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Dysphagia, defined as a dysfunction in any stage or process of eating, is common in patients with acute exacerbation of heart failure (HF). In some diseases, dysphagia worsens in-hospital mortality, length of hospital stay, and discharge disposition. However, it remains unclear whether dysphagia is associated with poor short-term outcomes in HF patients. The objective of the present study was to determine whether dysphagia affects short-term outcomes in patients with acute exacerbation of HF. A total of 327 patients hospitalized with acute exacerbation of HF were eligible for the study. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (NDG) based on results of the functional oral intake scale (FOIS), which evaluates a patient's ability of eating and swallowing. FOIS is a 7-point scale, with a level of ≤ 5 indicating dysphagia. Following the withdrawal of 16 patients, short-term outcomes such as in-hospital mortality, length of hospital stay, and discharge disposition, of 311 patients were analyzed. All indexes of short-term outcomes were significantly worse in the DG than in the NDG. After propensity score matching, which was performed to adjust for baseline characteristics such as age, sex, height, weight, body mass index, medical history, complications, HF severity, ejection fraction, and biochemical data excluding nutritional status, all short-term outcomes remained significantly worse in the DG than in the NDG. Multivariate analysis showed that FOIS was an independent predictor of in-hospital survival, length of hospital stay, and discharge to home. The present study suggested that dysphagia affected short-term outcomes in patients with acute exacerbation of HF. Therefore, early detection and intervention of dysphagia in HF patients are important.

OBJECTIVE Several clinical studies have reported that xanthine oxidoreductase inhibitors have antihypertensive and renal protective effects but their mechanisms have not been fully determined. This study aims to clarify these mechanisms by examining the effects of febuxostat, which is a novel selective xanthine oxidoreductase inhibitor, in Dahl salt-sensitive rats. METHODS Eight-week-old male Dahl salt-sensitive rats were fed a normal salt (0.6% NaCl) or high salt (8% NaCl) diet for 8 weeks. A portion of the rats that were fed high salt diet were treated with febuxostat (3 mg/kg per day) simultaneously. Additionally, acute effects of febuxostat (3 mg/kg per day) were examined after high salt diet feeding for 4 or 8 weeks. RESULTS Treatment with febuxostat for 8 weeks attenuated high salt diet-induced hypertension, renal dysfunction, glomerular injury, and renal interstitial fibrosis. Febuxostat treatment reduced urinary excretion of H2O2 and malondialdehyde and renal thiobarbituric acid reactive substances content. High salt diet increased xanthine oxidoreductase activity and expression in the proximal tubules and medullary interstitium. Febuxostat completely inhibited xanthine oxidoreductase activity and attenuated the high salt diet-increased xanthine oxidoreductase expression. Febuxostat transiently increased urine volume and Na+ excretion without change in blood pressure or urinary creatinine excretion after high salt diet feeding for 4 or 8 weeks. CONCLUSION Febuxostat ameliorates high salt diet-induced hypertension and renal damage with a reduction of renal oxidative stress in Dahl salt-sensitive rats. The antihypertensive effect of febuxostat may be mediated in part by diuretic and natriuretic action.

Dysphagia, defined as a dysfunction in any stage or process of eating, is common among heart failure (HF) patients. In some diseases state, dysphagia hinders patients from being discharged to home. However, it remains unclear whether dysphagia affects discharge disposition of HF patients. This study aimed to identify the impact of dysphagia on discharge disposition of HF patients. A total of 323 patients, hospitalized with acute exacerbation of HF, were eligible for the study (excluding patients who lived at nursing care facilities before admission). Following the withdrawal of 37 patients, a total of 286 patients were analyzed. Dysphagia was determined using the functional oral intake scale (FOIS), which evaluates a patient's ability to swallow. The FOIS is a 7-point scale, with a level of ≤ 5 indicating dysphagia. Of the 286 patients analyzed, 231 (80.8%) were discharged to home, and 55 were discharged to nursing care facilities or rehabilitation hospitals (non-home). FOIS level was significantly lower, and dysphagia incidence was significantly higher among patients discharged to non-home than among those discharged to home. Multivariate analysis showed that FOIS level was an independent predictor of discharge disposition. Additionally, after propensity score matching, which was performed to adjust for baseline characteristics, FOIS level remained significantly lower in patients discharged to non-home than in those discharged to home. In conclusion, dysphagia hinders patients hospitalized with HF from being discharged to home. We conclude that evaluating dysphagia and its severity on admission is useful for predicting discharge disposition in patients hospitalized with HF.

