in the airway of patients with asthma, and thrombin has been shown to increase the permeability of endothelial cell monolayers. Therefore, we suspected that thrombin affects airway permeability. Calu-3 cell monolayers were established on microporous membranes of tissue culture cell inserts. We examined the effects of topically applied thrombin or thrombin receptor-activating peptide (TRAP) on: (1) transepithelial permeability (luminal to serosal transfer) of radiolabeled mannitol and albumin, (2) changes in electrical resistance, and (3) actin fiber content as assessed by fluorescence microscopy. Compared with untreated control cultures, treatment of the monolayers for 24 h with thrombin or TRAP significantly decreased the electrical resistance and increased the permeability to mannitol and albumin. In addition, these treatments enhanced the appearance of actin stress fibers, and small gaps became visible at areas of cell-cell contact. Thrombin appears to increase epithelial permeability by receptor-mediated reorganization of the actin network in airway epithelial cells. This is likely to contribute to the impairment of the airway barrier function.

A CD14 gene polymorphism is associated with the IgE level for Dermatophagoides pteronyssinus

CONCLUSION

CD14/-159 plays a role in sensitization to Dermatophagoides pteronyssinus in Japanese patients with allergic rhinitis.

OBJECTIVE

An association between a polymorphism in the 5'-flanking region of the CD14 gene and atopic phenotypes has been identified in a pediatric American population and an adult Dutch population. The aim of this study was to determine whether the CD14/-159 polymorphism is associated with specific IgE levels in allergic rhinitis patients in a Japanese population.

MATERIAL AND METHODS

The CD14/-159 genotypes of 81 unrelated patients with allergic rhinitis and 78 healthy subjects were determined and compared. The total IgE level and the specific IgE levels for three aeroallergens were determined. The IgE levels for each genotype were compared.

RESULTS

The frequencies of CD14/-159 genotypes did not differ between the two groups. Among the allergic rhinitis patients, TT homozygotes had significantly fewer positive CAP-radioallergosorbent tests (CAP-RASTs) than CC homozygotes and CT heterozygotes, suggesting that the C allele is dominant. TT homozygotes also had significantly lower CAP-RAST scores for Dermatophagoides pteronyssinus, but not for Cryptomeria japonica or Dactylis glomerata, than CC homozygotes and CT heterozygotes. There was no significant association between total serum IgE levels and CD14/-159 genotypes in the allergic rhinitis patients.

Malignant external otitis: treatment with prolonged usage of antibiotics and Burow's solution

Malignant external otitis is a severe infection of the external auditory canal, generally caused by Pseudomonas aeruginosa in elderly diabetics patients. We describe a case of malignant external otitis in a 63-year-old man with severe otalgia, purulent otorrhea and polypoid granulation of the external auditory canal. Local debridement, insulin treatment and 6-week intravenous antibiotic therapy with carbapemens were very effective and the granulation tissue disappeared completely. However, the patient readmitted for recurrent disease 3 weeks later, despite the oral and ear drop administration with new quinolone. No recurrence has been noted after 4-week additional treatment with intravenous carbapenems followed by 3-week treatment with Burow's solution as ear drops.