We herein report the case of an idiopathic aneurysm of the accessory hemiazygos vein diagnosed by contrast-enhanced computed tomography (CT) and angiography. The patient was asymptomatic, and a posterior mediastinal mass was incidentally found on CT. Because endoscopic ultrasonography showed no thrombus formation in the aneurysm, the patient was therefore managed conservatively.
Tenascin C (TN-C) is an extracellular matrix glycoprotein whose expression is increased in several inflammatory diseases of the lung, including bronchial asthma. However, the exact function of TN-C in the pathogenesis of lung inflammation remains unclear. In the present study, we compared the degree of bronchial asthma in wild-type and TN-C-deficient (-/-) BALB/c mice. Bronchial asthma was induced by sensitization and challenge with ovalbumin. Littermates treated with saline were used as controls. Cytokines in bronchoalveolar lavage fluid and plasma were measured by enzyme immunoassays. The number of eosinophils in the lung was significantly increased in wild-type mice compared with TN-C-knockout mice. Airway hyperreactivity, NF-kappaB activation and concentrations of monocyte chemoattractant protein-1, IL-5, IL-13, metalloproteinase-9 and immunoglobulin-E in the bronchoalveolar lavage fluid were significantly decreased in ovalbumin-sensitized/challenged TN-C-knockout mice compared with their wild-type counterparts. In vitro experiments disclosed that TN-C significantly stimulates the secretion of IL-5, IL-13, IFN-gamma and immunoglobulin-E from spleen lymphocytes. These observations suggest that TN-C is involved in the pathogenesis of bronchial asthma.
A 54-year-old female patient diagnosed with Stage IIIb squamous cell carcinoma (cT2aN3M0) initially received chemoradiotherapy. Two years after initial treatment, cancer relapse led to the administration of nivolumab, which was halted due to the development of drug-induced pneumonitis. Subsequent management with prednisolone and eight different cytotoxic agents failed to prevent metastasis to the cervical lymph nodes. The tumor’s programmed death-ligand 1 (PD-L1) expression rate was recorded at 10%. Four years after her diagnosis, the patient received a ninth-line therapy combining cisplatin, gemcitabine, and necitumumab, followed by palliative neck radiation due to increasing lymph node size. Remarkable tumor regression occurred three months after introducing atezolizumab as the tenth-line treatment, suggesting that previous treatments, particularly radiotherapy and cisplatin, might have enhanced PD-L1 expression, aligning with the existing literature. This case highlights the urgent need for further research to elucidate the intricate interplay between treatment history and PD-L1 expression in squamous cell carcinoma, emphasizing the importance of accumulating case studies to inform therapeutic strategies.
Interstitial lung disease (ILD) is the leading cause of systemic sclerosis (SSc)-related death[1]. With the availability of antifibrotic agents to slow the progression of SSc-ILD[2], it is important for clinicians to be aware of the antibody profile predicting the severity and progression of SSc-ILD.
Objectives
To determine the impact of anti-U1 ribonucleoprotein antibody (αRNPab) in addition to anti-topoisomerase 1 antibody (ATA) on SSc related interstitial lung disease (ILD).
Methods
Patients with SSc who visited Mie University Hospital between December 2020 to December 2021 were consecutively registered. The severity and progression of ILD on chest computed tomography (CT) were assessed based on the ILD and traction bronchiectasis (TBE) scores, evaluated by using established method [3] with minor modification. We hypothesized that ATA had the greatest impact on ILD, followed by αRNPab, and accordingly stratified patients into three groups: group 1, ATA-positive; group 2, αRNPab-positive; and group 3, double-negative. At registration, patient characteristics were compared according to the presence of ILD, and the severity of ILD were compared among three groups. For patients who had earlier CT scans available, ILD progression was assessed.
Results
Among 48 patients (ILD/non-ILD; n=25/23), αRNPab positivity was significantly higher in the ILD than in the non-ILD group (32%, 0%, p<0.01). In 47 patients, the percentage of patients whose ILD score ≥ 20% was 83.3, 28.5 and 5.8% in groups 1, 2 and 3 (n = 6/7/34), respectively (p<0.01). In 25 patients, the percentage of patients with progressive ILD whose ILD score increased by ≥ 5% was 80.0, 50.0 and 14.3% in groups 1, 2 and 3 (n = 5/6/14), respectively (p<0.01).
Conclusion
The presence of αRNPab significantly affects the presence, severity and progression of SSc-ILD, although the effect is milder than that of ATA.
References
[1]Khanna D, et al. Arthritis Rheumatol 2022;74(1):13-27. [2]Distler O, et al. N Engl J Med 2019;380(26):2518-28. [3]Walsh SL, et al. Thorax 2014;69(3):216-22.
Acknowledgements
I have no acknowledThis work was supported by Nippon Boehringer Ingelheim Co., Ltd., Chugai Pharmaceutical Co., Ltd. and Mitsubishi Tanabe Pharma Corporation and AbbVie GK for the cost of anti-ARS antibody measurement. The design, execution, and interpretation of results for this study were entirely independent of these companies.gements to declare.
Abstract Introduction The presence of atrial fibrillation (AF) in patients with reduced left ventricular ejection fraction (LVEF) is associated with increased risks of mortality and hospitalization for heart failure (HF). Although prior studies reported that catheter ablation (CA) for AF in low LVEF patients reduced risks of all-cause mortality and HF hospitalization, the predictors of worsening HF after ablation has not been adequately evaluated. Purpose The purpose of this study was to investigate the impact of improvement in LVEF after AF ablation on the incidence of subsequent HF hospitalization in patients with low LVEF. Methods The Kansai Plus Atrial Fibrillation (KPAF) Registry is a multicenter registry enrolling 5,013 consecutive patients undergoing first-time ablation for AF. The current study population consisted of 1,031 patients with reduced LVEF of <60%. We divided the study population into 3 groups according to LVEF at follow-up; 678 patients (65.8%) with improved LVEF (≥5 U change in LVEF), 288 patients (27.9%) with unchanged LVEF (−5 U ≤ change in LVEF <5 U) and 65 patients (6.3%) with worsened LVEF (<−5 U change in LVEF). Results During the median follow-up of 1067 [879–1226] days, patients improved LVEF had lower rate of HF hospitalization, compared with those with unchanged and worsened LVEF (2.1%, 8.0%, and 21.5%, respectively, P<0.0001). Recurrent atrial tachyarrhythmias were documented in 43.5%, 47.2% and 67.7%, respectively (P=0.0008). Figure 1 Conclusion Among patients with reduced LVEF undergoing AF ablation, patients with subsequently improved LVEF in association with maintained sinus rhythm had markedly lower risk of HF hospitalization during follow-up as compared with those with unchanged or worsened LVEF.