Objective Exercise training has antihypertensive and renoprotective effects in humans and rats. However, the effects of exercise training on renal disorders that occur with salt-sensitive hypertension remains unclear. The study aim was to investigate the effects and mechanisms of exercise training on renal function in a rat model of salt-sensitive hypertension. Methods Six-week-old male Dahl salt-sensitive rats were divided into normal-salt (0.6% NaCl) diet, high-salt (8% NaCl) diet, and high-salt diet with exercise training groups. The high-salt diet with exercise training group underwent daily treadmill running for 8 weeks. Results The high-salt diet induced severe hypertension and renal dysfunction. Exercise training significantly improved high-salt diet-induced urinary protein, albumin, and L-type fatty acid-binding protein excretion, and glomerulosclerosis but not renal interstitial fibrosis without changing blood pressure. Exercise training significantly attenuated high-salt diet-induced oxidative stress in the kidneys and decreased high-salt diet-stimulated xanthine oxidoreductase activity but not nicotinamide adenine dinucleotide phosphate oxidase activity. The high-salt diet did not change urinary excretion of 20-hydroxyeicosatetraenoic acid and decreased cytochrome P450 4A protein expression in the kidneys. Exercise training increased urinary 20-hydoroxyeicosatetraenoic acid excretion and renal cytochrome P450 4A protein expression. Conclusion Exercise training improved renal disorders without lowering blood pressure in Dahl salt-sensitive rats. Exercise training also decreased oxidative stress and increased 20-hydroxyeicosatetraenoic acid production in the kidneys. These results suggest that improvements in oxidative stress and 20-hydroxyeicosatetraenoic acid production may be potential mechanisms by which exercise training improved renal disorders in Dahl salt-sensitive rats.

Accepted: 2017-03-15, 資料番号: SA1170013000

Unilateral training of both lateral limbs increases unilateral muscle strength, whereas bilateral training increases bilateral muscle strength, a phenomenon known as lateral specificity in resistance training. Although motor imagery (MI) combined with action observation (AO) (i.e., MI + AO) training increases muscle strength, it is not completely understood whether such training increases the lateral specificity of muscle strength in a way resistance training does. To investigate whether MI + AO induces lateral specificity of muscle strength increase, 18 healthy subjects were divided into groups: MI + AO and the control groups. The control group watched a movie of natural sceneries for ten minutes per day five times a week for three weeks, whereas the MI + AO group imagined bilateral shoulder flexion while watching a movie of athletes performing bilateral shoulder flexion with barbells or dumbbells, with the same time schedule. The MI + AO group alone showed a significant increase in bilateral shoulder strength at three weeks after the intervention compared with the baseline. Unilateral shoulder strength was not significantly altered. These results suggest that MI + AO training increases muscle strength, providing evidence that similar to resistance training, lateral specificity also exists in MI + AO training.

Arterial stiffness is widely used in assessing arteriosclerosis in the background of increased cardiovascular events. Arteriosclerosis also causes reduction in exercise capacity, which is a most important prognostic factor in patients with cardiovascular disease; however, data on the association between arterial stiffness and exercise capacity are limited. Therefore, a simple and noninvasive measurement of arterial stiffness that reflects the central circulation and exercise capacity is needed. The arterial velocity pulse index (AVI) is a parameter of arterial stiffness measurable with the cuff oscillometric method; however, the clinical utility of this method is unclear. We aimed to evaluate the trend of AVI in patients with coronary artery disease (CAD), and the association between AVI and exercise capacity. A cross-sectional study of 116 patients with cardiac disease (34 CAD and 82 non-CAD patients) was performed. Non-CAD patients were those with any cardiac diseases who did not have proven CAD. The results showed that the AVI was significantly higher in CAD patients than non-CAD patients (P < 0.05, analysis of covariance). The AVI was inversely correlated with peakVO2 (r = -0.239, P < 0.05) and was a significant explanatory variable for peakVO2 in stepwise regression analysis (β = -14.62, t = -2.5, P < 0.05). These results indicate that the AVI is strongly associated with CAD and predictive of the exercise capacity in patients with cardiac diseases. We, therefore, propose that the cuff oscillometric method is clinically useful in evaluating arterial stiffness in patients with cardiac diseases, especially CAD.

