Axillary lymph-node metabolic activity assessment on 18F-FDG-PET/CT in rheumatoid arthritis patients treated with biologic therapies.

Objective: Recent studies have provided new insights into the role of lymph nodes (LNs) in rheumatoid arthritis (RA). The aim of this study was to evaluate the metabolic activity of the axillary LNs in relation to that of the upper limb joints and the clinical assessment of disease activity in RA patients treated with biologic therapies.Method: 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) scans were acquired for 64 patients with RA at baseline and after 6 months of biologic therapy, and the patients' clinical status was evaluated. The maximum standardized uptake value (SUVmax), metabolic active volume, and total lesion glycolysis (TLG) were used to assess glucose metabolism in the LNs and 12 joints. Clinical evaluations included serum markers and the Disease Activity Score based on 28-joint count-erythrocyte sedimentation rate (DAS28-ESR).Results: Changes in the SUVmax and TLG for the axillary LNs correlated significantly with those of the ipsilateral wrist joints. There was a positive correlation between the changes in the three metabolic parameters of the axillary LNs and the changes in disease activity after treatment. After 6 months of biologic therapy, all metabolic parameters for the axillary LNs in patients with a DAS28-ESR < 3.2 were significantly lower than those of patients with a DAS28-ESR ≥ 3.2.Conclusion: A relationship between the glucose metabolism of the axillary LNs and the ipsilateral wrist joints was demonstrated by the 18F-FDG-PET/CT parameters. The metabolic activity and active volume of axillary LNs may reflect the therapeutic response to the biologic treatment of RA.

A clinical and ultrasonographic study of risk factors for elbow injury in young baseball players.

PURPOSE: To determine the risk factors for elbow injury and its association with glenohumeral internal rotation deficit among young baseball players. METHODS: 229 baseball players aged 9 to 14 (mean, 11) years completed a self-administered questionnaire with items related to years of playing baseball, hours of training per weekday, days of training per week, and past and present experience of elbow pain. Two orthopaedic surgeons measured the range of motion of both shoulders and elbows. Another 2 orthopaedic surgeons performed ultrasonography to detect any elbow abnormality such as fragmentation of the medial epicondylar apophysis and osteochondritis dissecans of the capitellum. Using univariate and multivariable analyses, participants with or without elbow abnormality were compared to determine the risk factors for elbow abnormality. RESULTS: Elbow abnormality was detected in 100 of the participants and comprised osteochondritis dissecans of the capitellum (n=18) and fragmentation of the medial epicondylar apophysis (n=82). Elbow abnormality was associated with being a pitcher, past and present experience of elbow pain, loss of elbow extension, and the side-to-side internal rotation difference. The 100 participants with elbow abnormality were stratified into symptomatic (n=57) or asymptomatic (n=43) of elbow pain. Those with elbow abnormality and elbow pain was associated with being a pitcher. CONCLUSION: Being a pitcher was a risk factor for both elbow abnormality and elbow pain. Nonetheless, 43% of baseball players with elbow abnormality were asymptomatic. The use of ultrasonography was effective in detecting elbow abnormality and enabling early treatment.

Indoor air quality and thermal comfort in temporary houses occupied after the Great East Japan Earthquake.

UNLABELLED: Thermal conditions and indoor concentrations of aldehydes, volatile organic compounds (VOCs), and NO2 were investigated in 19 occupied temporary houses in 15 temporary housing estates constructed in Minamisoma City, Fukushima, Japan. The data were collected in winter, spring, and summer in January to July 2012. Thermal conditions in temporary log houses in the summer were more comfortable than those in pre-fabricated houses. In the winter, the indoor temperature was uncomfortably low in all of the houses, particularly the temporary log houses. Indoor air concentrations for most aldehydes and VOCs were much lower than the indoor guidelines, except for those of p-dichlorobenzene, acetaldehyde, and total VOCs. The indoor p-dichlorobenzene concentrations exceeded the guideline (240 µg/m(3)) in 18% of the temporary houses, and the 10(-3) cancer risk level (91 µg/m(3)) was exceeded in winter in 21% due to use of moth repellents by the occupants. Indoor acetaldehyde concentrations exceeded the guideline (48 µg/m(3) ) in about half of the temporary houses, likely originating from the wooden building materials. Indoor NO2 concentrations in the temporary houses were significantly higher in houses where combustion heating appliances were used (0.17 ± 0.11 ppm) than in those where they were not used (0.0094 ± 0.0065 ppm). PRACTICAL IMPLICATIONS: In the winter, log-house-type temporary houses are comfortable in terms of humidity, dew condensation, and fungi based on the results of questionnaires and measurements, whereas pre-fabricated temporary houses are more comfortable in terms of temperature. In the summer, log-house-type temporary houses are comfortable in terms of temperature and humidity. More comfortable temporary housing in terms of temperature and humidity year-round is needed. Indoor air concentrations of p-dichlorobenzene and NO2 were quite high in some temporary houses due to occupants' activities, such as use of moth repellents and combustion heating appliances. The government should provide recommendations for safe use of temporary houses by occupants.

