Differentiating lung cancers from tuberculoma is very important, because in Japan, lung granulomas arise mostly from tuberculosis. However, diagnosis of tuberculoma is very difficult, because of its nonspecific radiographic appearances and the difficulty of bacteriological confirmation of the disease. 18F-FDG PET have contributed significantly to the diagnosis of lung cancer, but FDG is not a cancer-specific agent, so tuberculoma also have been reported to accumulate. Recently, 18F-FDG PET is useful as tools in evaluation of disease activity or for monitoring the response to chemotherapy in patients with tuberculoma. It may be possible to distinguish patients with tuberculoma from those with lung cancer by serial 18F-FDG PET examination (ie, before and after specific treatment of antituberculous treatment for several months).
Hypertensive disorders of pregnancy (HDP) is defined as BP ≥140/90 mmHg, with or without proteinuria (≥300 mg/24 h), emerging after 20 weeks gestation, but resolving by up to 12 weeks postpartum [8,9].It is mainly classified as preeclampsia (PE) or gestational hypertension (GH).GH is diagnosed in women who have hypertension without proteinuria, and conversely, PE is diagnosed when hypertension
Abstract Background and Aims Diffuse idiopathic skeletal hyperostosis (DISH) is an idiopathic degenerative disease characterized by ossification of spinal ligaments and entheses, especially in the anterior longitudinal ligament. The ankylosed spine is prone to fracture with minor trauma and may result in spinal cord injury. It is usually asymptomatic and often diagnosed incidentally by computed tomography or other imaging methods. Several reports have revealed DISH as a risk factor for stroke, cardiovascular disease, and metabolic disorders, such as diabetes mellitus, hyperinsulinemia, obesity, dyslipidemia, and hyperuricemia. However, there are few reports of DISH in patients with end stage kidney disease (ESKD) requiring hemodialysis. Epidemiology, etiology and risk factors of DISH in patients with ESKD are unknown. We aimed to examine the prevalence and predictors of DISH in maintenance hemodialysis patients. Method This was a case-control study using patients who received maintenance hemodialysis in our hospital in December 2018. The prevalence of DISH at enrollment was evaluated according to Resnick and Niwayama criteria by computed tomography (CT). The criteria is defined as follows: (1) Flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies, (2) Relative preservation of intervertebral disc height in the involved segment, (3) Absence of apophyseal joint bony ankylosis and sacroiliac joint erosion. We excluded patients who could not receive chest CT or with a history of thoracic spine surgery. Fisher exact tests were used to evaluate the relationships between categorical variables, and Kruskal-Wallis or Mann-Whitney U tests were used to evaluate continuous variables. We performed logistic regression analyses to identify variables that had a statistically significant association with DISH, as measured by the estimated odds ratio (OR) with the 95% confidence interval (CI). Results A total of 395 consecutive patients were treated with maintenance hemodialysis in our hospital in December 2018. After excluding 4 patients who could not receive chest CT and 2 patients with a history of thoracic spine surgery, the remaining 389 patients were analyzed. The median age was 70 years, and 61.2% of patients were men. One hundred and twenty-three (31.6%) patients were diagnosed with DISH. We assigned them to the DISH group and other 266 patients to the control group. The patients with DISH were significantly more likely to have advanced age, male sex, high body weight, high bone mineral density, prior vertebral fracture, and diabetic nephropathy. Multivariate analysis showed that having DISH was significantly associated with advanced age (OR 1.06, 95%CI 1.03-1.09, P<0.001), high bone mineral density (OR1.02, 95%CI 1.00-1.03, P=0.03), prior vertebral fracture (OR3.22, 95%CI 1.23-8.41, P=0.017), diabetic nephropathy (OR 2.00, 1.03-3.90, P=0.041). Conclusion The prevalence of DISH in maintenance hemodialysis patients was high. Advanced age, male sex, high body weight, high bone mineral density, prior vertebral fracture, and diabetic nephropathy were identified as a risk factor for DISH. Physicians involved in hemodialysis treatment should be aware of the existence of DISH as one of the comorbidities in the elderly ESKD patients.
The main purpose of the present study was to evaluate the physicochemical stability of cyclosporine A (CsA)-loaded glycerol monooleate-based dry emulsion (DE). DE formulations containing 5–25% CsA (DE5–25) were stored at 25°C/60% relative humidity for 4 weeks, and freeze-dried solid dispersion formulations containing 5–30% CsA (FD5–30) were also prepared as reference formulations. Even after the storage, no significant changes were observed in the appearance of any formulations. In the dissolution study, both DE and FD exhibited marked enhancement of solubility and there was at least 2.0-fold improvement in the initial dissolution rate of DE formulations compared with that of FD formulations. After storage, DE5, DE15 and FD5 maintained relatively high solubility, with 10% reduction compared with the initial state. However, the solubility of DE25 gradually decreased during storage, as evidenced by 76% reduction of the dissolution amount. No significant changes were seen in DE5–25 using powder X-ray diffraction, although thermal analysis revealed moderate changes in crystallinity in DE25 after storage, possibly leading to the decreased dissolution. Furthermore, particle size distributions of micelles in DE5 and DE15 were almost unchanged after storage for 4 weeks. From these findings, it appears that the physicochemical stability of CsA-loaded DE might vary depending on the manufacturing method and that further optimization could improve physical properties and stability.
Neutrophils induce lung injury by releasing superoxides (O2-) and elastases. Alveoli contain anti-neutrophil agents such as surfactant. We studied the effects of alveolar type II cells on neutrophil functions. Neutrophils were isolated from human venous blood and their O2- production was measured by the cytochrome C reduction method. Type II cells and fibroblasts were isolated from rat lungs. Neutrophil O2-production was inhibited in the presence of type II cells. This effect was specific to type II cells: fibroblasts caused no inhibition. The inhibition did not require cell-to-cell contact, and it was abolished by the nitric oxide synthase inhibitor L-NAME. These results show that type II cells can inhibit neutrophil O2-production, and suggest that anti-neutrophil activity in alveoli may involve both surfactant and type II cells.