BACKGROUND Clinical trials show potent renoprotective effects of pitavastatin (PTV), although the precise mechanism for these renoprotective effects is not fully clarified. The aim of this study was to examine the antihypertensive and renoprotective effects of PTV, focusing on the nitric oxide (NO) system. METHODS Male, 6-week-old, spontaneously hypertensive rats (SHR) and Wistar–Kyoto rats (WKY) were randomized to receive vehicle or PTV (2 mg/kg bodyweight) for 8 weeks. Blood pressure and urinary albumin excretion were measured every 2 weeks. After 8 weeks, plasma biochemical parameters and renal histology were examined. NO synthase isoform (neuronal, nNOS; inducible, iNOS; and endothelial, eNOS) expression and eNOS phosphorylation were examined by western blotting. RESULTS PTV attenuated hypertension and albuminuria development in SHR. PTV decreased glomerular desmin expression and medullary interstitial fibrosis in SHR. PTV tended to increase plasma NO in both strains but significantly increased urinary NO excretion only in WKY. PTV significantly increased nNOS and eNOS expression, enhanced eNOS phosphorylation at serine1177, and inhibited eNOS phosphorylation at threonine495 in the kidney of both strains. CONCLUSIONS PTV treatment led to increased renal NOS expression and upregulated eNOS activity in both SHR and WKY. The antihypertensive and renoprotective effects of PTV may be related to upregulation of the NO system.

The effect of aerobic exercise on physical function and mental health in various adult age groups (young-old, 65-74; old-old, 75-84; oldest-old, ≥ 85 years) is unclear. The aim of this study was to investigate the effects of the Kohzuki Exercise Program (KEP) on physical function and mental health in these age groups. The KEP consisted of 40-min supervised sessions 3 times per week for 6 months as follows: 5 min of warm-up, 30 min of lower limb aerobic exercise, and 5 min of cool-down. A total of 50 participants (22 young-old, 20 old-old, and 8 oldest-old) who participated in the KEP completed at least 88% of the sessions. In statistical analysis, 3 (group: oldest-old, old-old, young-old) × 2 (time: baseline and after 6 months) analyses of variance were used to determine if there were significant main and interaction effects. Significant interactions were probed using the post-hoc paired t test. The Short Physical Performance Battery (SPPB) score showed significant group × time interactions after 6 months (p = 0.031). In the post-hoc test, oldest-old (p < 0.001), old-old (p < 0.001), and young-old (p < 0.01) groups had significantly better physical function after 6 months. However, none of the mental health measures showed group × time interactions at 6-month. Our results suggest that a 6-month KEP led to improved physical function in oldest-old, old-old, and young-old adults. The KEP was effective for oldest-old adults in particular. The KEP exhibits good adherence, making it suitable for a wide age range in society.

[Purpose] This study aimed to develop a simple, inexpensive, and accurate method for measuring the strength of shoulder flexion (Experiment 1) and evaluate the bilateral force deficit in shoulder flexion (Experiment 2) in healthy subjects. [Subjects and Methods] In Experiment 1, maximal voluntary contractions (MVCs) in isometric shoulder flexion were measured on both sides using an isometric dynamometer (ID) and a hand-grip dynamometer (HGD), as an alternative dynamometer, in six subjects. In Experiment 2, bilateral force deficit was evaluated using HGD in 21 subjects who performed unilateral and bilateral MVCs in isometric flexions of the shoulder. The peak value of electromyography (PVE) in the lateral head of the biceps brachii and anterior deltoid was measured during MVCs. [Results] In Experiment 1, ID and HGD showed almost similar coefficients of variation. A strong positive correlation was found between the values obtained using the two methods. In Experiment 2, the bilateral force deficit in shoulder flexion associated with a reduced PVE (‒10.9%) was found in 85.7% of subjects. [Conclusion] The reproducibility of measurements was similar between ID and HGD. HGD could evaluate the bilateral force deficit in shoulder flexion and is a practical tool for measuring shoulder strength.