Uterine angiomyolipoma: case report and review of the literature.

Extrarenal angiomyolipomas (AML) have been reported at various anatomical sites, but infrequently in the gynecological region. In the uterus, only a few cases have been described. We describe a uterine angiomyolipoma occurring in a 40-year-old woman without evidence of tuberous sclerosis. The tumor arose on the right wall of the uterine body and was partially cystic, and it was associated with marked degeneration. It was composed of mature adipose tissue, anomalous blood vessels and non-vascular smooth muscle cells. Immunohistochemistry revealed that non- vascular smooth muscle cells were positive for alpha-smooth muscle actin (alpha-SMA), desmin, vimentin, antihuman muscle actin (HHF35) and progesterone receptor (PR), and negative for cytokeratin, antihuman melanoma (HMB45), CD34, S-100 and estrogen receptor (ER). It is of particular interest that non-vascular smooth muscle cells were negative for HMB45, in contrast to renal and other extrarenal AML in which HMB45 immunoreactivity has been demonstrated in these cells.

[Spontaneous rupture of malignant fibrous histiocytoma arising from the renal capsule: a case report].

We report a case of spontaneous rupture of malignant fibrous histiocytoma. A 50-year-old male with right flank pain was referred to our hospital. Computed tomography (CT) showed a heterogeneous space-occupying lesion on the upper pole of the right kidney. Selective right renal arteriography revealed a hypovascular mass. Preoperative clinical diagnosis was spontaneous rupture of renal cell carcinoma. Radical nephrectomy was performed. Histopathological diagnosis was malignant fibrous histiocytoma arising from the renal capsule.

Long-lasting muscle relaxant activity of eperisone hydrochloride after percutaneous administration in rats.

Potency and duration of muscle relaxant activity of eperisone hydrochloride were examined after percutaneous administration in the intercollicular decerebrated rat rigidity model and compared to those of eperisone after intravenous injection. A continuous movement was loaded on the hindlimb of the rat model to maintain stable rigidity. The tonus of the hindlimb was recorded by EMG from the triceps surae and was quantified by using the public domain NIH Image program. Eperisone ointment administered percutaneously showed significant muscle relaxant activity at 8.4 cm2 (4.2 mg of eperisone)/rat. The effect was dose-dependent and lasted over 60 min. Intravenously injected eperisone showed significant activity at 1.25 mg/kg, but the decrease of tone was lost within 30 min after injection. Plasma eperisone levels were monitored in the same model, and they were well correlated to the dosage. These results suggest that percutaneously administered eperisone is absorbed efficiently and shows potent and long-lasting muscle relaxant activity.

[A histopathological study on the biological behavior of carcinoma in situ of the uterine cervix].

Fifty-two cases of carcinoma in situ (CIS) of the uterine cervix were examined histopathologically and compared with seventeen cases of microinvasive carcinoma of the uterine cervix (restricted to the general rules for clinical and pathological management of uterine cervical cancer of the Japan Society of Obstetrics and Gynecology) in order to investigate the influence of the patient's age on the intraepithelial extension of CIS. The results were summarized as follows. 1. There was a positive correlation between circular spread and longitudinal spread of the lesion in CIS cases. 2. There was a positive correlation between circular spread and the depth of gland involvement of the lesion in CIS cases. 3. Circular spread of the lesion in microinvasive carcinoma cases was significantly more extensive than that in CIS cases. 4. Circular spread of the lesion in microinvasive carcinoma at menopause was significantly more extensive than that in microinvasive carcinoma at sexual maturity. These results suggest that CIS has intraepithelial extensibility, and that in CIS at sexual maturity there is a higher risk of invading stroma when circular spread of the lesion becomes greater than one fourth of the whole circle in the cervix, whereas CIS at menopause is more likely to invade the stroma when the circular spread of the lesion becomes greater than half of the whole circle in the cervix. In this respect we can find the influence of the patient's age on the biological behavior of CIS of the uterine cervix.

