Extensive myocardial infiltration by hemopoietic precursors in a patient with myelodysplastic syndrome

BACKGROUND: Although myocardial infiltration with leukemic blasts is a known finding in patients with acute leukemia, this phenomenon in myelodysplasia is not reported in the literature. Cardiac symptoms in patients with myelodysplasia are often due to anemia and may be due to iron overload and side effects of therapy. CASE PRESENTATION: Herein we report the first case of neoplastic infiltration of the heart with associated myocardial necrosis in a patient with myelodysplasia. It was associated with unicellular and multifocal geographic areas of necrosis in the left ventricle and the interventricular septum. It is likely that cardiac compromise in our patient was due to a combination of restrictive cardiomyopathy due to leukemic infiltration, concomitant anemia, cardiac dilatation, conduction blocks and myocardial necrosis. Myocardial necrosis was most likely due to a combination of ischemic damage secondary to anemia and prolonged hypotension and extensive leukemic infiltration. Markedly rapid decrease in ejection fraction from 66% to 33% also suggests the role of ischemia, since leukemic infiltration is not expected to cause this degree of systolic dysfunction over a 24-hour period. The diagnosis was not suspected during life due to concomitant signs and symptoms of anemia, pulmonary infections, and pericardial and pleural effusions. The patient succumbed to cardiac failure. CONCLUSION: Hemopoietic cell infiltration was not considered in the differential diagnosis and contributed to this patient's morbidity and mortality. This case highlights the clinical importance of considering myocardial infiltration in patients with myelodysplasia and cardiac symptoms

Metamorphosis of Subarachnoid Hemorrhage Research: from Delayed Vasospasm to Early Brain Injury

Delayed vasospasm that develops 3–7 days after aneurysmal subarachnoid hemorrhage (SAH) has traditionally been considered the most important determinant of delayed ischemic injury and poor outcome. Consequently, most therapies against delayed ischemic injury are directed towards reducing the incidence of vasospasm. The clinical trials based on this strategy, however, have so far claimed limited success; the incidence of vasospasm is reduced without reduction in delayed ischemic injury or improvement in the long-term outcome. This fact has shifted research interest to the early brain injury (first 72 h) evoked by SAH. In recent years, several pathological mechanisms that activate within minutes after the initial bleed and lead to early brain injury are identified. In addition, it is found that many of these mechanisms evolve with time and participate in the pathogenesis of delayed ischemic injury and poor outcome. Therefore, a therapy or therapies focused on these early mechanisms may not only prevent the early brain injury but may also help reduce the intensity of later developing neurological complications. This manuscript reviews the pathological mechanisms of early brain injury after SAH and summarizes the status of current therapies

Carfilzomib and dexamethasone versus bortezomib and dexamethasone for patients with relapsed or refractory multiple myeloma (ENDEAVOR): And randomised, phase 3, open-label, multicentre study

Background: Bortezomib with dexamethasone is a standard treatment option for relapsed or refractory multiple myeloma. Carfilzomib with dexamethasone has shown promising activity in patients in this disease setting. The aim of this study was to compare the combination of carfilzomib and dexamethasone with bortezomib and dexamethasone in patients with relapsed or refractory multiple myeloma. Methods: In this randomised, phase 3, open-label, multicentre study, patients with relapsed or refractory multiple myeloma who had one to three previous treatments were randomly assigned (1:1) using a blocked randomisation scheme (block size of four) to receive carfilzomib with dexamethasone (carfilzomib group) or bortezomib with dexamethasone (bortezomib group). Randomisation was stratified by previous proteasome inhibitor therapy, previous lines of treatment, International Staging System stage, and planned route of bortezomib administration if randomly assigned to bortezomib with dexamethasone. Patients received treatment until progression with carfilzomib (20 mg/m2 on days 1 and 2 of cycle 1; 56 mg/m2 thereafter; 30 min intravenous infusion) and dexamethasone (20 mg oral or intravenous infusion) or bortezomib (1·3 mg/m2; intravenous bolus or subcutaneous injection) and dexamethasone (20 mg oral or intravenous infusion). The primary endpoint was progression-free survival in the intention-to-treat population. All participants who received at least one dose of study drug were included in the safety analyses. The study is ongoing but not enrolling participants; results for the interim analysis of the primary endpoint are presented. The trial is registered at ClinicalTrials.gov, number NCT01568866. Findings: Between June 20, 2012, and June 30, 2014, 929 patients were randomly assigned (464 to the carfilzomib group; 465 to the bortezomib group). Median follow-up was 11·9 months (IQR 9·3-16·1) in the carfilzomib group and 11·1 months (8·2-14·3) in the bortezomib group. Median progression-free survival was 18·7 months (95% CI 15·6-not estimable) in the carfilzomib group versus 9·4 months (8·4-10·4) in the bortezomib group at a preplanned interim analysis (hazard ratio [HR] 0·53 [95% CI 0·44-0·65]; p<0·0001). On-study death due to adverse events occurred in 18 (4%) of 464 patients in the carfilzomib group and in 16 (3%) of 465 patients in the bortezomib group. Serious adverse events were reported in 224 (48%) of 463 patients in the carfilzomib group and in 162 (36%) of 456 patients in the bortezomib group. The most frequent grade 3 or higher adverse events were anaemia (67 [14%] of 463 patients in the carfilzomib group vs 45 [10%] of 456 patients in the bortezomib group), hypertension (41 [9%] vs 12 [3%]), thrombocytopenia (39 [8%] vs 43 [9%]), and pneumonia (32 [7%] vs 36 [8%]). Interpretation: For patients with relapsed or refractory multiple myeloma, carfilzomib with dexamethasone could be considered in cases in which bortezomib with dexamethasone is a potential treatment option. Funding: Onyx Pharmaceuticals, Inc., an Amgen subsidiary