著者人数: 11名, Accepted: 2014-02-01, 資料番号: SA1004603000

Objective: Aerobic exercise is known to have multiple beneficial effects including renal protection in type 2 diabetes mellitus and obesity. However, the mechanisms regulating these actions of aerobic exercise remain unclear. The present study evaluated the effects of chronic aerobic exercise on early stage of diabetic nephropathy focusing on renal oxidative stress and nitric oxide (NO), using Zucker diabetic fatty (ZDF) rats as an animal model of obese type 2 diabetes. Methods: Male ZDF rats (6 weeks old) underwent forced treadmill exercise for 8 weeks (Ex-ZDF). Sedentary ZDF (Sed-ZDF) and Zucker lean (Sed-ZL) rats served as controls. After the last exercise session, all rats were subjected to an intra-peritoneal glucose tolerance test. Result: Exercise ameliorated hyperglycemia with increased insulin secretion, and raised the values of homeostasis model assessment for β-cell function (HOMA-β) in ZDF rats. Exercise also reduced albumin excretion and normalized creatinine clearance in ZDF rats. Endothelial (e) and neuronal (n) NO synthase (NOS) protein expression, and NOS activity in the kidneys of Sed-ZDF rats were lower compared with Sed-ZL rats, while both NOS expression and NOS activity were upregulated by exercise in ZDF rats. Although there was no significant difference in plasma levels of adiponectin between the groups, plasma levels of leptin were significantly higher in the Ex-ZDF group compared with the Sed-ZL and Sed-ZDF groups. Exercise decreased plasma and urinary thiobarbituric acid-reactive substances (TBARS) as an index of lipid peroxidation in ZDF rats. Additionally, renal nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity and expression of p47phox protein were significantly higher in the kidneys of the Sed-ZDF group compared with the Sed-ZL group, and there was no significant difference between the Ex-ZDF and Sed-ZL groups. Immunoblots for Nox4, Nox2, namely gp91phox and p22phox protein were undetected in the kidneys of the Sed-ZDF and Ex-ZDF group as well as the Sed-ZL group. In addition, expression of nitrotyrosine as an index of peroxynitrite (ONOO–) formation was significantly lower in the kidneys of the Sed-ZDF group compared with the Sed-ZL group, and was significantly higher in the Ex-ZDF group compared with the Sed-ZDF group. Further, morphometric evidence of renal damage was alleviated in response to exercise. Conclusion: Upregulated NOS activity and NOS protein, and ameliorated NADPH oxidase activity and p47phox protein in the kidneys may be potential mechanisms by which chronic aerobic exercise can reduced early diabetic nephropathy in ZDF rats. Chronic aerobic exercise does have beneficial effects and may be a novel therapeutic approach for preventing the development of renal dysfunction in patients with type 2 diabetes mellitus and obesity.

Music and exercise can both affect autonomic nervous system activity. However, the effects of the combination of music and exercise on autonomic activity are poorly understood. Additionally, it remains unknown whether music affects post-exercise orthostatic tolerance. The aim of this study was to evaluate the effects of music on autonomic nervous system activity in orthostatic tolerance after exercise. Twenty-six healthy graduate students participated in four sessions in a random order on four separate days: a sedentary session, a music session, a bicycling session, and a bicycling with music session. Participants were asked to listen to their favorite music and to exercise on a cycle ergometer. We evaluated autonomic nervous system activity before and after each session using frequency analysis of heart rate variability. High frequency power, an index of parasympathetic nervous system activity, was significantly increased in the music session. Heart rate was increased, and high frequency power was decreased, in the bicycling session. There was no significant difference in high frequency power before and after the bicycling with music session, although heart rate was significantly increased. Additionally, both music and exercise did not significantly affect heart rate, systolic blood pressure or also heart rate variability indices in the orthostatic test. These data suggest that music increased parasympathetic activity and attenuated the exercise-induced decrease in parasympathetic activity without altering the orthostatic tolerance after exercise. Therefore, music may be an effective approach for improving post-exercise parasympathetic reactivation, resulting in a faster recovery and a reduction in cardiac stress after exercise.

著者人数: 11名, Accepted: 2011-04-11, 資料番号: SA1003245000

Although various effective antibiotics have been synthesized, deep neck abscess is still a serious and life-threatening infection. It is important to diagnose promptly and treat adequately, and contrast-enhanced CT is useful and indispensable for diagnosis. We reviewed our patients with deep neck abscess, and analyzed the location by reviewing CT images, and discussed the treatment. Surgical drainage is a fundamental treatment for abscess but if it exists in only one area such as the parotid gland space, it can be cured with needle aspiration and suitable antibiotics.