[A histopathological study on intraepithelial extensivity of carcinoma in situ of the uterine cervix in the period of sexual maturity].

To investigate intraepithelial extension of CIS, thirty-two cases of carcinoma in situ (CIS) of the uterine cervix in the period of sexual maturity were examined histopathologically and compared with ten cases of microinvasive carcinoma of the uterine cervix (restricted to Japanese criteria). The results were summarized as follows. 1) A positive correlation was found between the circular spreads and longitudinal ones in the lesion in CIS cases. 2) A positive correlation was found between circular spread and the depth of gland involvement in the lesion in CIS cases. 3) Circular spread of the lesion in microinvasive carcinoma cases was significantly more extended than that in CIS cases. These results suggest that CIS in the period of sexual maturity is intraepithelially extensive and that there is a high risk possibility of invading stroma when circular spread of the CIS lesion is greater than one fourth of the whole circle of the uterine cervix.

Nitroblue tetrazolium reduction by leukocytes in the cervix of pregnant women.

We examined nitroblue tetrazolium reduction activity in leukocytes from cervical mucus as well as peripheral blood from pregnant and nonpregnant women by histochemical methods. More than 90% of the cells examined were polymorphonuclear cells. Nitroblue tetrazolium reduction in polymorphonuclear cells from peripheral venous blood was significantly enhanced in pregnant women compared with that in nonpregnant women. However, there was no difference in activity between pregnancy periods. On the other hand, nitroblue tetrazolium reduction in cervical polymorphonuclear cells excluding women with cervicitis was also greater in pregnant women than in nonpregnant women. Moreover, activity in cervical polymorphonuclear cells gradually increased as pregnancy progressed. This enhanced activity in polymorphonuclear cells may be involved not only in the defense mechanism but also in cervical ripening in pregnancy.

[A study on the ability of leukocytes in the cervical mucus of pregnant women to produce superoxide anions using the histochemical nitroblue tetrazolium reduction test].

We performed the histochemical nitroblue tetrazolium (NBT) reduction test for leukocytes in cervical mucus and peripheral blood in women in pregnancy to investigate the leukocyte functions in the uterine cervix during pregnancy. The results were as follows. (1) With regard to leukocytes in cervical mucus, the proportion of NBT positive leukocytes was significantly highest in women in the third trimester and was higher in pregnant women than in non-pregnant women. (2) With regard to leukocytes in peripheral blood, the ability of leukocytes to reduce NBT in pregnant women was significantly greater than that of leukocytes in non-pregnant women. These results suggest that the bactericidal activity of leukocytes in cervical mucus during pregnancy is probably more accelerated than that of leukocytes during non-pregnancy.

Metabolism in vivo of 3,4,3',4'-tetrachlorobiphenyl and toxicological assessment of the metabolites in rats.

1. Metabolism in vivo of 3,4,3',4'-tetrachlorobiphenyl (TCB) and toxicological assessment of the metabolites were investigated in the rat. 2. Four metabolites were isolated from faeces of rats dosed with 3,4,3',4'-TCB. Two were identified as 5-hydroxy-3,4,3',4'-TCB and a chlorine-shift metabolite, 4-hydroxy-3,5,3',4'-TCB, by comparison of melting points, chromatographic mobilities and spectral features with those of the synthetic samples. A dihydroxy-TCB and monohydroxy-trichlorobiphenyl were also indicated by mass spectrometry to be excreted in faeces as minor metabolites. 3. Faecal excretion of unchanged 3,4,3',4'-TCB, 5-hydroxy-3,4,3',4'-TCB and 4-hydroxy-3,5,3',4'-TCB was 0.8%, 19.6% and 11.6% of dose, respectively, in 5 days after i.p. injection of 3,4,3',4'-TCB at a dose of 50 mg/kg. 4. From the inability to cause the liver hypertrophy and thymus atrophy, both monohydroxy-metabolites of 3,4,3',4'-TCB are much less toxic than the parent 3,4,3',4'-TCB. In addition, these phenolic metabolites did not induce the activities of benzo[a]pyrene hydroxylase and DT-diaphorase, whereas 3,4,3',4'-TCB greatly induced these activities. These results indicated that unlike PCB congeners with phenobarbital-type inducing ability, 3,4,3',4'-TCB, a prototype of 3-methylcholanthrene-type inducers, is detoxified by metabolic hydroxylation.

