Background and Aims: Since November 2019 when Coronavirus Disease 2019 (COVID-19) was first identified in Wuhan, China, it rapidly developed into a global pandemic.The efficacy of corticosteroids and tocilizumab, IL-6 receptor antagonist monoclonal antibody, has been reported and the combination therapy are often conducted for patients with COVID-19.However, there is no consensus on the way to use tocilizumab with corticosteroids.The aim of this study was to determine the effective administration timing of tocilizumab with corticosteroids.Methods: The COVID-19 patients who admitted to our hospital and were treated with tocilizumab were retrospectively analyzed.The patients were divided into the two groups: the concurrent and sequential use groups in which tocilizumab was started within and more than 24 hours after corticosteroids administration.The clinical characteristics and courses were compared between the two groups.Results: Fifty patients were included.Disease severity of most patients was severe.Mean time of tocilizumab administration after corticosteroids was 0.31 AE 0.69 days and 5.39 AE 2.57 days in the concurrent use (n=32) and the sequential groups (n=18), respectively.In the concurrent use group, the duration of oxygen therapy after starting corticosteroids treatment was significantly shorter (13.9 AE 2.86 vs 22.8 AE 3.22 days, p=0.002) and the survival rate tended to be higher compared to the sequential use group.Conclusions: For patients with COVID-19, concurrent administration of tocilizumab with corticosteroids is more effective compared to sequential administration.
Background Transbronchial biopsy for peripheral pulmonary lesions is generally performed under X-ray fluoroscopy. Virtual bronchoscopic navigation (VBN) is a method in which virtual images of the bronchial route to the lesion are produced based on CT images obtained before VBN, and the bronchoscope is guided using these virtual images, improving the diagnosis rate of peripheral pulmonary lesions. VBN has the possibility of eliminating the need for X-ray fluoroscopic guidance for bronchoscopy. Aims and objectives To determine whether VBN can be a substitute for X-ray fluoroscopy, a randomized multicenter trial (non-inferiority trial) was performed in VBN and control groups. The non-inferiority margin in the VBN group compared with the control group was set at 15%. The subjects consisted of 140 patients with peripheral pulmonary lesions with a mean diameter > 3 cm. Methods In the VBN group, the bronchoscopewas guided to the lesion using a navigation system (Bf-NAVI; Cybernet Systems, Tokyo). In the control group, the same bronchoscope was guided to the lesion under X-ray fluoroscopy. Subsequently, in both groups, the lesion was visualized using endobronchial ultrasonography with a guide sheath, and biopsy was performed. Results The subjects of analysis consisted of 129 patients. The diagnosis rate was 76.9% (50/65) in the VBN group and 85.9% (55/64) in the control group. The difference in the diagnosis rate between the two groups was -9.0% (95% confidence interval: -22.3% - 4.3%). The non-inferiority of the VBN group could not be confirmed. Conclusion During transbronchial biopsy for peripheral pulmonary lesions, VBN cannot be a substitute for X-ray fluoroscopy.
We report a case of eosinophilic granulomatosis with polyangiitis (EGPA) complicated with a IgG4 related disease like symptoms presenting as eyelid swellings. In the present case, the serum level of IgG4 and the ratio of IgG4 to IgG were generally increased by the disease course of EGPA. Considering the course of clinical symptoms, there is a possibility that orbital manifestations were one of the clinical features during the disease course of EGPA while the histological features of right eyelid tissue and other ocular manifestations were consistent with the diagnosis of IgG4 related disease.
Objective: Fractional exhaled nitric oxide (FeNO) is widely used as a biomarker of allergic airway inflammation. At present, both stationary chemiluminescence and portable electrochemical analyzers produced by different manufacturers are available. However, it remains debatable whether those analyzers are comparable to each other. We compare FeNO levels obtained by different analyzers.Methods: For the first study, 153 subjects were enrolled to compare differences in FeNO levels measured using three analyzers (NA623NP®, NObreath®, and NIOX MINO®) which were produced by different manufacturers. For the second study, 30 subjects were recruited to compare FeNO levels obtained by the two analyzers (NIOX MINO® and NIOX VERO®) produced by the same manufacturer. FeNO was measured twice using each analyzer in random order.Results: FeNO levels obtained using the NIOX MINO® and NObreath® were more variable than those measured using the NA623NP®. There were strong positive correlations in FeNO levels measured by the NA623NP®, NIOX MINO®, and NObreath® (p < 0.001). The NA623NP® and NIOX MINO® provided the highest and lowest FeNO levels, respectively; whereas, those obtained by NObreath® were intermediate. No significant differences were observed in FeNO levels obtained using the NIOX MINO® and NIOX VERO®.Conclusions: FeNO levels measured by the NIOX MINO® and NIOX VERO®, both of which were produced by the same manufacturer, have comparability. However, significant differences in FeNO levels exist when measured by analyzers manufactured by different manufacturers. This should be taken into account for FeNO measurement.
Several preclinical and clinical studies have demonstrated that cyclooxygenase‑2 (COX‑2) inhibitors are efficient for the treatment of non‑small‑cell lung cancer (NSCLC). However, two recent phase III clinical trials using COX‑2 inhibitors in combination with platinum‑based chemotherapy failed to demonstrate a survival benefit. Thus, validation and discussion regarding the usefulness of COX‑2 inhibitors for patients with NSCLC are required. We conducted a prospective trial using COX‑2 inhibitors for the treatment of 50 NSCLC patients accrued between April, 2005 and July, 2006. Patients with untreated advanced NSCLC received oral meloxicam (150 mg daily), carboplatin (area under the curve = 5 mg̸ml x min on day 1) and docetaxel (60 mg/m2 on day 1) every 3 weeks. The primary endpoint was response rate. The response and disease control rates were 36.0 and 76.0%, respectively. The time‑to‑progression (TTP) and overall survival (OS) were 5.7 months [95% confidence interval (CI): 4.6‑6.7] and 13.7 months (95% CI: 11.4‑15.9), respectively. The 1‑year survival ratio was 56.0%. Grade 3 neuropathy was observed in only 1 patient. We performed tumor immunohistochemistry for COX‑2 and p27 and investigated the correlation between their expression and clinical outcome. COX‑2 expression in the tumor tended to correlate with a higher response rate (50.0% in the high‑ and 18.2% in the low‑COX‑2 group; P=0.092). Based on our results and previous reports, various trial designs, such as the prospective use of COX‑2 inhibitors only for patients with COX‑2‑positive NSCLC, including the exploratory analysis of biomarkers associated with the COX‑2 pathway, may be worth further consideration.