Several clinical and basic studies have reported that febuxostat (Fx), xanthine oxidase (XO) inhibitor, has anti-hypertensive and renal protective effects. However, these effects of Fx are controversial, and the mechanisms have not been clarified. In this study, we investigated the effects of Fx on blood pressure and renal functions in Dahl salt-sensitive rats. Eight-week-old, male Dahl salt-sensitive rats were divided into three groups: 1) normal salt diet (NS) group; 2) high salt diet (HS) group; 3) HS + Fx group. The NS or HS groups were fed diet containing 0.6% or 8% NaCl, and the Fx group treated with Fx (3 mg/kg/day in drinking water). After 8 weeks, the systolic blood pressure (SBP), renal functions, and renal histology were examined. HS significantly increased the SBP, urinary protein excretion, and plasma creatinine and uric acid (p

Clinical trials have demonstrated renoprotective effects of atorvastatin (ATV) and pitavastatin (PTV), which belong to the strong statins, are more potent than other statins. We reported previously that ATV attenuated the development of hypertension in SHR with increasing the endothelial and neuronal NO synthases (eNOS, nNOS) expressions in the kidney, whereas ATV inhibited the eNOS phosphorylation at serin1177 (J Hypertes 28: 2278-2288, 2010). To clarify the mechanisms of renoprotective effects of PTV, the present study examined the effects of PTV on blood pressure, renal functions, NOS and oxidative stress in the kidney of SHR. Five-week-old, male SHR were given orally PTV (2mg/kg/day) or vehicle for 8 weeks. The systolic blood pressure (SBP) was measured. The NOS expression and eNOS phosphorylation were analyzed by Western blot. The NADPH oxidase activity was measured by the lucigenin-enhanced chemiluminescence method. PTV attenuated the progression of hypertension (220 ± 8 vs. 177± 4 mmHg, P

Exercise training is known to exert multiple beneficial effects including renal protection in type 2 diabetes mellitus and obesity. However, the mechanisms regulating these actions remain unclear. The present study evaluated the effects of chronic running exercise on the early stage of diabetic nephropathy, focusing on nitric oxide synthase (NOS), oxidative stress and glycation in the kidneys of Zucker diabetic fatty (ZDF) rats. Male ZDF rats (6 weeks old) underwent forced treadmill exercise for 8 weeks (Ex-ZDF). Sedentary ZDF (Sed-ZDF) and Zucker lean (Sed-ZL) rats served as controls. Exercise attenuated hyperglycemia (plasma glucose; 242 ± 43 mg/dL in Sed-ZDF and 115 ± 5 mg/dL in Ex-ZDF) with increased insulin secretion (plasma insulin; 2.3 ± 0.7 and 5.3 ± 0.9 ng/mL), reduced albumin excretion (urine albumin; 492 ± 70 and 176 ± 11 mg/g creatinine) and normalized creatinine clearance (9.7 ± 1.4 and 4.5 ± 0.8 mL/min per body weight) in ZDF rats. Endothelial (e) and neuronal (n) NOS expression in kidneys of Sed-ZDF rats were lower compared with Sed-ZL rats (p

Cysteinyl leukotrienes (cysLTs) are a class of closely structurally related lipid molecules, originally described as slow-reacting substance of anaphylaxis, with a myriad of biologic functions. These activities include producing smooth muscle contraction and mucus secretion, recruiting allergic inflammatory cells, modulating cytokine production, influencing neural transmission, and altering structural changes in the airway. Administration of cysLTs to animals and human subjects reproduces many features of allergic inflammation and asthma. Leukotriene (LT) blockers have independent efficacy in asthma and improve pulmonary function when added to inhaled steroids. Conversely, blockade of this pathway both in animals and in human subjects results in important reductions in inflammation and its consequences and might reduce structural changes of remodeling. These data collectively make a compelling case for an important role of cysLTs in airway inflammation and asthma. However, the magnitude of effect of anti-LTs is smaller than that of corticosteroids, and there is more variability in benefit of LT blockade than is seen with inhaled steroids. In addition, adding anti-LTs to inhaled steroids in asthmatic patients does not appear to produce added anti-inflammatory benefit. Genetic polymorphisms and environmental factors, such as tobacco smoke exposure, might underlie some of the heterogeneity of response to LT blockers.