[Quantitative nitroblue tetrazolium reduction test of peripheral blood polymorphonuclear leukocytes in women in pregnancy and labor].

We performed the quantitative nitroblue tetrazolium (NBT) test for normal peripheral blood polymorphonuclear leukocytes (PMNs) to investigate the functions of PMNs during pregnancy and labor. The results were as follows. With regard to the spontaneous NBT test, the ability of PMNs to reduce NBT in pregnant and parturient women was significantly greater than to reduce NBT in non-pregnant women. The greatest ability was observed in PMNs in parturient women. With regard to the PMA-stimulated NBT test, the ability of PMNs to reduce NBT in pregnant and parturient women was significantly greater than to reduce NBT in non-pregnant women. Stimulation of NBT reduction was observed when PMNs were exposed to kallikrein. These results suggest that PMNs are so much affected by pregnancy that their functions are accelerated in pregnancy and labor, and that PMNs may have favorable effects on pregnancy and labor not only in the aspect of defense mechanisms but also in the aspect of the ripening of the uterine cervix, and that PMNs may be affected by kallikrein during labor.

Quantitative NBT reduction test with or without stimulation of peripheral polymorphonuclear cells from pregnant women.

We performed the nitroblue tetrazolium (NBT) reduction test to investigate the function of polymorphonuclear cells (PMN) from prenatal, intrapartal, postpartal and nonpregnant women with or without stimulation by phorbol myristate acetate (PMN). The capacity for NBT reduction of PMN was significantly increased in pregnancy, followed by a further increases during labor without any stimulation. On the other hand, when stimulated with PMA, there were no differences between pregnancy and labor in the reactivities of PMNs, although they were still significantly higher than those of nonpregnant women. Kallikrein increased the activity of PMN in an in vitro study, suggesting that it may be associated with the change in PMN function in labor.

Cellular changes in severe dysplasia of the uterine cervix progressing to malignancy.

Of a total of 1321 cases of severe dysplasia of the uterine cervix, 237 lesions (18%) were found by punch biopsy and cytological examination to have progressed to carcinoma in situ or microinvasive carcinoma later in the course of follow-up. The changes in exfoliated cells during the progression to malignancy were examined in 95 of the 237 cases. Results obtained were as follows: (1) The ratio of parabasal (immature) cells to the whole dysplastic cells gradually increased in each specimen. (2) Immature dysplastic cells showing increased nuclear membrane tension and irregular staining of the nuclear membrane gradually increased. (3) The number of immature dysplastic cells with finely or coarsely granular chromatin patterns gradually increased.

The diagnostic accuracy of combined colposcopy, cytology, and target biopsy of carcinoma in situ of the uterine cervix.

The results of cytology, colposcopy and target biopsy in 91 cases diagnosed by conization as uterine cervical carcinoma in situ and 39 cases diagnosed as microinvasive carcinoma were compared. Lesions limited to the ectocervix could be identified by colposcopy, and those identified as carcinoma in situ by cytology or target biopsy were all included in the group diagnosed as carcinoma in situ by conization. Among the 29 cases of carcinoma in situ limited to the ectocervix, 19 (66%) were similarly diagnosed by both cytology and target biopsy, allowing for us to avoid conization. For cases diagnosed as microinvasive carcinoma using target biopsy, conization must also be performed in order to determine the depth of invasion. Even in cases diagnosed as dysplasia or carcinoma in situ by target biopsy, when it is thought that the lesion may extend into the cervical canal or in cases where agreement with the cytological results is not found, conization is necessary.