An analysis of factors related to the effect of sublingual immunotherapy on Japanese cedar pollen induced allergic rhinitis

Background: Sublingual immunotherapy (SLIT) can improve the symptoms of allergic rhinitis and modify its natural history; however, its efficacy varies among patients. This study aimed to determine which factors modify the effect of SLIT through post hoc analysis of a previous phase 3 trial of standardized Japanese cedar (JC) pollen extract (CEDARTOLEN®). Methods: The study included 482 patients who had previously completed a phase 3 trial during two seasons. The SLIT and placebo groups each contained 241 subjects. Because pollen dispersal differed in the two seasons, we identified good and poor responders from the SLIT group in the 2nd season. We compared patient baseline characteristics, changes in serum immunoglobulin, and severity of symptoms in the 1st season between good and poor responders, as well as between SLIT and placebo groups. Results: When we compared the baseline characteristics of good and poor responders, a significant difference was observed in body mass index (BMI) such that the patients with BMI ≥25 presented with lower treatment efficacy. No significant difference was observed in correlation with any other factors or treatment-induced alterations of serum immunoglobulin levels. We found that 75.3% of the patients with moderate symptoms and 50.9% of the patients with severe or very severe symptoms in the 1st season met our criteria for good responders in the 2nd season. Conclusions: BMI might modify the effect of SLIT; however, other factors were not related clearly. The severity of symptoms in the 1st season of treatment does not predict that in the 2nd season. Keywords: Allergic rhinitis, Japanese cedar pollen, Phase 3 trial, Post hoc analysis, Sublingual immunotherap

Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction

Background: Malignant afferent loop obstruction (ALO) is rare condition and is difficult to manage. Endoscopic transluminal treatment has become easier with the advent of balloon-assisted enteroscopes with a large working channels and self-expandable metal stent (SEMS) with a 9 Fr delivery system. Methods: From July 2016 to March 2022, 22 patients with symptomatic malignant ALO who underwent endoscopic transluminal treatment (Initial cohort), of which 18 patients received endoscopic transluminal SEMS placement (SEMS cohort), were retrospectively evaluated. We evaluated outcomes of endoscopic transluminal treatment and long-term outcomes of SEMS placement for malignant ALO. Results: In the Initial cohort, technical and clinical success rates were both 95.5%. The median procedural time was 28.0 min. One case of guidewire-induced micro-perforation occurred as an early complication (4.5%). In the SEMS cohort, and no early complication was observed. Recurrent obstruction occurred in two cases (11.1%) during the follow-up period (median: 102 days). One was managed by additional SEMS placement and the other was treated conservatively. Conclusions: High technical and clinical success was achieved by endoscopic transluminal treatment with short procedural time for malignant ALO. Endoscopic SEMS placement also appears to be safe and effective, and additional SEMS placement can be considered in cases of re-obstruction

The Influence of Environmental Exposure to Formaldehyde in Nasal Mucosa of Medical Students during Cadaver Dissection

ABSTRACTBackgroundEnvironmental exposure to formaldehyde is commonly associated with clinical symptoms such as mucosal irritation and olfactory disorders. However, the impact of such exposure on the development of mucosal inflammation and its outcome has not been carefully evaluated.MethodsThe observational non-comparative study was planned. The study population consisted of group of 41 medical students who had signed up for a cadaver dissection course as part of their gross anatomy teaching at the school of medicine Chiba University in Japan. During such dissection course, the students are exposed to variable levels of environmental formaldehyde routinely employed for the preservation the cadavers. The subjects were evaluated by a detailed medical examination. We measured their serum IgE levels. In addition, an olfaction test and nasal mucosal sensitivity to histamine was serially determined, immediately before and after the course and 6 months after the completion of the course.ResultsOlfactory abnormalities were observed in 13/41 (32%) subjects and increased nasal mucosal hypersensitivity to histamine was observed in 17/41 (41%) during and immediately after completion of the course. These subjects had evidence of preexisting allergic rhinitis. 6/41 (15%) other students with no prior evidence of allergic rhinitis also exhibited formaldehyde associated clinical symptoms during the dissecting course. However, the symptoms disappeared upon completion of the course in all subjects studied.ConclusionsTemporary abnormalities in the olfaction test and increased nasal mucosal hypersensitivity to histamine were observed in a few students with preexisting allergic rhinitis after environmental exposure of high concentrations of formaldehyde. These effects appeared to be transient

TGF-beta and TNF-alpha: antagonistic cytokines controlling type I collagen gene expression.

The balance between production and degradation of type I collagen plays a critical role in the development and maintenance of organ and tissue integrity. It also represents the most crucial element governing the process of tissue repair. The synthesis of type I collagen gene is highly regulated by different cytokines at the transcriptional level. Especially, transforming growth factor beta (TGF-beta), a key player in the physiopathology of tissue repair, enhances type I collagen gene expression. In contrast, tumor necrosis factor alpha (TNF-alpha), whose matrix-remodelling function is opposite to that of TGF-beta, reduces type I collagen gene expression. This review focuses on transcriptional regulation of type I collagen by TGF-beta and TNF-alpha and on the molecular mechanisms that control the antagonistic activity of TNF-alpha against TGF-beta-driven type I collagen gene expression