With the recent rapid shift in pharmaceutical education to the development of clinical experts, emphasis on education in humanism and communication has increased. However, there is a lack of experience in these fields of pharmaceutical education in Japan, and there have been few studies on the curriculum, from admission to the pharmaceutical science to the stage before on-the-job training. Also our previous survey of communication-related education revealed there is no consensus on the interpretation of communication-related education. In this study, therefore, we investigated communication-related education is incorporated before on-the-job training at 46 schools of pharmaceutical science in Japan. Communication-related education was carried out at 26 (56.5%) of the 46 schools, and role-playing was incorporated in the program at 23 (88.5%) of these 26 schools. However, SP (simulated patient/standardized patient) was adopted at 12 (46.2%) of these 26 schools. There was a psychologist or a communication specialist on the staff at only 10 (38.5%) of these 26 schools, revealing the lack of instructors in these fields. Interest in education related to communication was generally weak at national and public universities, and marked differences in the approach to pharmaceutical education among university types were observed. The preparation of basic guidelines and textbooks for stepwise communication education from lower to higher grades and the training of instructors are urgently needed.

There is a paucity of data regarding prevalence and characteristics of adult seafood allergy in United States cohorts. This study was designed to determine the characteristics of patient-reported seafood allergy in a large allergy referral adult population. Retrospective analysis was performed of laboratory and clinical characteristics of seafood-allergic patients in three allergy clinics in the Texas Medical Center between January 1,1997 and January 30,2010. Of 5162 patients seen in this adult allergy referral population, 159 had physician-diagnosed seafood allergy with an average age of diagnosis of 50.2 (18–81 years) years. Shellfish allergy (59.1%) was more frequent than fish allergy (13.8%). Crustacean allergy (82.6%) was more frequent than mollusk allergy (7.2%). Shrimp (72.5%), crab (34.8%), and lobster (17.4%) were the most common shellfish allergies and tuna (28.6%), catfish (23.8%), and salmon (23.8%) were the most common fish allergies. One-third of seafood-allergic patients reported reactions to more than one seafood. Shellfish-allergic adults were more likely to experience respiratory symptoms than fish-allergic adults (p < 0.05). The likelihood of having anaphylaxis (32%) was not statistically different between shellfish- and fish-allergic subjects. Severe reactions were 12.9 times more likely to occur within the 1st hour of ingestion compared with nonsevere reactions (p < 0.005). The percentage of seafood allergy in this adult allergy referral population was 3.08%.

We are now developing Web-GIS based collaboration environment for lunar and planetary science. This system, called WISE-CAPS aims for promotion of researchers' collaboration and data sharing through the network. In WISE-CAPS, all data are stored in server and data access to server is controlled with security modules of the server and control files. This system combines easy-to-use user environment and flexible and robust security.

Purpose of review To highlight recent literature that informs our understanding of severe asthma. Severe asthma is an increasingly important part of specialty practice, is responsible for disproportionate healthcare utilization, and contributes significantly to the costs of care. Better recognition of this subset of asthma can lead to improved healthcare. Recent findings Key recent observations in severe asthma include demographic characterizations of several large study populations and the increasing understanding that relative steroid resistance is a virtually universal feature. In addition, strong associations with interleukin-13 and mammalian chitinase have emerged, and abnormalities of endogenous anti-inflammatory pathways have been examined. The role of protein biomarkers to identify and delineate severe asthma is now being investigated. The pathogenic significance of each of these observations is still being clarified, but it appears that severe asthma may have mechanistic underpinnings distinct from that of mild or moderate asthma. Summary Severe asthma is a discrete, but variably defined phenotype of asthma. Steroid resistance is extremely common, patients may require doses of inhaled steroids for control that exceed usual guidelines and may also require multiple controller agents. New mechanistic insights could provide important avenues for novel therapeutic interventions.