EFFICIENT RISK DETERMINATION OF RISK OF ROAD BLOCKING BY MEANS OF MMS AND DATA OF BUILDINGS AND THEIR SURROUNDING

Massive earthquake named “Tonankai Massive earthquake” is predicted to occur in the near future and is feared to cause severe damage in Kinki District . “Hanshin-Awaji Massive Earthquake” in 1995 destroyed most of the buildings constructed before 1981 and not complying with the latest earthquake resistance standards. Collapsed buildings blocked roads, obstructed evacuation, rescue and firefighting operations and inflicted further damages.To alleviate the damages, it is important to predict the points where collapsed buildings are likely block the roads and to take precautions in advance. But big cities have an expanse of urban areas with densely-distributed buildings, and it requires time and cost to check each and every building whether or not it will block the road. In order to reduce blocked roads when a disaster strikes, we made a study and confirmed that the risk of road blocking can be determined easily by means of the latest technologies of survey and geographical information

Estimation and comparison of the contents of blood group B antigens in selected human tissues by microphotometric quantification of Griffonia simplicifolia agglutinin 1-B, staining with or without prior a-galactosidase digestion

Griffonia simplicifolia agglutinin 1-B4 (GSAI-B4) has broader specificity for B antigen variants and can recognize the antigens in a wide variety of human tissues. Thus, the concentration range of GSAIB4 required for staining and the susceptibility of staining to a-galactosidase digestion is presumed to correlate well with the density of B antigens in tissue sections. By microphotometric quantification of staining intensity at different concentrations of GSAI-B4 with or without agalactosidase digestion, concentration of B antigens in selected tissues was evaluated and compared. Based on the present results and the previous ones of direct measurement of galactose of B antigens in sublingual glands and red blood cells (Ito et al., 1993), the order of concentration of B antigens in tissues examined was estimated as follows; mucous cells of sublingual glands from German nonsecretors < red blood cells and vascular endothelial cells (=2.7x10-3nmole/cm2), thyroid papillary carcinomas and Hassall's corpuscles from nonsecretors < mucous cells of sublingual gland from Japanese nonsecretors < pancreatic acinar cells from both secretor and nonsecretors, Hassall's corpuscles and kidney collecting tubules form secretors < mucous cells of sublingual gland from secretors (>8.5-11.7 nmole/cm2) and mucous cells of Brunner 'S gland from nonsecretors < mucous cells of Brunner's gland from secretors. From the above estimation, it is apparent that the expression of B antigen in Brumer's gland is partly dependent on the secretor status of individuals and that Japanese nonsecretors secrete substantial amounts of B antigens from sublingual gland while German nonsecretors do not. The present results also revealed an unexpected staining behavior of GSAI-B4 in some tissues, i.e. in mucous cells of sublingual glands and collecting tubules of kidney from secretors, staining olrprint reguests to: Nobuaki Ito, Ph.D., Department of Legal Medicine, Nara Medical University, Kashihara Nara 834, Japan intensity was markedly depressed at higher concentration of the lectin and this depression was recovered by prior a-galactosidase digestion. In addition, the present method was successfully applied for the estimation of the content of B antigens neoexpressed in thyroid papillary carcinomas, showing that the content of B antigen had a similar leve1 to that of red blood cells and vascular endothelial cells