IL-10 can be considered an important agent in the resolution of inflammation. Originally named "cytokine synthesis inhibitory factor" for its ability to inhibit IFN-gamma and IL-2 production in Th2 cells, it is secreted by monocytes, macrophages, mast cells, T and B lymphocytes, and dendritic cells (DCs). IL-10 production and release by monocytic cells in response to allergic challenge is upregulated by TNF-alpha, and by negative feedback regulation of itself. However, it is also secreted by T regulatory cells (Tregs), under the control of IL-2. Importantly in the context of asthma, IL-10 inhibits eosinophilia, by suppression of IL-5 and GM-CSF, by direct effects on eosinophil apoptosis, and effects on cell proliferation through down-regulation of IL-1. A number of its cytokine suppressive characteristics are now thought to occur through its upregulation of suppressor of cytokine signaling (SOCS)-3. IL-10 is also a suppressor of nitric oxide (NO) production, which may have ramifications for its role in airway inflammatory diseases. Initial clinical trials have demonstrated relative safety and few clinically adverse events at doses of recombinant human IL-10 below 50 microg/kg, with mixed success in treatment of patients with inflammatory bowel disease and psoriasis. However, both steroid therapy and allergen specific immunotherapy are known to elevate endogenous IL-10 levels, which may account for their efficacy, suggesting that further study of IL-10 as a target for treatment of airway inflammatory diseases such as asthma and COPD is warranted.

Background Although albuterol remains the standard treatment for asthma in the emergency department, formoterol fumarate may be more advantageous, with its rapid and long-lasting bronchodilation. Objective To compare formoterol fumarate with albuterol in controlling acute asthma exacerbation. Methods Patients aged 18 to 65 years who presented to the emergency department with mild to moderate asthma exacerbation (peak expiratory flow rate [PEFR], 40%-60% of predicted) were randomized to receive either formoterol fumarate aerolizer (12 μg) or albuterol nebulizer (2.5 mg) every 30 minutes up to 2 treatments. Symptom scores and PEFRs were measured at each treatment. Results Thirty-four patients (19 in the albuterol arm and 15 in the formoterol fumarate arm) were enrolled. At 30 and 60 minutes, the mean PEFR of the albuterol group increased from 43.7% of predicted to 51.9% of predicted and 54.6% of predicted, respectively, and the formoterol fumarate group had changes in the mean PEFR from 49.3% of predicted to 55.5% of predicted and 57.3% of predicted, respectively, and the mean change in the 2 groups was not significantly different at 30 and 60 minutes ( P = .64 and .57, respectively, by t test). The albuterol group improved in symptom scores by 3.7 and 5.5 from 0 minutes to 30 and 60 minutes, respectively, and in the formoterol fumarate group these values were 3.1 and 4.9 at 30 and 60 minutes, respectively, and the mean change in the 2 groups was not significantly different at 30 and 60 minutes ( P = .61 and .76, respectively, by t test). Conclusion Formoterol fumarate is as effective as albuterol inhalation for the treatment of adults with mild to moderate asthma exacerbations in the acute care setting.

膵頭十二指腸領域癌への全胃幽門輪温存膵頭十二指腸切除術 (以下本術式) の適応を組織学的因子から検討した.対象は膵頭部癌, 乳頭部癌, 中下部胆管癌, 胆嚢癌, 十二指腸癌245例で, 本術式の適応を左右すると考えられるNo.(3),(4),(5),(6),(7) リンパ節いずれかへの転移 (以下N-meta因子), 十二指腸第一部または胃への直接浸潤 (以下D-inf因子) の有無の2点を検討し, 以下の結論をえた.1.乳頭部癌はN-meta因子 (+) 症例は3.7%, D-inf因子 (+) 症例は0%であり, 本術式のよい適応と考えられた.2.中下部胆管癌, 胆嚢癌, 十二指腸癌ではD-inf因子 (-) 症例は全例N-meta因子 (-) 症例であり, D-inf因子の有無で本術式の適応を考慮してよいと考えられた.3.膵頭部癌ではD-inf因子 (-) でかつN-meta因子 (+) 症例は7.5%に認め, 根治性を追求する限り幽門側胃切除は必要と考えられた.

Anaphylaxis is a life-threatening condition closely linked to IgE activation of mast cells with subsequent release of preformed mediators, including histamine, neutral proteases (tryptase and chymase), and proteoglycans (eg, heparin) from intracellular granules. These factors participate in the development of classic symptoms involving the skin, respiratory tract, circulation, and gastrointestinal system. Release of these granules is followed quickly by increased synthesis from membrane arachidonic acid of prostaglandins and leukotrienes that have an additional role in clinical symptoms. Thereafter, mast cells release numerous chemokines and cytokines that initiate recruitment and activation of additional inflammatory cells, including basophils, eosinophils, and Th2 cells.